AAHomecare Gears Up for Reimbursement Fight, End of PHE

DALLAS—Securing better reimbursement rates and moving to new technologies like eprescribing are the top priorities for home medical equipment (HME)advocates in 2023, industry leaders said March 30 at Medtrade, the country’s largest HME conference and tradeshow.

Perhaps the main item on the list is making sure that the 75%/25% blended rate for non-rural areas not subject to competitive bidding lasts beyond December 2023, said Tom Ryan, president and CEO of the American Association of Homecare (AAHomecare). Ryan spoke at the annual AAHomecare update alongside three members of the organization’s board: Board Chair and President Bill Guidetti, who is president of the East Region at Apria Healthcare; Josh Marx, incoming board chair and CEO of Medical Service Company; and Ryan Bullock, incoming vice chair and chief operating officer at Aeroflow.

“That is a life preserver,” Ryan said about the blended rate, which was instituted during the COVID-19 public health emergency (PHE) and advocates managed to get included in the 2022 omnibus spending bill. If not extended, it will expire at the end of 2023.

Another major focus is persuading more providers to switch to e-prescribing and other technologies that will allow them to better interface with referral sources and better collect data. That data, in turn, should help convince payers of the value that HME brings to the health care continuum.

“The question is not if but when and what does it take to get there,” Guidetti said. “I think we all should embrace it and if we do, I’m telling you it’s a game changer for this industry.”

The organization itself is searching for data on disposable supplies from providers as well, surveying members in March about costs and challenges, especially around enteral, ostomy, urological and wound care products. Some areas haven’t seen rate increases in two decades, Ryan said.

“That helps us as providers to be able to say, ‘here’s what’s happening on aggregate nationally,’ and ‘here’s my story,’” when lobbying national and state legislators, Bullock said.

Also on the radar is the upcoming end of the PHE on May 11. Marx said that the pandemic has changed how HME operates.

“Over the last few years, consumer expectations have changed,” he said, and the focus has switched to managing patient care in the home. “We should not be looking at our industry ans a retail medical equipment company or a last mile delivery company. We’re a disease management company.”

Making that clear to consumers and to Congress is critical moving forward, Guidetti said.

“Once we demonstrate that value, it’s undeniable, because that’s where health care is going,” he said. “Think about the big payers out there … Where do they want to spend the big dollars? At home.”