Hold ‘Em or Fold ‘Em?

The exuberant atmosphere that so often characterizes Medtrade Spring was largely absent at this year’s event, held April 24-26 in Las Vegas. But most HME providers who attended agreed the expo was the place to be for those seeking critical information on how to do business in an industry turned inside out.

About 7,500 providers, manufacturers and others allied to the home health industry turned out for the event, according to show officials. It was the first industry conference after CMS released its final rule on competitive bidding and set an Aug. 31 accreditation deadline for providers in the 10 cities where bidding will roll out.

Questions about the two topics were pervasive, and providers crowded seminars covering the issues, often overflowing into the halls of the Las Vegas Convention Center.

“Competitive bidding is foremost in everybody’s mind, that and the accreditation [deadline] coming up in August,” said Sherman Mead of Golden Technologies in Old Forge, Pa. “They’re trying to get a feel for what the reimbursement is going to be, the changes [coming up] and how they are going to affect their business.”

“Everybody is trying to figure out how to stay in business,” said Viola Jenkins, whose HME company, VitaCare Inc., is located in Dallas, one of the initial competitive bidding areas. “Everything we do is in there,” Jenkins said about the products included in the bid. “All of our products are going to be affected.

“Medicare is a huge percentage of our business,” she continued. “We will bid; we’re just trying to figure out how to bid.”

Seminar presenters were inundated with questions like Jenkins’ and others about competitive bidding, ranging from the very basic “What is competitive bidding?” to “Should I even stay in the business?”

“People are trying to understand what this means for them and what they need to do in their business,” said Mike Mallaro, CFO for The VGM Group, Waterloo, Iowa. The buying group’s booth drew scores of members and non-members alike, many of whom wanted suggestions for new niche markets and cash-only items to shore up their bottom lines, he said.

While it appeared difficult for many providers to comprehend the reality of what lies ahead for HME, Mallaro said, “I think most people are beginning to understand. But the devil’s in the details.”

And the details of the 401-page final rule were overwhelming for providers to absorb in such a short time, stakeholders said.

“The [providers] I spoke to … didn’t understand competitive bidding at all,” said Robert Thompson of DMETrain in West Springfield, Mass., adding that his booth was “swamped” with providers clamoring for information.

The topic of accreditation was equally confusing for those who flocked to accreditors’ booths.

Susean Nichols of Millennium Management Services in Long Beach, Calif., said most providers were hoping for easy answers to their accreditation queries, but unfortunately, they were disappointed. “They’re trying to grasp onto the slightest bit of information like that’s it. And that’s not it. That’s just the starting point,” she said.

Christine MacDonnell of the Com-mission on Accreditation of Rehabilitation Facilities also noted that the issue was just “too new” for most providers, especially small company owners who had never before considered accreditation. “They don’t know the questions to ask,” she said.

Karen Taylor, a physical therapist with Dove Medical Supplies in Cheektowaga, N.Y., called accreditation “a little overwhelming,” but added, “we better get it going.” She and others from her company, including owner Loretta Carr-Stock, R.N., were checking out all the accreditors to find one that would suit their business.

“With competitive bidding and Medicare changing everything, it seems like everything is coming at once,” said Carr-Stock.

While new products and new manufacturers on the exhibit floor sparked some providers’ enthusiasm, a number questioned whether, in light of competitive bidding and mandatory accreditation, they would even stay in the business.

“I think there will be people who throw up their hands and walk away,” said Nichols on the last day of the show.

“But this industry is built on the backs of small providers. So they can’t go away.”

Heard at the Show

On choosing an accreditor:

“The critical fact is, [providers] need to do their homework.”
— Christine MacDonnell, Commission on Accreditation of Rehabilitation Facilities, Washington, D.C.

On getting accredited:

“[Accreditation] is just one more hoop I’d have to jump through. And I don’t know if I want to jump through any more hoops.”
— Mary Ostendorf, Lavender ‘n’ Lace, Freeport, Ill.

On competitive bidding:

“I’ve noticed some doom and gloom among providers, but we’re very, very positive … because there are opportunities for growth, opportunities to grow our business. [Competitive bidding] just forces us to be better at what we do.”
— Richard Davis, Barnes Healthcare Services, Valdosta, Ga.

“A lot [about competitive bidding] is open to interpretation. It’s very difficult to get a true understanding as to what the guidelines really are.”
— Michelle Hermann, Chad Therapeutics, Chatsworth, Calif.

“Competitive bidding doesn’t give the patient any freedom of choice. It’s taking that choice away from the Medicare patient.”
— Jim Goldman, Havasu Medical Supply, Lake Havasu City, Ariz.

“Why would anybody want to [bid]? All I see is a nightmare … you’re going to wind up losing money no matter what you do.”
— Don Adler, Care Medical and Rehabilitation Equipment, Portland, Ore.

“If the people that are making the decision to go ahead with competitive bidding use [what comes out of the first round] as the new allowable, they could save all of the waste of money [and] the loss of some dealers, too.”
— Nagle Bridwell, Ultimate Resource, Newtown Square, Pa.

“Payers, and especially CMS, have increasingly come to expect the industry to provide the services of a hands-on supplier while being paid as a hands-off dealer. In the not-too-distant future, I foresee our industry changing into a two-tiered delivery system with hands-on, full-range services going only to those patients who satisfy the necessary criteria and those payers who will pay appropriately. Arriving at that resolution, however, may well be a nasty fight.”
— Neil Caesar, Health Law Center, Greenville, S.C.

“As far as competitive bidding, I thought we were prepared for it, but I was really excited that it didn’t come to Atlanta and I didn’t have to worry about it in the first round. [When it comes, if we don’t win a bid], we would try to maintain service and grandfather with most of our patients … I certainly want to stay in there and stay strong and continue in the industry. I’m very optimistic because I feel like there are a lot of opportunities still.”
— Todd Tyson, Hi-Tech Healthcare, Norcross, Ga.

“I think [competitive bidding is] a terrible idea. Would you want your parent or loved one to get equipment that went to the low bidder? And quite frankly the way it’s currently set up, we’re going to have, I think, a loss of patient access to high-quality, innovative new products.”
— John Ledek, Invacare, Elyria, Ohio

New Product Pavilion Awards

Based on attendee votes, the winners were:

Innovation Award: Respironics, Murrysville, Pa., for its RUSleeping RTS apneic screener device

Providers Choice Award: SuperQuad, Roseville, Calif., for the Wijit Voyager

Merit Award: Hanmedics, Seoul, Korea, for CareClean, a personal automatic urine collector with bidet