You name it, home medical equipment providers are worried about it. From reimbursement cuts to bad press. From claims processing and payment time to ASP+6.

You name it, home medical equipment providers are worried about

From reimbursement cuts to bad press. From claims processing and
payment time to ASP+6. From stiff competition and fraudulent
dealers to high gas prices. Not to mention competitive bidding and
the Medicare Modernization Act (MMA). When the responses to
HomeCare's annual Forecast Survey were tallied, in fact,
home care companies had given us a two-page, single-spaced list of
things they're concerned about for 2005 and beyond.

It's no big surprise that many of these issues are directly
related to effects of the MMA.

The good news is that providers responded with an even longer
list of the measures they are taking to meet — and master
— the challenges they face.

And in spite of what for many is shaping up to be an uncertain
New Year, the majority of the HMEs we surveyed (65 percent) told us
they not only expect to survive 2005 but to grow their revenue over
2004 figures, on average by 5.6 percent. An additional 18 percent
expect revenue to remain constant over the two-year period.

About the Survey

In September, HomeCare mailed survey questionnaires to
1,500 randomly selected domestic subscribers asking about their
intended product purchases, their business operations, future plans
and their thoughts on the state of the industry. Of 353 companies
that returned completed surveys, the majority (68 percent)
indicated their organization is a home medical equipment/service
provider. The remaining participants said they work for a
pharmacy/chain drugstore with HME or for a specialty home care

Respondents operate in a variety of locations and represent a
wide range of company sizes. The largest group of respondents, 28
percent, said their companies are located in a small urban area,
while another 25 percent said their operations are located in rural
areas. Eleven percent of the respondents said they operate in one
of the 10 largest U.S. cities (where competitive bidding will begin
in 2007), and 15 percent said they are located in one of the
country's 80 largest cities (where the bidding program will expand
in 2009). Eight percent of the respondents said their operations
are national.

While these companies operate a median one location, 44 of the
companies participating said they have more than 50 branches. On
average, respondents employ 38 people. Thirty-nine percent said
they have 10 or fewer employees, though 24 percent said they employ
100 or more.

Again on average, respondents' estimated 2004 revenue is $6.6
million, with a median of $2.3 million, but 41 respondents placed
their company revenue at $25 million or more.

Moving Away from Medicare

Of the companies surveyed this year, revenue is generated from:
Medicare, 37 percent; Medicaid, 16 percent; managed care (MCOs,
HMOs, PPOs, etc.), 14 percent; retail sales, 12 percent; private
insurers, 11 percent; commercial accounts, 7 percent; and other
sources, 2 percent.

One goal many providers share for next year is moving away from
Medicare, and more than a third say they will diversify their
company's payer mix in 2005. They also plan to cut costs and
increase productivity to protect profits. Other means they are
banking on to stay in the black include a string of
“betters:” better and more aggressive marketing, better
use of software, better qualification of patients, better

As to exactly how they will diversify both payers and products,
a number say they are looking to increase retail sales, and overall
buying plans reflect the intent. For the first time, bath safety
products moved up on providers' shopping list to tie with manual
wheelchairs in the top product spot. Ambulatory aids, beds and
mattresses and nebulizers round out the top five purchases
providers say they will make in 2005.

Other products most providers will be buying include lift
chairs, incontinence products and oxygen concentrators, patient
lifts and CPAP/bi-levels. Power wheelchairs and scooters, which
grabbed the headlines throughout this year, rank at Nos. 11 and 12,
respectively, on providers' list of purchases.

Across the product spectrum, the biggest group of respondents
(35 percent) anticipates the respiratory sector will account for
their company's largest revenue growth in 2005, with many still
counting on continued growth in the sleep market.

Among survey respondents who expect next year's income to
decrease from 2004 levels, 83 percent believe the downturn will be
directly related to reimbursement cuts mandated by the MMA. About
those cuts, providers said the change in oxygen reimbursement would
hurt their business most (42 percent), while 24 percent said they
would be hurt most by payment cuts for power wheelchairs.

About the full impact of MMA, providers had even more to say.
More than a third of respondents indicate they will change their
service to accommodate reimbursement changes set forth by the
legislation, and more than one in 10 say that MMA's scheduled cuts,
based on Federal Employees Health Benefits Plan (FEHBP) median
pricing, will cause them to sell or close their business sooner
than they otherwise would have.

