Page 18 - HME Business, January/February 2021

Business Solutions
Congress has since extended this relief for an additional 90 days, but given that the pandemic will last well past the end of March, the industry urging members of Congress that they extend the pause. The best way to do that is to incorporate the language of H.R. 315, legislation launched by Reps. Brad Schneider (D-Ill.) and David McKinley (R-W.V.) would continue that pause through the duration of the PHE.
At press time, AAHomecare was calling on providers to contact their Senators and Representative healthcare staff and ask that their lawmakers include H.R. 315’s provisions in the COVID-19 relief package. Given how expensive providing HME is during the pandemic has grown, that extension will play a critical role in their cost structures and profitability.
OXYGEN SUPPLIES AND SERVICES
One of the key categories of HME that is facing COVID-19 is oxygen services. Throughout the pandemic, providers of oxygen have had to develop all-new care and service protocols in order to ensure that they continue to support patients that need liquid oxygen, oxygen concentrators and portable oxygen concentrators for long term oxygen therapy for treating COPD and similar condi- tions. They’ve had to do that in such a way that they put a premium on infection control, social distancing and similar practices. That’s one way oxygen providers have had to contend with the PHE.
Another issue is the supply side of oxygen care. In order to contend with COVID-19 and treat patients that contracted the disease, many hospitals are ordering oxygen concentrators for use in the hospital, or sending home with patients that had COVID-19, are safe to discharge and receive care at home but still need temporary supplemental oxygen therapy.
Providers can still make reimbursable claims for this thanks to waivers — and it will be interesting to see how that lasts — but it has put a strain on the oxygen equipment side. Fortunately, the supply issue appears to be regional and inconsistent for now. Much depends on how hospitals are handling the disease and how bad the outbreak is in their area. It’s safe to say that supplies are getting tight, and providers need to be judicious in that regard.
To read more about the current state of oxygen services, turn to this month’s cover story, “Breathing Easy?” starting on page 20.
CMS’S ROUND 2021 PUNT
At the end of October, CMS announced that after originally taking bids for 16 product categories in the 130 competitive bid areas of Round 2021 of its competitive bidding program, it was only awarding contracts for the off-the-shelf back and knees braces categories.
As for the 13 remaining categories (CMS had already removed the non-invasive ventilator category due to the COVID-19 public health emergency), CMS announced it would not issue contracts because it “did not achieve expected savings.” In other words, CMS decided to punt.
That means that given the last competitive bidding contracts expired on Dec. 31, 2018, and that the bidding program has since been dormant, DMEPOS providers can continue to provide these 13 categories without contracts. That’s an attractive prospect to providers, but they do so knowing that DMEPOS reimbursement
is essentially frozen at 2018 rates.
Will the HHS and CMS under the Biden Administration steer
back toward competitive bidding? It’s tough to say. It’s clear that CMS realizes it has reached a bid floor. It also knows that it’s more expensive for providers to deliver care and products during COVID-19 and that HME providers have demonstrated they are an indispensable component of American healthcare. Whenever and if ever competitive bidding makes a return, the pieces on the board will need to be reset if CMS wasn’t the game to be sustainable.
PAYER-PROVIDER CONVERGENCE
Back in the 2019 Big 10 list, we talked about the convergence of payers and providers being a key trend to watch, and highlighted the fact that major deals such as United Healthcare and dialysis giant Davita, pharmacy chain CVS and Aetna, and Humana and Kindred Healthcare would change how healthcare is delivered.
Well, back in July 2019, CVS announced its plans to transform many of its locations into what it has dubbed HealthHUBs, a sort of a mix of a pharmacy, a clinic, and a DME provider. A customer can get treatment for common illnesses, meet with nurse prac- titioners, physician assistants, licensed practical nurses and pharmacists, and pick up DME items. CVS company rolled out 50 HealthHUBs in 2019 and aimed to cut the ribbon on 600 HealthHUBs in 2020. The company’s stated goal was to create 1,500 locations by the end of 2021.
Also, in August, and Aetna announced a plan that would let its members access appointments at its parent company’s HealthHUB locations with no copay and get discounts on items at those CVS locations.
Clearly, the convergence is coming into focus, and it’s a little scary looking. The HealthHUBs are offering supplies for two heavily used DME categories that are funded both through private payer insurance as well as Medicare and other public payer sources. Also, a September 2020 survey from the National Community Pharmacists Association showed 79 percent of community pharmacists complained that patients’ prescriptions were transferred to another pharmacy in the last six months without their patients’ knowledge or consent (a practice known as “patient steering”).
But the limited offerings from HealthHUBs or the need to engage in patient steering also underscored the value HME providers, local DME pharmacies and community pharma- cies offer to their local marketplace. The kind of service and care offered by those businesses can’t be replicated by a large, big-box chain. Providers will need to make their service and expertise a primary messaging point in their patient- and partner-directed marketing and communications.
18 HMEBusiness | January/February 2021 | hme-business.com
Management Solutions | Technology | Products
It’s clear that CMS knows it’s reached a bid floor. It also knows that it’s more costly for providers to operate during COVID-19.