Invest in business automation now to adapt to radical HME industry changes
by Dave Cormack

This year is a tipping point for the HME industry as CMS forces providers to become far more efficient than they have ever been. Extreme pressures from competitive bidding, audits, compliance initiatives and new technology standards are hitting at an unprecedented rate. To keep pace national providers such as Apria and Lincare spend millions on technology development. That, along with many other signals, should make it clear to independent providers that the ability to automate their businesses and streamline processes will determine who succeeds in 2013 and beyond. In addition, the speed of technology progress has accelerated dramatically, so you owe it to your business to explore the latest innovations. Here’s why you need to make bold moves now.

Legacy electronic billing applications aren’t good enough: Today, you need a business management platform rather than a traditional electronic billing application. The platform must deliver automation and other capabilities across your business, from comprehensive reporting and analytics to patient contact, delivery, audit response and more. Every HME software vendor wants to say that its solution “automates.” But just because it’s electronic doesn’t mean it delivers true automation. And just because it’s HME software doesn’t mean it is a business management solution. It may just be a cumbersome billing application. I guarantee that the nationals are investing in automation across their businesses. Why? Because it enables them to provide better service and operate more profitably.

Regulation places more demands on you and your software: The complexity and speed of regulatory change is exponentially greater now than just a couple of years ago. The 5010 electronic claims format, massive ICD-10 transition, CMS esMD audit program and expansion of HIPAA rules all make it critical that you have an advanced, well-supported platform. A strong software partner must invest in development as new standards emerge. In addition, a tsunami of audits and new rules for CPAP, power mobility and other product types mean you must do more work with less reimbursement. The right platform allows you to adapt quickly and address compliance effectively.

Interconnectivity will define who’s at the table: In addition to regulatory changes, overall market dynamics are evolving. Soon you will need to connect electronically not only to payers, but also to suppliers, physicians, hospitals and patients. Innovative providers are already making these connections. To work with Accountable Care Organizations (ACOs) and adapt to new payment models, you need a platform that is complete and secure as well as interoperable.

Positive patient outcomes will determine your success: Improving patients’ lives is one reason many providers get into the industry, but your ability to prove outcomes will soon be the standard by which payers will compensate you for your hard work. An advanced platform will help you deliver the right supplies, stay in touch with patients, manage documentation and report on outcomes for reimbursement or continued referrals. If you cannot run basic reports today, you will not be able to do the reporting required to prove you achieved desired outcomes. This is the top issue I hear from providers on legacy systems: they cannot get to their data to understand how effectively they operate.

Your software vendor must be a long-term business partner: In 2005 there were at least 25 commercial HME software systems available. Today there are half that many and the majority of providers are consolidating on a single platform. It’s critical to ask yourself whether your technology vendor is growing, invests significantly in products and customer service, and has the expertise and resources to help you apply best practices in your business over the long term. Remember, you are competing with companies that invest significant amounts of money in technology now.

A silver lining: There is no doubt that there are many market challenges. However, I see a silver lining. The number of providers will go down while the number of patients seeking services will go up. Providers who survive industry consolidation will have, on average, three times the number of patients they have today. There will be winners, but being one of them requires that you stop waiting. Every day you wait to invest in innovation puts your business at risk and leaves money on the table. Make your move.