Apria’s Getson on Humana Deal: Contracts Won and Lost Every Day

LAKE FOREST, Calif. — Rumors have abounded since the news
surfaced that Apria Healthcare has struck a deal with insurance carrier
Humana to be its provider of choice for HME.

While it’s a move that could cement the company’s future in an
uncertain time, the agreement has heightened the anxiety level of
some industry providers who are already seeing business fade away
in the face of competitive bidding, out-of-control audits,
tightening regulations and the possibility of even more cuts as
legislators hack away at the nation’s bottomless deficit.

Setting the record straight for HomeCare, Lisa M.
Getson, executive vice president, government relations and
corporate compliance for Lake Forest, Calif.-based Apria, stated
that “contracts are won and lost by providers across the country
every day … but they don’t seem to be newsworthy. Our own
public disclosures cite Apria managed care contract losses in the
millions of dollars for 2010-2011, which were subsequently awarded
to numerous small and independent providers in states in the
Southeast, central and northeastern U.S.”

Getson took issue with a comment from a Kentucky provider who
said last week he was fearful that providers billing out of network
could see the price for concentrators drop as low as $72.

“That is not even on the same planet as the actual rates,”
Getson said.

Following are Getson’s responses to other questions regarding
the agreement.

HC: How long is the agreement?

Getson: It is a multi-year agreement.

HC: Does it cover all states?

Getson: It is a multi-state arrangement with a
few exceptions carved out, based on certain unique Humana health
plan models or contracting relationships the health plan has in
place.

HC: Will Apria need to subcontract with other providers
in some areas?

Getson: At Humana’s request, Apria is working
diligently to ensure that the patient transition occurs smoothly
and in accordance with Humana’s expectations concerning timing
because of contract expirations. Patients in extremely rural
markets may need to be served by subcontracted providers and, if
so, Apria’s first consideration will be for the provider currently
caring for the patients.

HC: In areas where you do not have a presence, will you
also be looking to purchase some providers?

Getson: We are always looking for opportunities
to add home care companies with a reputation for quality, ethical
operations and active compliance programs in place to the Apria
Healthcare family of companies. The most recent example is the
U.S. Praxair
Healthcare Services acquisition, which we completed on March
4.

HC: What are the benefits to Apria in contracting with
Humana?

Getson: There are advantages to both parties,
including administrative simplification, the implementation of
condition-specific clinical programs, which will yield consistent
patient outcomes across multiple locations and electronic
connectivity that reduces paperwork and overhead costs.

HC: Some sources have said they believe the contract is
38 percent below current Medicare allowables. If this is so, how is
Apria able maintain its high quality?

Getson: Our fee schedule and terms are
proprietary. It is important to note that neither Humana nor most
other non-government payors in the U.S. cap oxygen at 36 months
because they recognize the flawed policy’s negative impact on
patients and providers. To compare managed care to Medicare is an
apples-to-oranges comparison that should not be made. In fact, many
different parties in the home care industry have made that very
point to government agencies that study our industry’s benefit
structure. Even the government acknowledges that in its most recent
studies on oxygen and competitive bidding. Our patient and referral
satisfaction scores have steadily increased in the past year and we
are confident that we will continue to offer Humana members high
quality home care services as we and the former Praxair Healthcare
Services were already preferred providers in Humana’s network.

As to a question about Apria’s plans for Round 2 of competitive bidding,
Getson said, “Like others in the industry, we are awaiting either a
proposed rule or subregulatory guidance concerning Round 2 to be
published by CMS. The rule should give us a better sense of how CMS
plans to operate Round 2 and so it would be premature to comment
now.”

In Round 1, Apria won contracts for oxygen and enteral nutrition
in all nine competitive bidding areas along with contracts for CPAP
and hospital beds in eight CBAs and walkers in three.