Diversification is the new reality for what once were many niche businesses. Consider the pharmacy that at one time only filled prescriptions and sold over-the-counter medical supplies but then found it necessary to add beauty items. Slowly, through expansion, many have become mini-marts. Consider the butcher who expanded and became the local full-service grocery store and the ladies dress shop that expanded to become a department store. All of these changes were efforts to increase offerings and sales and remain a viable, relevant business and member of the community. Now it’s the HME provider’s turn to either change models or continue with the status quo and likely get left behind. Clearly, competitive bidding has impacted the bottom line, but adding retail inventory is a viable expansion opportunity. How the HME industry diversifies in this changing regulatory and economic environment will determine who succeeds and who fails. To paraphrase Gen. George Patton, now is the time to “lead, follow or get out of the way.” However, unless your community and your customer know that you are changing and what you have to offer, why bother? While shopping in general may have become a leisure activity, this trend has not yet reached the HME outlet. Let’s state an obvious fact—customers rarely come into your store just to browse and see what’s new. By expanding offerings and transitioning, at least in part, to an HME “gift store” you have the opportunity to showcase items that are more likely to lead to impulse purchases. While you may never have seen yourself in the “senior” or “disabled” gift business, now is the time to rethink that position. With the number of seniors increasing every day, you are uniquely positioned to take on this growing market. Currently, the typical HME customer comes into your store to get what the doctor has prescribed, what he or she needs for recovery from an accident or to fill a short-term need until the arrival of a monthly delivery. The customer picks up the necessary items and leaves as quickly as possible. Leisurely browsing is just not part of the experience. You need to change that mindset.

1. If you have space, host meetings for local medical support groups. When you promote meetings within the community, you become an information resource as well as a product resource.
    
2. If your customer purchases a shower bench, walker or wheelchair, offer a coupon with 10 to 20 percent off an accessory, if purchased within 30 days. You want to bring them back.
    
3. If you handle wheelchair repairs in-house, take a cue from your local auto dealer and offer light refreshments while the customer waits.
    
4. Offer practical gift items for seniors or the disabled that are not found in traditional retail outlets, and showcase them in eye-catching displays.
    
5. Schedule and market a grand reopening. Your community needs to know that you have changed.
    
6. Your customer base also needs to recognize you as a valuable resource in the community. As you seek to expand and become a community resource consider the following.
   1. Become a member of your chamber of commerce and host a chamber event at your store to enable other businesses to see how you have expanded your offerings. Encourage them to act as a referral for you.
       
   2. Work with activity directors at local assisted living facilities to bring what’s new to them. Activities directors are frequently looking for new programs; why not be one?
       
   3. Support local church and civic groups by sponsoring a speaker or helping them to promote a community medical expert at their event.
       
   4. Participate in local senior wellness fairs and healthy living expos to distribute information and showcase new gifts.
       
   5. Many seniors still enjoy reading the newspaper. Advertise, particularly if there is going to be a special holiday gift guide or health care section. Offer to guest-write a column.
       

   It would be remiss not to mention how online shopping has impacted today’s shopper. Internet shopping makes it easy to compare pricing and find new products. The Web has effectively taken “let your fingers do the walking” to a whole new level. While years ago it was important to have a Yellow Pages presence, today it is equally important to have an online presence. Today’s customers self-educate and often make purchasing decisions by searching online before ever entering a brick-and-mortar store. Your website can showcase a full inventory and offer an opportunity for online purchases, or it can just be a page or two indicating the type of items you carry and your store hours and location. An online presence lends credibility, indicates stability and allows an ever-increasing number of shoppers to browse where and when they want to. In addition, social media is a large part of reaching customers in this electronic age. Designate an employee to handle your Facebook, Twitter and email accounts. Electronic media is a quick and easy way to communicate with your customer base and let them know what is new and what is going on in your store.

   Clearly, competitive bidding has impacted the bottom line, but adding retail inventory is a viable expansion opportunity.

