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would be followed and would involve outcomes tracking. The idea was to create a pilot for the industry in order to generate data so that other providers could look at the model, study it, and then sell it or a similar model to new referral partners.
The effort was inspired by a Bailit Health study, “The Role of State Medicaid Programs in Improving the Value of the Healthcare System,” that examined different models being used by large Medicaid programs and one was based on episodic care, rather than ongoing care. (The report can be found by searching the medicaiddirectors.org site, or by visiting bit. ly/2TdZakb.) AAHomecare enlisted various experts from organizations such as The MED Group and the American Association for Respiratory Care as well as various oxygen providers who worked for approximately a year to see if a similar concept could be applied to HME.
“When we looked at episodic care, it’s kind of kindred to the home health world,” Williard says. “In home health, you may have a long-term condition, but providers get paid for episodes of care, and in the home health world that is 60 days. So, with Medicare, you get paid for a 60-day episode of care and everything is included in that.
“That’s kind of our theory around episodic care,” she continues. “Obviously, when I take it to payers, they have different ways of reim- bursing, so you really have to listen to them on what they want to do and partner with them and be willing to modify your program to fit their needs. But that’s where we’re starting the conversations.”
Per-Member Payment
Another alternative respiratory model that is coming to the fore is per- member/per-month payment.
“I think a lot of what I’m seeing from providers now is they are getting paid similar to what a, for example, a Medicaid plan that has an ACO,”
Williards says. “It’s a per-member/per-month payment to take care of that patient, so I’m seeing quite a few of the per-member/per-month payments for patients out there. They’re specific to specific diagnoses or specific services or types of items, too.
“It’s probably a little bit earlier to sell, too, because a lot of commercial plans also have a Medicaid business line as well,” she notes. “They’re kind of used to that.”
That said, while health plans might be used to that model, HME providers might have a little trepidation upon approach, because like the episodic care model, it’s very new territory for any business that has depended on a Medicare-style model for a long time.
“From an HME perspective because it is very different from what we are used to and we need to be leading the way,” Williard explains. “We don’t want to just be part of someone else’s value-based model and providing an add-on service. I mean, we are trying to get away from being labeled as a commodity provider; that we are a service industry. ... There’s been a real hesitancy, but people are starting to come around on that.”
The key in being successful with this model lies in establishing what outcomes the provider wants to deliver to the payer, the patient, the health system, or whoever winds up being the final client, according to Williard. Expectations have to be set and met.
“[Providers] need to figure out how to track those outcomes, and they also need to know the cost,” she advises. “You want to make sure you look at every avenue of cost every step of the way — if they want to add a clinical services, if they’re going to add an additional RTD or staff, if they want
to add any type of data outcome tracking, or use an outsourcing agency that might incur additional cost. ... You don’t want to put yourself out, put yourself in a situation where you’re getting reimbursed less than what you’re actually putting in.” n
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What’s Inside:
HME Leadership by the Book . . . . . 13 News, Trends & Analysis . . . . . . . . . . 8 MakinganO2‘ModelMatch’ . . . . . . . 12 Orthopedic Opportunities . . . . . . . . . 24 Retail-ReadyProducts . . . . . . . . . . . . . 26 9 Ways to Thrive in Tough Markets . . . 30
With Diverse Revenues and Patients, HMEs Need RCM
For large healthcare
r h g e a a n l t i hz a n t i e o t n w s o s r u k c s , h t ah s e h p o r as pc t i t i c a el s o a f n d revenue cycle management has been
a fundamental element of how they do business for years . Now, HME busi- nesses are starting to employ RCM to help them survive and thrive in a tight funding market .
Fortunately, those larger health entities have blazed some RCM trails . They have developed businesses processes and workflows, metrics that help them manage their RCM, and employed a variety of technology tools that have helped them improve efficiencies to boost revenues and margins . These are best practices that can help smooth the RCM learning curve in HME .
That said, running an HME business isn’t like running a hospital . There is a multitude of factors and challenges that are unique to the HME landscape provider owners and management must address . Moreover, how providers approach those challenges is unique, as well .
