Using Education to Fight Reimbursement Woes

Thompson Home Medical Equipment in Traverse City, Mich., faces issues common to HME businesses across the country: The company is struggling to provide the most appropriate equipment and services in a reimbursement environment that is at odds with its clients’ clinical needs. So, what is its solution? Education.

Shawn Boyt, ATS, says as the 31-year-old company continues to fight for changes impacting mobility providers, one thing is clear: He must educate clients, referral sources, legislators, staff members — and, yes, even his competitors — on the reimbursement restrictions that are limiting the choices the company can offer.

According to Boyt, co-manager of Thompson’s HME division, Michigan’s Medicaid program is in a dire situation. Providers are experiencing cuts, denials and exasperatingly lengthy DSOs of more than 120 days. Calls to Medicaid representatives continue to go unanswered, Boyt says, so he recently hosted a meeting with two state legislators — Sen. Jason Allen, R-Traverse City, and Rep. Howard Walker, R-Traverse City — in the company’s facility. The timing was perfect as representatives from Medicaid of Michigan had been communicating with Allen regarding pricing issues, notably the difference in Medicare allowables versus Internet pricing.

“They were both very receptive to listening once we put the issues in laymen’s terms. These guys actually took time out of their busy schedules at a time when they [were] trying to balance the budget of Michigan,” says Boyt. “I was very honest with them, although I did not shoot the messenger. Sen. Allen’s biggest point in his response was that the state of Michigan does not need for another business to go under.”

Getting legislators to listen is an obvious challenge providers face, but explaining the restrictions to clients is even more difficult. However, Boyt says it is essential.

“We must educate the people that are receiving the services about what they are getting. Often, they take it for granted because of how it has worked in the past,” he says. “We [tell them] there’s a new sheriff in town and you can’t just assume everything is going to work the same as it has previously.”

Boyt and other staff members keep clients informed of issues such as competitive bidding and encourage them to write letters and make calls to their legislators. They also have adopted a model that is designed to empower end-users.

“The end-users and the caregivers need to be their own advocates. Every day I come into work and tell a client that he or she is going to have to fight for access to the equipment they need instead of saying, ‘We’ll take care of it,’” he explains. “I have to put it all back into their lap and empower them with information.”

He adds that he always educates clients about the available reimbursement for the prescribed item, emphasizing the payment is according to the payer’s guidelines. “It works when you’re up front with them. A lot of times I am brutally honest and even offer the phone numbers of our competitors, telling [people] they will find the same situation,” he says.

Members of Thompson’s staff are key components of the educational process. According to Boyt, technicians and drivers are kept informed of the situation so they don’t get “broadsided by the clients.”

Networking with competitors has escalated recently, mostly out of necessity, Boyt says. He likes to share his thoughts with the group through phone calls and emails, but he says more communication needs to occur.

“My brother is a contractor. I went to a Homebuilders Association meeting with him and saw a room of over 100 competitors coming together and getting educated on new codes and other issues affecting their industry,” he says.

“They were breaking bread and learning together and, then, they walked out of the room and became competitors again. We need to do that.”