   Floor layout is more important now than ever, as many shoppers are conditioned by the Web or big-box stores to navigate for themselves. Floor layout needs to be logical from the customer’s point of view. Look at your floor space objectively and adopt the store-within-a-store model. This will make it easier for your customer to differentiate between traditional HME and gift items. Eye-catching displays will better showcase gift items purchased for your target demographic. If you have street-front windows, be sure to dedicate at least one window to promote gift items and not just HME products. Customer service remains key as always but takes on a new meaning in the current environment. From the time your customer pulls into your parking area they are making decisions about you. If the exterior of your store says that you do not care, how are your customers to believe that you will care about them? Appearance and attitude matter, particularly to someone shopping for the first time or to someone who has come to you with a problem they wish they didn’t have but need solved. We all know that people talk, so word of mouth about new, interesting and helpful items, fabulous customer service and support of local advocacy groups will help to develop the positive reputation you are seeking. Will you be an HME product leader, follow what others are doing or be left behind? The choice is yours. It requires an investment of time and money but more importantly, it requires a new way of looking at your business and the people you serve. Gen. Patton also said, “Accept the challenges so that you can feel the exhilaration of victory.” The market and customer base are there. They are yours to lose.

   This article is the second of a two-part series on HME merchandising solutions.

After several retractions, CMS announced that Jan. 6, 2014, is the day that Phase Two of the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) will go into effect. PECOS is the system created by CMS to ensure that only vetted and acknowledged (enrolled) and appropriate prescribers prescribe certain services and products in the home care community. After Jan. 6, 2014, CMS will deny all HME, Part B and Part A home health agency claims that are submitted by providers with products and/or services ordered by health care professionals who are not enrolled in the PECOS system. You might remember that PECOS was ready to be implemented a few years ago, but at the last minute, CMS decided to put the start date on hold. At the time, a very small percentage of prescribers actually were enrolled in PECOS, and the new online system was complicated and lengthy. Due to the extremely high number of warnings that HME providers were receiving, AAHomecare immediately asked CMS to take a much more measured 
approach and delay the start of Phase 
Two until data showed that the vast 
majority of ordering clinicians were enrolled in the system. And now that date is here. Since 2011, suppliers have been receiving warning notices for submitted claims with clinicians who are not enrolled in PECOS. Hopefully, you and your staff have not been ignoring these edits for the last few months and have spoken to your non-enrolled prescribers. “CMS indicates that they have taken proactive steps to enroll ordering and referring providers,” said AAHomecare officials in a message to members. They are ready to launch the program. CMS estimates that less than 1 percent of ordering clinicians have not enrolled in PECOS. Do you think that less than 1 percent of your prescribers are not enrolled? Most of my clients say no, that it is much higher. This presents a challenge for you. Are you going to take referrals from prescribers who are not enrolled? The answer is no. These prescribers have been receiving edits on their own claims for Part B services for months, warning them that they must be enrolled. You and your peers in HME and home care who receive referrals from them have been (or should have been) warning the prescribers as well. There is no retroactive process to pay claims if the prescriber does not enroll in PECOS until after this effective date. Your claims will be unpaid and not paid on resubmission. You must stop taking referrals from non-enrolled prescribers right away. Realize that all post-acute providers will not be accepting those referrals, as none of them will be paid. As soon as they are enrolled, you can return to accepting their referrals again. If you have providers who are not enrolled as of the effective date, you can do two things. Print the PECOS application and enrollment materials, with the instructions, and bring them to your non-enrolled prescribers. Hand them the copies and explain that you, and other post-acute providers, are no longer able to bill Medicare for their patients and that you can no longer accept referrals as of Jan. 6. Avoid unnecessary denials and ensure that you are submitting claims using an individual clinician’s National Provider Identifier (NPI) rather than an organization NPI. Many practices have been accustomed to providing an organizational NPI with referrals. While CMS has tried to discourage this during the past years, some are late to implement the change and get updated NPI numbers for each practitioner, even though they have had a few years to get this done. Your accreditation organization may have sent you information on this requirement, but you have been receiving this information on your claims from your DME MAC for years. Surveyors conducting accreditation surveys after Jan. 6 
will certainly ask to see the process 
you have in place for maintaining your current listings of PECOS enrolled providers. PECOS enrollment is not just 
a requirement to get your claims paid 
but also an accreditation requirement 
to be in compliance with all payer 
requirements.