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.