Deadly Tornadoes Push Southern HME Providers to the Limit

ATLANTA — Home care providers with the best of emergency
plans were stretched to the breaking point during last week’s
devastating storms and tornadoes that hit seven southern states. At
press time, The Associated Press estimated 341 people dead; the
Alabama Emergency Management Agency had confirmed 254 fatalities in
that state alone.

“This is almost too large to plan for,” said Mike Hamilton,
executive director of the Alabama Durable Medical Equipment Dealers
Association (ADMEA). “This is like Katrina, and most providers’
emergency preparedness plans have been overwhelmed because the
storms covered such a huge area.”

With thousands injured and without power, HME companies
throughout the South were left scrambling to take care of patients.
Leigh Ann Matthews, owner of Complete Care, with locations in Fort
Payne and Scottsboro, Ala., swung into action to help patients in
devastated areas.

“We are now trying to go in and replace backup systems for our
oxygen patients,” said Matthews, who also serves as president of
ADMEA. “Some of those areas are almost impassable. We are just
trying to get to them by whatever route possible. We have also had
patients who have completely lost their homes and had to
relocate.”

The last set of storms came through about five miles from
Matthews’ Fort Payne location, a town that saw widespread
destruction and more than 30 fatalities. Officials told Fort Payne
residents they might not have power until some time during the week
of May 2, and Matthews was preparing for that situation.

As soon as the storms broke April 27, Matthews directed delivery
personnel to hit the road, and they went non-stop all day. These
efforts are mostly not reimbursable under Medicare guidelines, and
providers across the region will likely feel the hit.

“It will be a financial burden,” acknowledged Matthews. “And we
have no idea how much equipment we have actually lost, because
there are some areas we have not been able to get into,” she said
Friday. “If it was one small area that was hit, you could handle
it, but when every oxygen patient you have does not have power, it
makes it very difficult.”

The full measure of the storms’ impact will continue to be
revealed in the days ahead. For some, it could end up as a double
whammy of damage to both business and home.

“I talked to one supplier this morning, and he had locations in
Tuscaloosa, Birmingham and Huntsville,” said Matthews. “His home
had been damaged, and he said, ‘I don’t even know if I have any
businesses standing.’”

Joe Bryant, owner of Happy Home Health, escaped damage to his
business in Pelham, Ala., and his home in Alabaster, Ala. However,
many of the patients he serves in Bibb, Blount, Chilton, Jefferson,
Shelby, St. Clair, Talladega, Tuscaloosa and Walker counties were
not so fortunate.

“The biggest problem is electrical power disruption,” said
Bryant. “Patients on oxygen who are without power have been handled
in one of two ways. First, LOX systems do not require electricity,
so we made these systems available to as many of our patients as
possible. Second, some years ago we purchased portable
gasoline-powered generators, and we have made these available as
needed.”

Bryant faced a similar situation years ago with Hurricane Opal
(1995). At the time, he had to supply rural patients with oxygen
cylinders, since he was not heavily involved in LOX.

“Following that hurricane, we swore we would not go through that
many oxygen cylinders again and the headaches associated with the
logistics of refills and delivery,” said Bryant. “So far, we have
met all of our patients’ needs and are operating under our
emergency preparedness plan.”

All these secondary devices — LOX systems and generators
— are not subject to reimbursement because they are
considered backup systems. “The costs have to be absorbed by the
DME provider,” said Bryant, echoing the sentiments of Matthews. “I
know of no other industry that does this. This is non-reimbursement
as mandated by Medicare, Medicaid and other insurance carriers,
including Blue Cross Blue Shield.

“Wouldn’t it be nice if banks and mortgage companies had to
supply you with a house at no cost until you replaced your lost or
damaged home?”

The disaster sparked industry advocates to question again the
wisdom of nationwide
competitive bidding and how it might affect patients in times
of dire need.

“The fewer suppliers you have,” said Hamilton, “the less likely
it is that you will be able to respond properly to a disaster like
this.”

Bill Hewlett, a VGM member and vice president of the Kentucky
Medical Equipment Suppliers Association (KMESA), wrote that a lack
of providers — especially in rural areas — would surely
be felt once competitive bidding spreads.

“When competitive bidding comes to this rural area, will we all
still be around to make sure patients are cared for in a proper
way? Probably not,” said Hewlett.