Tuesday, September 26, 2017

Unmanageable Medicare Cuts Put Another HME Out of Business

As reported recently in HME News, Northern Rehab Equipment & Respiratory closed after 19 years serving the community. AAHomecare reached out to Stephanie Schwartz PT, ATP, CAPS, to understand the full story and to share her experience. She said the following:

“Yes, the reimbursement rates and policies had a huge effect on my business and is why I closed.  Just to summarize the recent events for you: I am a very proactive owner and I like to make business decisions in advance of changes of sales and circumstance if possible. I owned three stores in the area at one period of time.  Downsized to decrease cost since it is more expensive to provide products and services over the distances rural providers have to go.

At my Redding store, when we saw the cuts coming we made models to predict if we could stay with our current overhead and staffing and make ends meet.  We could not, according to the models, so we began to change. I have been in business almost 20 years here in Redding and I was well aware that any poor decision could affect my retirement as I am 62 years old. So, we sold some areas of business that were getting too difficult to manage due to so many rules for documentation, qualification and constant changes in reimbursement and constant audits.

We sold our Rehab Division to National Seating and Mobility. Five of my employees went with them, so I felt good about retaining those jobs for them with a good new employer.  We then had the first round of cuts in January, surprisingly we did okay and we were still profitable and doing a lot of business. We were adding more retail sales due to the fact in our town many providers had stopped providing beds due to the severe audits and strict, arduous qualifications. 

Physicians were not willing to rewrite notes three and four times to get the documentation right so providers just stopped providing beds through insurance.  We picked up more retail sales that seemed to help balance out the initial 20% cut. 

When it appeared that there was to be no reprieve from the next 25% cuts in July, we again did models and reassessed our profit on individual items to see which ones would be profitable to sale.  WOW those were huge, unmanageable cuts that Medicare made in July. The cuts ranged from 25%-45% off the 20% cuts made in January.

I made the decision then to do a soft close of my business because so few items were going to show a profit and the delivery costs for a rural provider are so much more.  We added an Accessible Living Division a few months before the July cuts, selling ramps, lifts and bathroom inserts and remodels and were hoping to survive on mostly cash and retail sales and this new division. We cut staff again, as the cuts in July began and decided to sell off our respiratory division. We managed to stay in business almost 12 months after closing the respiratory division by getting some VA accounts for our ramps and lifts. But ultimately, I knew we could not survive, so we closed in August 2017. 

I did go not bankrupt, I paid all my bills and said good bye to some faithful customers, managed to find jobs for almost all the staff.  I always followed the Medicare rules and guidelines but the new qualification rules, audits, documentation, reimbursements are not made to be sustained by small businesses. Unable to purchase products at the reduced bulk cost of a larger business, our gross profit was always less than a larger business. This along with the effect the reimbursement cuts had and the cost of accreditation and audits was the reason we could ultimately not continue.”

Stephanie went further to say that she would like to own a small business again, clarifying, “one where there is a more equal playing field, one where I do not have to fight the government and prove every day I am not a fraud, a thief, a criminal or prove that I provide a worthy service to others. My new business will add value to my community. My new business will provide an excellent service or/and product.  I will not be a whipping boy of Medicare ever again. I am not angry or sorry for myself, I am simply a small business owner who used simple math to figure out the reimbursement schedule, weighed against the costs of doing business with Medicare was not sustainable for my business.”

Thursday, September 21, 2017

Concerns Continue for Access to Durable Goods at State Level

Access Press published a piece on the plight of homecare providers in Minnesota and a current law requiring Minnesota to bid out incontinence products:
The Midwest Association of Medical Equipment Suppliers (MAMES), its members and other advocates are asking to overturn a law requiring Minnesota to bid out incontinence products. The law was tucked into the 2017 health and human service omnibus bill in the final hours of the legislative session. Bill Amberg, who is MAMES’ lobbyist, said member medical supply dealers are frustrated that the bill addition came without debate or discussing. “There wasn’t even a conversation with stakeholders.”
MAMES and its allies are working to overturn the bid requirement before it takes effect next year. That could happen during the 2018 legislative session.
Amberg said that if the change goes into effect next year, it would be yet another blow to Minnesota’s medical supply and durable medical equipment providers. More than half a dozen companies have closed during the past year including longtime Twin Cities firm Key Medical Supply. Key had waged a long and ultimately unsuccessful legal battle over the Centers for Medicare and Medicaid Services’ (CMS) competitive bidding program as it related to enteral nutrition supplies or feeding tubes.
It will also inconvenience many people who need the incontinence supplies for daily living. “It just gets tougher for people with disabilities and senior citizens,” Amberg said. “They can’t find caregivers, they can’t have reliable supplies and medical equipment for their daily lives. It’s hard to talk about people staying in their home communities on one hand and forcing them out on the other.”

