State Associations Say Members Grappling with Too Many Uncertainties

ATLANTA–Home medical equipment associations across the country
are facing challenges on both the state and federal levels this
year, but the biggest one is a question mark, association officials
said last week.

“The primary concern that the independent [HME] companies have
is the uncertainty of the health care industry, the Medicare
implications and the fact that nobody quite knows what the future
bears,” said Tom Renk, executive director of the Illinois
Association of Medical Equipment Suppliers. “Everybody is
frustrated. They can’t read the tea leaves. They can’t see where
this is heading.”

The biggest area of concern is accreditation, according to Rose
Schafhauser, executive director of the Midwest Association for
Medical Equipment Services, which serves Iowa, Kansas, Minnesota,
Missouri, Nebraska, North Dakota and South Dakota. “The number one
question has been the time frame for when all the providers are
required to be accredited,” she said.

Competitive bidding and the oxygen cap are also up in the air,
officials noted, and rehab is a concern.

“In custom rehab, [providers] are dealing with the effects of
the new [power mobility device] guidelines, codes and reimbursement
and the impact this is having on other payers, especially
Medicaid,” said Karyn Estrella, executive director of the New
England Medical Equipment Dealers Association.

Estrella said NEMED–which covers Connecticut, Maine,
Massachusetts, New Hampshire, Rhode Island and Vermont–has also
communicated to state Medicaid departments members’ worries about
providing medically necessary equipment to dually eligible
beneficiaries. “There is great concern about funding for Group 4
chairs for duals since Medicare will not pay for these chairs,” she
said.

While all the above are also issues for the Pacific Association
for Medical Equipment Services, which covers Oregon and Washington,
there’s another challenge for Washington providers. The state is
one of only four that taxes HME and services, said Tom Coogan,
president-elect of PAMES. “We’re trying, for the seventh year in a
row, to change that law. We’re hopeful that this year we’ll finally
be able to get that legislation passed.”

Coogan also cited as issues the CPI freeze, inherent
reasonableness and, perhaps most important, declining
reimbursement.

Several association officials said they are trying to help
providers not only with reimbursement cuts but also with lagging
reimbursement and stalled payments.

Both Bob Achermann, executive director of the California
Association of Medical Product Suppliers, and MAMES’ Schafhauser
said their members are having problems getting paid through
Noridian Administrative Services, the new Region C DME Medical
Administrative Contractor. Achermann said CAMPS will provide
workshops on the issue at its annual meeting in March.

Renk said another issue for Illinois providers is slow Medicaid
payments. In his state, they can take months, he said, citing the
example of a small HME company that waited nearly a year for $1.6
million. The company would not have survived if it hadn’t been
attached to a hospital, Renk said.

In an effort to help contain the spiraling level of frustration
among their members, associations are using numerous tools to
provide guidance and information on the issues. NEMED plans
seminars on the new PMD coding and reimbursement at its March
meeting, and is planning education sessions on developing new
product lines.

IAMES’ annual conference in April will feature billing
workshops, updates on regulatory issues and even information on
selling a business. The latter reflects a membership reality, Renk
said. “In IAMES, companies are either giving up and getting out of
the business or we have also seen a whole bunch of mergers.”

MAMES will focus its March spring convention, “Thriving in the
New Reality,” on the new world of HME. “Our industry has always had
challenges, but we have overcome those challenges by being creative
and adjusting our strategic plans to address the challenges,” said
Schafhauser. “We will need to operate our business in the ‘New
Reality’ in order to be successful in the future.”