Medication Management
by Michael Kutsak

These days the HME industry is faced with its share of challenges, from competitive bidding to complex payer requirements. So suppliers are looking for new revenue opportunities.

As health care continues to evolve, the trend for quicker, better and more cost-efficient care grows. That is where patient self-testing presents an increasing opportunity for the HME supplier.

You may have heard of people taking a drug called warfarin (brand name, Coumadin). While the drug is very effective, patients who are on this drug require frequent testing to maintain the desired results and prevent serious complications. The current health care model requires the patient to visit their anticoagulation clinic, physician’s office or lab for regular blood draws. Patients with a chronic condition are often in need of long-term medication use for condition management. These patients may be eligible for self-testing at home.

The self-testing model gives patients a device that allows them to test a blood sample quickly and easily at home. Once the test result is obtained, all those involved in the continuum of care—from the physician to the home health nurse to a family caregiver and the patient—can be notified in real-time and accelerate the care treatment process for improved outcomes.

Companies that facilitate patient education, support and delivery of the testing device are called INR monitoring providers. They serve as the facilitator of the patient self-testing and as the intermediary between the patient and the patient’s physician. While improving patient care, they also have a very healthy business model.

These providers are enrolled as an Independent Diagnostic Testing Facility also known as an IDTF.

The HME call points for finding the patient population suitable for home INR testing may lie within your current referral streams. Providers including but not limited to primary care, cardiology, hospitals and outpatient practices are great options for introducing INR patient self-testing.

An aging baby boomer population continues to drive INR patient self-testing. Despite the growing number of oral anticoagulant medications available, the contraindications for these drugs along with their higher costs keep warfarin as the gold standard in medication options.

In general, health care is evolving, and patients and clinicians are embracing the shift to faster, better and more convenient care. Innovation in technology and a growing acceptance of this will continue to drive patient self-testing models. Through smartphone-enabled applications, patients can engage in their care in real time and manage INR self-testing along with medication adherence.

So where does a provider start when it comes to entering into the home INR monitoring business? The first step involves assessing the regulatory and procedural guidelines of becoming an IDTF with government and commercial payers. The next is creating a financial model where you look at reimbursement for billing codes related to home INR monitoring, including the code G0249, which is billed on an ongoing basis for managing these patients, and analyze what your costs of goods including the diagnostic INR monitors and disposables.

Finally take a look at your current referral streams and determine what kind of potential volume of patients you can absorb and the incremental increase in operational overhead needed to meet your financial goals.

If your current operation has the infrastructure to model in-home INR monitoring, then you may be well on your way to a healthy new revenue stream.