Thursday, July 6, 2017

Stemming the Tide Through Payer Relations

As reported in Wednesday in Washington, AAHomecare remains focused on legislative and regulatory strategies to move the industry forward. But our investment in payer relations has also produced impressive returns for HME providers in our first year focusing on this area.

“With increasing pressure to save money on state budgets, it’s critical that we have a strong capability to help respond to proposed Medicaid rate cuts and rally providers and state associations to advocate for fair reimbursement policies,” explains Tom Ryan, AAHomecare’s president and CEO.

In just one year, AAHomecare has been successful in stemming the tide and in some cases reversing further cuts with the help of state associations, utilizing a multi-pronged approach. Here are just a few results:

  1. With the aid of AAHomecare’s Dobson DaVanzo Study which analyzes the full operational costs plus cost of goods against the current Medicare reimbursement environment, the industry has effectively negotiated pricing agreements for DMEPOS providers with state and national payers. 
  2. The Association consulted with legal staff on how the CURES Bill impacted TRICARE, Medicare Advantage, and Managed Care payers. AAHomecare provided a reference for the industry to use in discussions with payers on getting July-December 2016 claims reprocessed. The Association also worked with Brown & Fortunato to obtain legal opinion on the rights and responsibilities of the states in implementing CURES language.
  3. Over the course of the year, AAHomecare has built relationships with many private payers that directly impact the health of our industry and future reimbursement decisions. On the national level, payers included Anthem, TRICARE, the Defense Health Agency, AIM Sleep Management, and Carecentrix. We believe these relationships will build to greater impact on policy and operational changes for HME providers.
  4. At the state level, AAHomecare has worked with regional associations to secure wins in several states who were following suit with Medicare reimbursement. These include working with NEMEP to secure a freeze of current rates until further notice with the New York Medicaid Incontinence Program. AAHomecare also joined Big Sky Association of Medical Equipment Suppliers to evaluate strategy and create a white paper for presentation to BCBS Montana regarding reimbursement cuts to the 2017 fee schedule. Further, in conjunction with the Maryland-National Capital Homecare Association, AAHomecare worked to establish a strategy for fighting pricing cuts with DC Medicaid. We have received notice the Agency is evaluating the information given and analyzing the budget before finalizing decisions, but expect changes to be made.

Williard Elevated to Vice President Role

These efforts on behalf of AAHomecare have been led by AAHomecare’s Laura Williard, who the Association has just promoted to Vice President of Payer Relations. “Laura Williard has brought significant expertise and energy to her role as leader of our payer relations efforts,” said Ryan. “She has gained a great deal of credibility with HME providers and has established solid relationships with state healthcare stakeholders and other major payer organizations.”

You can read a more extensive review on payer relations efforts and the work of Laura Williard here.

Laura can be reached at LauraW@aahomecare.org – and follow her on Twitter: @WilliardLaura.

Monday, June 26, 2017

CMS Announces Long-Term Relief on CRT Accessories

Policy Change Marks an Important Win for CRT Providers and Patients Who Depend on Highly Specialized Mobility Products

The Centers for Medicare & Medicaid Services announced that accessories for group 3 power Complex Rehab Technology (CRT) mobility products will continue to remain exempt from the application of competitive bidding derived pricing for Medicare beneficiaries.  Congress has twice passed legislation delaying the application of bidding derived pricing, including a six-month delay as part of last December’s CURES bill that was set to expire on June 30.  This policy change, announced here by CMS, essentially extends the CURES provisions indefinitely.  From CMS’ announcement:

CMS is issuing a new policy on how adjustments to the fee schedule based on information from competitive bidding programs apply to wheelchair accessories and back and seat cushions used with group 3 complex rehabilitative power wheelchairs.  Section 16005 of the 21st Century Cures Act currently allows higher payments for these items but is set to expire after June 30, 2017. By continuing these higher payments, this new action will help to protect access to complex rehabilitative power wheelchair accessories on which people with significant disabilities depend.

The full release and AAHomecare president Tom Ryan's remarks on this issue can be found in the Association's press release.

Friday, May 19, 2017

DMEPOS RAC to Look at Potential Underpayments for Group 3 Wheelchair Options & Accessories

The industry is pleased to see that Performant Recovery, the DMEPOS RAC, has been approved to add an audit that will look at the underpayment of Group 3 power wheelchair options.  All wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs will be reviewed regardless of modifiers.  This issue recovers the incorrect reductions owed to suppliers for claims for these items for DOS 1/1/2016 - 6/30/2016.

This is a very positive development as it is the first time an underpayment for our industry has been audited!