DME Industry Experts Discuss Future of Independent Suppliers

BIRMINGHAM, Alabama—Small durable medical equipment (DME) suppliers are being unfairly painted as the main culprit in fraud, waste and abuse, according to industry experts who spoke at a recent webinar. A webinar hosted by MiraVista featured a panel of experts in reimbursement, health care law, insurance contracting, billing and accreditation who discussed the growing pressure on small DME suppliers and why the independent model still matters.

“Core Cause of Fraud”

One of the key topics of “The Once and Future Role of the Independent DME Supplier” discussed the current environment that brands small and independent DME suppliers as core causes of fraud, waste and abuse in the health care system.

“With the 2026 DMEPOS final rule including the competitive bidding provision, it seemed to me anyway there’s an explicit belief that small and independent suppliers are the problem,” said Derrick Stark, operations partner for MiraVista. “The recent DME enrollment moratorium and the subsequent press conferences that went with that seemed to take it even further painting small DME suppliers as the primary causes of some of the fraud, waste and abuse.”

Stark added he sees a problem with legacy suppliers where they’ve built a model centered on payer-forward operations, so the price point is the same across the board and the patient’s individual needs aren’t considered. 

“I want to treat the patient as my sole customer, and I want to find a price point that makes sense based on the retail relationship,” Stark said. 

Dealing With Out-of-Pocket Responsibilities

Jeffrey Baird, chairman of health care group of Brown & Fortunado, and Andrea Stark, a member and reimbursement consultant for MiraVista, covered retail options for insured patients with significant out-of-pocket responsibilities. Both said they were a firm supporter of retail patient pay cash businesses where the supplier can set their own prices and still establish a degree of separation.

“I think there are very few suppliers who are set up to really be effective and efficient at collecting patient payments when they’re in these … high deductible plans, basically they’re in that donut hole,” Andrea Stark said. “So if I were to have a separate retail location, we can better tune our model to go after those patients, set a reasonable price. You can play with the model.”

“If you have two separate corporations, they’ve got to act like separate corporations, separate bank accounts—to an extent—separate employees, separate operations, because you want to avoid the situation where somebody has a claim against a Part B company can pierce that corporate veil and go after the retail sales company,” said Baird. 

Partnership Through Education

Heather Davis, president of Visionera, emphasized how small shifts in patient education and payer strategy can make a huge difference  for suppliers and why providers must stop seeing payers as enemies and start thinking bigger. Davis said understanding the challenges in the payer world makes it easier to form a partnership between payers and providers. She also touched on AI technology and how despite recent advancement, health plans overall prefer being aided by a human if resources are available.

“I think one of the keys to that is really making sure customer service people really understand the product and they know how to trouble shoot it,” she said. “Let’s say you’re doing catheters: you want to be able to help patients that have maybe just been prescribed that product or they’re not sure how to use it or they’re uncomfortable using it. 

“They really want to talk to someone who understands that product really well,” Davis continued. “So if you’re just doing one product line that’s easy, but if you’re doing multiple you may need different experts for different things in your office. But that patient education piece is really just huge to the health plans.”

Davis said risk stratification, or identifying patients who have more complex disorders and are more at risk than other patients, can make a huge difference in payer and provider relationships because resources are being focused on higher priority situations.

“If you had a patient that is very complex and has certain combinations of comorbidities and diagnoses that has just been recently discharged from the hospital, you want to make sure that when that box got to the door they opened it and they know how to use it because it could put them at really high risk for reentering the hospital,” she said. “So, one of the ways you can think about patient education and value based care, is not necessarily, ‘I’m going to put an equal amount of resources towards every patient,’ it can be as simple as trying to identify your more high risk patients that way you get a good return on your investment.”

The Responsibility of Documentation

Dawn Clayton, founder of DME medical billing company Chapman RCM Group, said it isn’t fair for independent suppliers to be labeled as the core reason for fraud when they are “carrying the responsibility of documentation that we don’t control.” 

“[DME suppliers are] mostly nonclinical people, and we are that last line validation for the clinical documentation,” Clayton said. “I was speaking with a nurse practitioner friend of mine recently, and I asked, ‘When you’re ordering a wheelchair for Medicare patient, how do you know what’s required in your documentation? How do you know to document use required in the home and that the patient needs it to perform their MRADLS?’ And her response was, ‘Oh, well, a couple of years ago, the DME supplier up the street gave us some laminated cheat sheets to go by.’ And so I immediately had two thoughts, which were—of course, they did, because financially, you know, they’re responsible for that.”

Clayton stressed the importance of staying up-to-date on payer policies because they are always changing, and it’s vital for suppliers to be proactive instead of reactive when it comes to learning about different policies. 

“Payer policies are very fluid, they don’t remain static,” she said. “So, you know, it’s important that we do treat those referral sources as our customers, because that’s where the business is coming from a lot of times, and to keep them updated on changing payer policies, to create those guides for them that they can use … And it really creates a great opportunity for independent suppliers, because the more control that we can have upstream, the more we can control the outcome downstream. I feel like it’s really giving us a leg up, because we’re kind of shaping the documentation before it’s created, instead of reacting to bad documentation after the fact.” 

Derrick Stark said when it comes to the future of DME suppliers, the current path is the right path.

“The future role is not to go, ‘Oh my gosh, we have to be somebody else,’” he said. “I think who we’re being is exactly right.”