It’s a little bit hard to feel joyous heading into this new year. Economic predictions range from shaky to dire, with stagnant growth, continued inflation, a tighter-than-ever labor market and soaring deficits bringing bad news. On top of that, a continuing public health emergency and shifting control of Congress all make it harder than ever to predict what’s to come in the world of homecare. And yet, our industry experts weigh in here about their biggest predictions and priorities for the future—and most say they are optimistic about the future.
1. A View From Washington
By Tom Ryan, President, American Association for Homecare
Of course, reimbursement rates will remain a top concern for the home medical equipment (HME) community and for the American Association for Homecare (AAHomecare), but I’ll take this opportunity to highlight a particularly pressing issue for 2023. We hope and expect that the Biden administration will be able to lift the COVID-19 public health emergency (PHE) sometime this year, and when that finally happens, there will be a significant impact on various flexibilities and waivers granted to health care providers during the PHE.
For HME providers, the waivers for oxygen and continuous glucose monitors that were put in place for the duration of the PHE are especially important. We will need to lobby Capitol Hill and the Centers for Medicare & Medicaid Services (CMS) to grandfather in all of these patients set up during the pandemic. We also want to see telehealth flexibilities made permanent, and policymakers need a find a way to maintain access to care for the millions of people who could potentially lose eligibility for Medicaid and who are currently utilizing HME.
We need to ensure a stable Medicare reimbursement methodology that reflects the full scope of costs associated with providing high-quality, home-based care. We can’t move forward again with a competitive bidding construct that allows CMS to reject bidding results because they didn’t see the cost savings they wanted. Why should suppliers go through that exercise again only to potentially have CMS reject the results?
In the nearer term, we’ll continue to press for a 90/10 blended rate for suppliers in former competitive bid
areas (CBAs) and to have the 75/25 blended rate in non-CBAs and 50/50 blended rates in rural areas made permanent.
I’m optimistic about the future prospects for homecare, and, if inflation rates and supply chain challenges continue to ease, I see the industry being in a better place at the end of 2023.
Two of our country’s biggest challenges in decades ahead are rising health care costs and meeting the needs of an aging population. HME should be a major component of addressing both of those. We’ve made some strides in communicating more effectively about the value of HME and high-quality home-based care to policymakers and the public, but I think we’ve just scratched the surface of what this industry can achieve in highlighting those messages.
2. Question: What one question should homecare providers ask themselves as they enter 2023?
"The one question providers should ask themselves as they prepare for 2023 is: How can they maximize their return on investment on the services they provide? We all feel the pain of increased prices since the pandemic—fuel, equipment, service fees, labor, etc. It is more important than ever to determine how to become efficient in your operations.
You may not be able to affect the costs of goods, but you can look at how you are processing orders, claims, deliveries, and so on and make changes that will reduce the cost attributed to those tasks. Ask yourself:
- Can you outsource any functions?
- Are there products or services you need to cut to be more profitable?
- Can you hire a consultant to help identify the waste and duplication of efforts that reduce your profit margin?
- How can you better leverage technology to decrease costs?
These questions seem logical, and suppliers have asked these for decades, but the issue is that they are asked and maybe even some action is taken, but long-term execution of those initiatives rarely come to fruition. Make it your 2023 resolution to act and execute on those profit-making plans."
—Sarah Hanna, VP of Consulting Services, ACU-Serve Corp.
3. Question: Do you see providers ending 2023 behind or ahead of where they are now and why?
"I try to be the eternal optimist, so that’s why I would say I suspect that providers should be further ahead in 2023. If employee shortage challenges dissipate and technology continues to improve, providers should be assisted in shoring up their operational efficiency—and, of course, their bottom line.
I also believe that as payers continue to provide integrated services such as HME and they contract with HME companies, providers will need to be more savvy and selective about the businesses they partner with. Even when they want to negotiate for a contract, they’ll have to make sure that pricing is such that they can still earn a profit.
With regard to pricing itself, the consumer price increase—which will be a fairly healthy this year—will help improve the situation. Even as the public health emergency waivers and loosening of the pricing regulations goes away, we’ll still see still some relief. And because we have payer diversification and don’t rely so heavily on Medicare, I believe we’ll be in a position to negotiate better pricing with some contracted parties or third-party payers, so I look forward to more diversified opportunities for HME companies.
With respect to the recall and supply chain shortages, I believe this will continue to improve in 2023, and will enable HME businesses to get back to doing business the way they know how and dispense products in a more timely fashion, which will in turn help with operational efficiency."
—Miriam Lieber, President, Lieber Consulting
4. Question: What do you think will be the biggest issue to face the industry in 2023?
The biggest challenge in the complex rehab and mobility sector will be educating state legislatures on real solutions to address the delays consumers are experiencing in getting timely access to wheelchair service and repairs. Unfortunately, it is a multifaceted problem that will require multiple actions to resolve, but both the National Coalition for Assistive and Rehab Technology and AAHomecare are working in collaboration with members to proactively address it.
The biggest opportunity for this segment of the industry is on the Medicare coverage side. CMS is scheduled to release a proposed decision memo for Medicare coverage of power seat elevation systems in February, and the power standing systems national coverage analysis (NCA) should be released for comment in 2023 to start that coverage process. Over 3,500 supportive comments were submitted to CMS as a part of the initial comment period on the power seat elevation NCA, and coverage of this technology is a win-win for all stakeholders, including Medicare.