How can RCM help HME busi-
n i m e p s s l e e ms ? e H n o t i w n g s h R o C u M l d ? t Wh e h y a a t p a p r e r o t h a e c h
p a n i t d f a s l l e s r t v h i c e e y s s a h r o e u a l d v a a i v l a o b i d l e ? t Wo h h a e t l p t o o l s them? Read this month’s cover story to learn more .
Revenue Cycle
Management for HME . Page 17
May 2018 Volume 25, Number 5 hme-business.com
BLAST OFF
7 7 I I D D E E A A S S T T O O H H E E L L P P Y YO O U U R R BUSINESS TAKE FLIGHT
What’s Inside:
ManagingWinningTeams . . . . . . . . 24 News, Trends & Analysis . . . . . . . . . . 6 What’sYourHIPAARisk? . . . . . . . . . . . . 9 HMEInventory . . . . . . . . . . . . . . . . . . . 27 DreamWear’s Full-face Option . . . . . . 28 RetailHME’sFive-YearPlan . . . . . . . . . 30
A Collection of How-to Articles to Help HMEs Achieve Lift-off Welcome to the 11th edition o y e f a o r u w r e a n t n r y u t a o l H p Mr e E s e H n a t n a d n b u o m o b k e . E r a o c f h easy-to-digest articles that provide HME business owners and managers with ideas on how they can drive new revenues and drive new efficiencies . Consider these handbook a launch- pad to hit new heights .
We have published the HME Handbook since 2008, and the product has changed over the years . When we first started, the Handbook aimed to help providers prepare for significant industry changes that were on the way, such as competitive bidding, claims audits and other cuts . However, where regulatory change once represented market disruption, now providers are old hands at being pushed out of their comfort zone . Now the Handbook aims to help providers consider a shifting market- place to be familiar territory .
In this issue, we look at seven topics including accreditation, women’s health, portable oxygen, home access, professional education, and enteral nutrition . Some of the articles discuss o i d p e e n r t a i f t y i o n n e a wl e b f fiu c s i i en ne cs s i e o s , p wp ho i r l t e u on t i t h i e e s r s o r mstreattheogdys . Afolsros,htaorphenlpinygoyuoduirgbeustsitnhess information, we summarize key points and provide links to help you learn more about the topics .
2018 HME Handbook . . Page 10 June 2018
Volume 25, Number 6 hme-business.com
Management Solutions | Technology | Products
hme-business.com | November/December 2018 | HMEBusiness 25
CYCLE MANAGEMENT
July 2018 Volume 25, Number 7
2018 BUYER’S
W W h h a at t ’ ’ s s t t h h e e r r i i g g h h t t s s t t r r a at t e e g g y y ? ? W W h h a at t t t o o o o l l s s c c a a n n h h e e l l p p? ?
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What’s Inside:
Effectively Using Planograms . . . . . 19 Special Portable Oxygen Section . . 22
e-PrescribingComestoHME . . . . . . . . 8 HowKPIsDriveProfitability . . . . . . . . 10 TheLatestSleepProducts . . . . . . . . . 32 Going the Distance Against Bidding . 34
E-COMMERCE WINNERS
10 HME categories that drive online sales
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As HMEs Enter e-Commerce, What Products Actually Sell?
The future is here: e-com- merce is becoming a business imperative in the HME industry, and if providers aren’t already diving in, they are making it a part of their strategic business planning .
Simply put, it’s where the customers are . According to a June 2017 Forbes article, online sales grew faster in 2016 than they had over the past three years and account for 11 .7 percent of overall retail sales . There seems to be no stopping this sea change of how customers shop and get much of their product information, and that includes home medical equipment and related products .
The question is what products not only lend themselves to e-commerce but actually sell? You can offer all sorts of products, but what are the things that will get clients to add items to their cart and enter their credit card information . To answer that question, we got some expert insight into the 10 categories of HME products that have proven themselves to be e-commerce winners, and some of those categories just might surprise you .
Additionally, we rounded up a number of product examples for each of those top 10 e-commerce catego- ries to give you a picture of the types of items you can add to your online offerings . Flip to this months’ cover story to learn more .
e-Commerce Winners . Page 11
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Special Portable Oxygen Section Inside:
• Oxygen Rental Models
• Remote Patient Monitoring
• Traveling With Oxygen
August/September 2018 Volume 25, Number 8 hme-business.com