Page 14 - HME Business, January/February 2022

Business Solutions
“I would like to have us as an HME community figure out how to drive value, and then work on how we get paid for lowering total cost of care.”
— Casey Toomajian, Hometown Healthcare
the CARES Act, the temporary pause on Medicare claims audits, and the Paycheck Protection Program, as well as a CPI-U adjust- ment that resulted in an average 5 percent DMEPOS fee schedule increase that started the first of the year.
However, there is much more work to be done, notes Marx, who is also the vice chair of the board of directors for the American Association for Homecare (aahomecare.org). For instance, the industry is working to extend the 75/25 blended rate for non-rural areas beyond the end of the PHE, and apply a 90/10 reimbursement rate to items in Round 2021’s 13 un-awarded categories.
“But we know that there’s so much more that has to be done as it relates to truly right-sizing the reimbursement structure,” Marx notes. “AAHomecare can do that, but we need industry-wide advo- cacy and engagement to make sure that we’re all rowing in the same direction, and have that scale to be heard by the federal government and all the necessary government bodies such CMS and the FDA.”
Fortunately, because of the industry’s rapid Covid-19 response, it might have some new allies. The industry has raised its profile during the public health emergency, and hospitals, health systems and other stakeholders took notice.
“I think that with the hospitals now observing what we do, more than ever we’re going to have more leverage working with the health systems to really underscore the value of homecare,” Marx says. “When they needed that hospital bed freed up, or when they need to clear out the parking lot of the emergency department, that they know who they could call. There’s only one company that they call, the DME company. I think that that is where the magnifying glass has shined the most.”
Marx says that hospitals and health organizations are truly recog- nizing the value of HME providers and not just seeing them as another contractor. Rather, those stakeholders are seeing that getting patients into the home helps them provide better overall care.
“We’re hearing that more than we ever heard it in the past,” Marx says. “They understand that post-acute care is not an area that they do well. ... They have always known that hospice care and home health nursing have been needed. But they never understood that third leg of the stool, which is DME.”
And those stakeholders that come to rely on the value offered by HME providers should make solid allies.
“I do think that there’s more attention from the hospital system on what we do and why it matters,” Marx says. “We’re going to have to find a way to leverage that, and collaborate for that support and common advocacy over the long run.”
NEW CARE MODELS
In addition to leveraging providers’ hard work for fixes to very imme- diate reimbursement problems, the sorts of new care employed to get more patients in the home setting could help build a new future for home healthcare services, particularly when it comes to respiratory care.
It’s important to remember that when HME stepped in to save the day, it leveraged equipment that spells out a deeper value proposition.
“One of the things that I think could create more of that ‘hospital in the home’ model is leveraging more of the premium respiratory devices that are out there,” Toomajian says. “Leveraging their data connectivity technology, to be able to track patients that have been discharged, and look at things that would indicate if they’re stable, or if they need some sort of more support to keep them in the home and out of the hospital.
“For example, the home vent that we work with gives us informa- tion about the patient’s respiratory rate, and gives us information about how much of the machine is doing the breathing versus the patient doing the breathing,” he adds. “... That technology would allow us to not only support the patients, but if there is a problem, get ahead of that so that they don’t go back into the hospital.”
According to data from CMS, national healthcare expenditures are projected to hit 6.8 trillion in 2028. (As of 2020, they had hit $4.1 trillion, according to the agency.)
“If you look underneath the hood of what’s driving increased health costs, it’s chronic disease that’s being mismanaged,” Toomajian explains. “And then you start ranking these diseases by their biggest driver of cost, and you’ve got cardiac heart stuff at the top. COPD, I think, is in the top five in terms of driving cost, and a lot of that is just because of COPD exacerbation.”
Many of the COPD patients who can’t catch their breath to the point they must visit the hospital to get stabilized, do so on a repeat basis, setting up a very costly revolving door of admissions and discharges that could be preventable.
“We’ve had some patients that have been admitted 20 some- thing times over a two-year period, simply because they have these preventable exacerbations,” Toomajian says.
The telehealth and remote monitoring assets that providers put in place during the Covid-19 PHE could prevent that and further cement home healthcare’s value in the patient care continuum. The question is whether or not healthcare possesses the uniform will to build that model?
14 HMEBusiness | January/February 2022 | hme-business.com
Management Solutions | Technology | Products
“If you look underneath the hood of what’s driving increased health costs, it’s chronic disease that’s being mismanaged.” — Casey Toomajian, Hometown Healthcare
“You would think that products tied to the medical community that’s specifically caring for Covid patients should take priority for microchip provisioning.”
— Josh Marx, Medical Service Company