Twenty-two percent of providers told us they plan to exit HME
within the next five years. Many said that they are just ready to
retire, while others mentioned “burnout” and
“frustration” because of lower reimbursements, red tape
and paperwork, along with doubts about their companies' continuing
viability in the industry's vastly changed market.

Then Again …

Then again, three-fourths of responding providers say they plan
to stay in business through 2005, through 2007 when competitive
bidding kicks in and through 2009, when HHS could expand the
bidding program nationwide.

Preparing to grow in spite of next year's lower reimbursements
will certainly keep them busy. Two-thirds of the respondents have
plans to increase their business by adding patients, and 44 percent
say they will enter new product areas. A third will expand into
another geographic area.

Twenty-three percent will open a new branch in their current
market, and 18 percent say they will grow through acquisition. Some
respondents also note that they are likely to or plan to affiliate
with a hospital/physician (41 percent), home health agency (34
percent) or health maintenance organization (31 percent).

To improve efficiency, most providers say they will be cutting
costs through better inventory control (72 percent) or by asking
manufacturers for better pricing (67 percent). Forty-four percent
plan to concentrate buying with fewer vendors, and 40 percent say
they will buy in bulk.

Nearly four in five respondents (78 percent) plan to purchase
products direct from the manufacturer next year, and 52 percent
plan to purchase through distributors. Nearly half (49 percent) say
they are affiliated, or have plans to affiliate, with a buying

Accrediting bodies should be another busy bunch next year.
According to the survey results, only 44 percent of responding
providers say their organizations are currently accredited. Among
HME companies that are not, 27 percent plan to apply for
accreditation within the next 12 months.

Accreditation also made the list of subjects that providers see
among their biggest challenges. A laundry list of others includes
local and national competitors, keeping up with legislation and
regulations, claims and payment problems and staff issues involving
retention and training. As a group, however, these HMEs singled out
the 2005 FEHBP-based reimbursement cuts and 2007/2009 competitive
bidding as their “most pressing” business concerns.

On the flip side, providers listed the nation's aging
population, advancing technology and improved products, growing
retail sales and managed care among items that have had a positive
impact on their companies and the industry over the past year.
Interestingly, managed care also made the list of factors that
providers believe have had a negative impact, proving once again
just how different home care companies — and their individual
business plans — can be.

On the state of the industry in general, however, as a group
more than a third of providers (35 percent) believe that HME has a
somewhat or very favorable future. An additional 35 percent believe
the industry is holding its own but not advancing, and 20 percent
believe the industry is in a state of decline.

To cope, providers will implement all sorts of strategies. Some
say going forward they will expand more profitable lines and
eliminate low-profit products. One said he would “just say
no” to bad business. Others said their companies would focus
on retail sales, while another plans specifically to “fit in
where [competitors] fail.”

To sum it up, wrote one provider, in 2005 he will be
“working like a madman, trying to dodge dozens of bullets
each month.” Still another said he has come to believe
“there are no measures you can take when the government
controls all.”

Other HME executives apparently share the sentiment and are
appealing to a higher power. In response to the question
“What measures are you taking to survive the industry's
current changes?” there were several mentions of prayer.

For the Record

Survey methodology conforms to accepted marketing research
methods, practices and procedures and the guidelines set forth by
American Business Media. Data was collected Sept. 9, 2004, through
Oct. 15, 2004. Percentages are based on responses from 353
companies. Not all respondents answered every question, and some
totals may add to more than 100 percent due to multiple responses.
For a complete copy of the 2005 Forecast Survey, visit our Web site
at and click on the button titled
“Purchase Exclusive HomeCare Research.”

2005 Product Shopping List

(Ranked by percentage of HME providers who intend to
1. (Tie) Bath safety products 70.5
Manual wheelchairs 70.5
3. Ambulatory aids 69.7
4. Beds/mattresses/pads 68.6
5. Nebulizers 66.6
6. Lift chairs 61.2
7. (Tie) Incontinence 56.1
Oxygen concentrators 56.1
9. Patient lifts 54.7
10. CPAP/Bi-level 54.1
11. Power wheelchairs 53.5
12. Scooters 52.7
13. Portable oxygen systems 52.1
14. Oxygen conserving devices 51.8
15. Compression hosiery 50.1
16. Seating and positioning 47.0
17. Orthopedic softgoods 46.7
18. Nutrition 46.5
19. Bariatrics 45.6
20. Pulse oximeters 42.2
21. (Tie) Diabetes 41.9
Scooter/wheelchair lifts 41.9
23. Support surfaces 41.1
24. Compressed gas regulators 38.5
25. Urological/ostomy 38.2
26. Ramps 38.0
27. Hot and cold therapy 36.0
28. (Tie) Sleep disorders 35.7
Sore prevention 35.7
30. Skin care 34.3
31. Orthotics/prosthetics 31.2
32. Liquid oxygen systems 30.3
33. Pediatric mobility 28.0
34. Pediatric respiratory 26.6
35. Apnea monitors 26.3

Which of the following markets will account for your
company's largest revenue growth in 2005?