—Seth Johnson, Senior Vice President, Government Affairs, Pride Mobility Products Corp.
5. QUESTION: Is there a single thing—a regulation, legislation, or economic factor—that would make the greatest impact on the industry?
"Yes: Any regulation or legislation outlining value-based quality and outcomes metrics that can be directly impacted by home-based care. The idea is to incentivize care that’s less fragmented and siloed in favor of coordinated, longitudinal care. We’ve seen a lot of movement to value-based care over the past decade, and while that will continue, we need to be clear on aligning incentives specific to home-based care so that we get the desired outcomes—including better patient outcomes, lower cost, and higher patient satisfaction. These are consistent with CMS’s goals in its value-based care programs."
—Vijay Kedar, CEO and Co-founder, Tomorrow Health
"The biggest issue for 2023 will be the unwinding of all the activities related to the end of the public health emergency. HME providers will have to address a myriad of issues, many of which we don’t know because Medicare and other payers have yet to articulate the important transition issues regarding coverage and documentation for the provision of respiratory and other items to patients who have continued medical need."
—Cara Bachenheimer, Head of Government Affairs Practice, Brown & Fortunato
“One significant external factor that will dramatically affect the whole industry is the continued rise in interest rates. The Federal Reserve Bank will continue to raise interest rates at an aggressive rate throughout the foreseeable future in an effort to curb inflation. In particular this will greatly affect the mergers and acquisition market, resulting in more scrutiny in due diligence, longer transaction cycles, less leverage and private equity being more careful with their acquisitions.”
—Bradley M. Smith, Managing Director/Partner, VERTESS
6. A Future Focus for PACE
By Carlos Perez, Executive Vice President, CareVention HealthCare at Tabula Rasa HealthCare
For people with complex care needs, receiving highly coordinated home-based medical and social services is essential to safely aging in place. Value-based care programs, such as the Program of All-Inclusive Care for the Elderly (PACE), which assume full financial risk for participants’ medical and social services needs, are becoming an increasingly attractive option for those wishing to remain in their communities. PACE-covered services include the core benefits provided to all Medicare recipients such as primary care, physical and occupational therapies, home care, hospital care, social services, and prescription medications—but PACE also offers so much more in the way of flexibility and creativity to deliver personalized care to enrolled participants.
Since many PACE participants have complex care needs, often driven by multiple chronic diseases, it’s common for participants to take several medications. Ensuring that all medications and their doses work together safely and optimally is crucial for individual well-being. For example, certain drugs for urinary incontinence are associated with delirium, dementia and falls. Taking higher doses of these medications could increase risk for the participant. And since value-based programs like PACE use a capitated payment model of care, where the organization is paid a set fee to deliver the person’s care, this quickly becomes a cost risk to the organization.
Optimizing drug therapy is key for PACE programs to promote health and well-being while avoiding unnecessary downstream health care expenses. While traditional medication therapy management targets people based on the number of chronic diseases and how many different drugs they take, modern, more sophisticated technologies can simultaneously analyze how all the drugs being taken interact with each other. This approach better determines the risk of harm from a person’s daily medication routine, which can be particularly complex.
With opportunities to launch new programs and expand enrollment in existing programs on the horizon, PACE is well-positioned for growth in 2023. Integrated solutions that include modern, sophisticated medication therapy management can help programs drive success by optimizing drug routines and promoting the health and wellbeing of their participants, all while avoiding unnecessary health care expenses and improving operational efficiency.
Beyond optimizing medication use, PACE programs have opportunities to reduce costs and enhance efficiencies in other areas of their operation such as third-party administration, provider education, and risk adjustment with partners expert in supporting value-based care organizations. When all of these functions are part of an integrated suite of solutions, tailored specifically to value-based care, programs can deliver optimized care to participants, streamline operations, lighten administrative workload for staff, and make data more accessible and useable.
7. A Path to Home Access
By Jim Greatorex, Vice President, VGM Live at Home
The home access industry has seen a turning point arrive in the last 18 months. There has been a great deal of investment into the industry, public awareness has grown, legislation has been introduced and, most of all, the increased demand for our services has resulted in our estimation an 18% to 20% industry growth rate for 2022.
We believe that double-digit growth will continue through the next four to six years fueled by the retail market for aging in place.
The industry is starting to take steps to define what we do and professionalize ourselves. To ensure sustainability, we are starting to build an apprenticeship program for field technicians. This will be a long-term project that will bring more value by providing skills and knowledge to the current workforce and incubate a whole new generation of technicians who are attracted to the construction field and the meaningful customer touch that home access brings.
Here at VGM, we are working to produce a white paper that will detail the best practices for collaboration between clinical specialists and home access professionals. By defining roles and conforming the assessment process, we hope to build an industry that can become an added and valuable piece to the homecare spectrum—and more broadly to the continuum of care.
The one question home access companies need to ask themselves as they prepare for 2023 is: “What infrastructure and systems should I implement into my business operations to allow for scalable growth moving forward?” As a small but growing niche industry, we currently do not have project management or operating software specifically designed for our unique needs. In many cases, we also do not have polished sales programs that enable us to effectively present ourselves and our solutions to retail prospects. We foresee potential solutions on the horizon and the home access industry needs to embrace this type of technology and growth.
I see the next two years as the time where the home access industry shows great progress in its maturity and becomes a known entity in the United States market. There are many challenges ahead, but market growth is not one of them.