Moving the HME Industry Forward

Legislative/Advocacy

AAHomecare Continues to Collect Reactions from Around the Country

August 22, 2016

WASHINGTON, DC – AAHomecare received more stories from HME providers in rural and non-bid areas about the challenges they face in light of the latest round of cuts.  

Contacts on Capitol Hill have told association officials that demonstrating the effects of the latest round of cuts on rural and non-bid area providers is critical to generating support for legislative action. Here are excerpts from the most recent comments.

• Georgia – We have adopted multiple changes in the way we do business due to the recent reimbursement cuts. We have stopped providing CPAP and oxygen for Medicare patients. We are looking at products like walkers, rollators, standard wheelchairs, and beds as items we don’t take on Medicare assignment. We know that these policies will hurt patients and keep them from getting needed equipment, but we are tired of getting lower-than-cost reimbursement…This is a very sad situation, as we have built our business on superior customer service, but now more and more we have to tell our customers we can’t help them. Our survival as a business depends on reducing our Medicare exposure… I expect things to get a lot worse for patients until Medicare finally sees the light.

• West Virginia – We have about 630 home oxygen patients in our area. We have a number of patients on tank oxygen and we are having to be creative as to how tanks are provided.  As we are doing that we are giving them information to contact their Representatives and Senators and also telling them to contact Medicare and Medicaid as they were the ones saying that these new prices would cause no problem…We are no longer taking assignment for walking aids such as rollators, and walkers/wheeled walkers.

• Wisconsin – We laid off twelve people; six of them were respiratory therapists. Some of the things we have changed as a company include: a) No more one-on-one CPAP setups; b) Tanks are provided on a standard delivery schedule or can be picked up; and c) Some items, such as wound care we will not carry anymore, because it is too time consuming for the reimbursement…The government expects us to operate as a professional healthcare provider, i.e., HIPPA, Accreditation, Medicare guidelines, and more, while paying us with pawnshop reimbursement. We have made serious cuts in our operating cost to see if we can make this work. We will find out if we can stay in business in a month or so.

• Kansas – Being in a rural area, the distance to travel is just not feasible with the new pricing. We have cut our home visits in half and we are considering closing our second location which will force us to check equipment even less and drastically reduce what we deliver.

Contact Tilly Gambill at tillyg@aahomecare.org to share your story, or with any questions.

AAHomecare Opens Dialogue with Anthem and AIM Sleep Management Program
WASHINGTON, DC – Laura Williard, AAHomecare’s senior director of payer relations met with representatives of Anthem Blue Cross/Blue Shield and the AIM Sleep Management program to establish a relationship and open a dialogue to represent HME provider interests.

Anthem shared that medical guidelines for the company are established and are consistent across the 14 states they serve, while authorization guidelines are developed at the state level. While Anthem is not able to engage in discussions on specific contract pricing, they expressed interest in value based purchasing models that AAHomecare is working on with respiratory stakeholders. They also agreed to follow up on specific provider concerns that Williard shared with them and to ongoing meetings for future collaboration.  

Williard also met with representatives of the AIM Sleep Management program to share input from AAHomecare’s Sleep Management subgroup.  AIM Specialty Health (AIM) is a benefits management company owned by Anthem that specializes in the management of radiology, cardiology, oncology, sleep management, and specialty drugs.  

One of the main issues addressed with AIM is their requirement that providers supply proof of compliance within 90 days of receiving ongoing supplies.  As a result, patients are having to wait to get supplies until compliance data can be obtained, and the additional cost and burden of getting that data falls to the supplier.  AAHomecare suggested changes to the policy that would eliminate this policy.  However, AIM believes this is an integral part of their sleep management program.  

AAHomecare discussed potentially looking at the timeframes for this to eliminate some duplication of efforts.  AAHomecare also submitted other recommended changes to the sleep management policy. AIM agreed to evaluate these recommendations and to follow up with AAHomecare on these recommendations. They also shared a link to a resource where suppliers can find more information that also includes their sleep clinical guidelines and frequently asked questions.

Thanks to Missy Cross, Christopher Salmen, Beth Guevara, Mark Vages, Jim Duncan, Diana Guth, Peggy Powers, and Kathy Murzyn for their work on AAHomecare’s Sleep Management subgroup that developed our recommendations and input for the meeting.  Contact Laura Williard at lauraw@aahomecare.org for more information.