Respiratory 35.4%
Sleep disorders 12.7%
Power wheelchairs 12.5%
Pharmacy 11.0%
Scooters 6.8%
Diabetes 5.9%
Infusion 5.7%
Manual wheelchairs 5.7%
Orthopedics 5.1%
Bariatrics 4.2%
Beds/mattresses 4.0%
Bath safety 3.1%
Seating/positioning 1.7%
Women's health 1.7%
Pediatrics 1.1%

What has had a positive impact on your company/the industry
in the past year?

Nearly 150 individual providers shared their thoughts when
answering this survey question. Following is a representative
sample of the responses they gave in their own words.

“Advancement of technology”
“Affiliation with a home health and hospice
“Aging population”
“Adding patients”
“Adding services”
“Baby boomers”
“Better inventory control”
“Better products”
“Better staff retention”
“Buying groups”
“Cash sales”
“Electronic billing”
“Elimination of product lines”
“Excellent customer service”
“Expansion into new geographic area”
“Expansion into new product lines”
“Getting more aggressive and politically
“Growth in respiratory market”
“Increased advertising”
“Increased need for HME products”
“Involvement in our state association”
“Newer and better products”
“Managed care”
“Manufacturer financing and co-op advertising”
“Manufacturers have held the line with price increases. Some
have even come down.”
“Mergers/buyouts of competition”
“More people needing our services”
“Moving away from Medicare reimbursement”
“O2 revenue”
“Productivity-based management applications”
“Providing the best possible service and
“Quality personnel through training”
“Retail sales”
“Trade organizations and magazines”
“We get to help people when they are in need. That is why
most of us are still in the business: to make other people's lives
easier and better.”

What has had a negative impact on your company/the industry
over the past year?

An even 180 survey respondents answered this question, and
they did not mince words. A representative sample of these
individual providers' comments, in their own words,

“Allowable freezes”
“Bad press from fraudulent dealers”
“Being small and getting our referral sources to give us
“Billing issues”
“Concern over ASP+6”
“Consistent downward payment level pressure by all
“Continual acquisition of smaller DMEs by large
“Continued scrutiny of the HME business by CMS, constant
regulatory mandates.”
“Crackdown on power mobility”
“Direct/TV advertising by manufacturers”
“Employee retention”
“Ever-increasing government regulations”
“Future price cuts, more red tape”
“Gas prices”
“Government position toward HME”
“Hospital-based DMEs placing discharge planners in their
“Illegal, unethical practices of other HME
“Increased competition by national companies”
“Internet sellers. Manufacurer-direct sellers. Single
product, national ‘code-killing’ companies”
“Lockout by HMO and insurance plans”
“Looming competitive bidding”
“Managed care contracts”
“Medicare Modernization Act”
“New computer system to be HIPAA-compliant. Can we say
“Payment processing/time for payment”
“Power wheelchair regulations. Excessively slow payments.
Unfair claim rejections”
“Red tape, bureaucracy”
“Rule changes, reimbursement cuts”
“State Medicaid cuts”
“Torrential legislation/regulations”
“Unethical competitors in the marketplace”

What are the biggest challenges facing your company?

Government reimbursement cuts 59.2%
Claim processing/payment time 43.6%
Competitive bidding 42.2%
Claim denials 41.9%
Paperwork/administrative activities 24.9%
Local HME competition 22.4%
Accreditation 21.5%
Keeping up with legislation/regulations 20.1%
Staff issues (training, retention, etc.) 19.8%
Manufacturers selling directto consumers 19.3%
Managed care contracting 18.1%
Mail order/Web-direct HME sales 16.4%
Hospital-based HME competition 16.1%
National HME competition 13.9%
Compliance 11.0%
Keeping up with technology 11.0%
HIPAA 9.1%
Quality patient care/services 5.1%
Retail pharmacy with HME 4.5%
NSC Medicare supplier standards 4.0%