Page 29 - HME Business, October 2018

The questions aren’t easy to answer, Baird notes, because providers have to balance the increased revenue against the likely more stable business models they have developed over the past years.
“It’s a lot of uncertainty,” he says. “Really the question is, does the supplier want to play the Medicare competitive bid game ... Basically. this gap period that’s about to hit is going to force DME suppliers to figure out what they want to do with their lives.”
Protecting Patient Data
Wayne van Halem, presi- dent and founder of
The van Halem Group LLC, a division of the VGM Group Inc.
TPE and UPIC audits
have been a key audit
trend for providers this
year, but van Halem sees even more on the horizon: For starters, his firms is seeing a lot of managed care plans auditing out- of-network providers and implementing extrapolated overpayments
“Quite honestly, it’s questionable whether they even have that authority to do that,”
he notes. “... We’re finding that they’re a
lot more challenging than Medicare, solely because while the rules are similar, the plans aren’t very familiar with them, so they inter- pret the regulations and the policies a little bit differently. Also, in many cases, they haven’t given our clients the appropriate appeal rights that they’re supposed to be afforded.”
Also, van Halem highlights HIPPA and Office of Civil Rights (OCR) reviews designed to protect patient healthcare information (PHI). In initial phases, the OCR identified
the parameters of its review and performed more than 200 audits. Now it’s compiling the data and van Halem says the results have so far shown that none of the providers passed all of the audit components and 86 percent failed in a certain category either by making either minimal efforts to comply, negligible efforts, or no efforts whatsoever.
“When you have results that surprising, I think it’s gotta be a wake-up call to providers that HIPPA compliance, cybersecurity, and protecting patient information has got to be a priority for them,” he says. “... But we’ve seen a number of companies in the DME space that have had some hacks that have resulted in patient data getting stolen. ...
So I think that’s really a key thing that our industry needs to getter better on.”
To confront this, van Halem says providers must implement a HIPPA compliance program that includes education and
training, as well as conducting a security and risk assessment that addresses not only administrative safeguards, such as policies and procedures, but also looks at the physical safeguards, such as buildings, equipment and technical safeguards.
“There are a number of actions out there that suppliers should be taking to protect them- selves through firewalls and other authentica- tion methods,” he says. “... The fact that they’re holding patient-specific data makes them a significant target, so they have to improve technology, have a compliance program that specifically addresses the technical safeguards that are required by HIPPA, and perform a regular security and risk analysis.”
A Continuing Drive
to Revenue Diversity Tom Ryan, president and CEO, the American Association for Homecare
While fighting the indus-
try’s legislative and regula-
tory battles as the leader
of the industry’s national association, for many years Ryan ran Definitive Homecare, a large regional provider in New York, and the big trend he’s seeing is the continued need for providers to broaden their revenue sources.
“We’re moving in a direction of not having all our eggs in the Medicare basket,” he says, adding that providers need to make sure “that whatever business you do is going to have a healthy margin to it so you can grow your business. ... Many providers who have been on the sidelines for three years without a contract survived and will continue to survive by having a diversified payer mix.”
Obviously, a key way to diversify is through cash, but that’s not the only route, Ryan says. Providers have a variety of payers both private and public outside of Medicare
that they need to pursue. This is why the American Association for Homecare has doubled down on its payer relations efforts. The goal is to help providers sourcing funding from a wide spectrum of payers.
We’re looking to actually grow when it comes to working with the provider commu- nity because more and more of the needs
are in the states and with the individual ACOs and managed care organizations,” he says. “Our job is to see if we can get guidelines on what’s worked in some states before to help the providers. Also, we don’t particularly like the sole source initiatives that have gone on in some of the states. We put some resources and time and a sub-group together to talk about how important it is to have a broad panel, to
have patient choice and good access.” For providers that are just starting to
branch out, Ryan suggested that an increas- ingly untraditional Medicaid market, 70 percent of which is now managed car or accountable care organizations, is a good place to start.
“You have to be part of the panels and you’ve got to look for the RFPs,” he advises. “They’re not going to fall in your lap, they’re not going to be sent to your address just because you’re a DME company. You’ve got to proactively go after those RFPs, know when those contracts are out, knowing those RFPs are coming out, go in, meet the people who are sending the RFP out, get them to know who you are, and respond diligently. ... You have to be aggressive and go after them.”
Taking Referral Sales Strategy to the Next Level Ty Bello, RCC, president and founder of Team@Work
As providers find them-
selves in an increasingly
competitive post-acute
marketplace, they need to
do a must stronger job of analyzing their sales position, according to Bello.
How do they do that? He suggests providers envision a Venn diagram with three overlapping circles of sales data, the sales plan or process, and finally the provider’s customer relationship management (CRM). The sweet spot where all three overlap should be a provider’s unique sales niche in its post-acute marketplace.
Starting with data, providers need to use the information available to them more strategically. For instance, they can drill down to HCSPC code, diagnosis codes, and even which physicians are referring patients based on those codes.
“I say this to providers all the time,” Bello says, “would you rather have your sales rep calling on 150 different locations ... or would you rather spend your time and talent of that individual focusing on 50 that you know are the top producers in that market segment? Well, the answer’s pretty obvious.”
Next, providers must examine their plan and the process.
“From the data, leadership can gain immediate competitive market analysis of referral rankings, claim counts, and can also understand the revenue growth and profit- ability calculation of what’s going on in that marketplace,” Bello says. “We can glean real-time productivity and even sales perfor- mance metrics of our team and we can help set not just the plan or process, but, the thing
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