Despite a host of impending challenges — not the least among them a 9.5 percent across-the-board cut on round one bid items and the 36-month cap on home oxygen rental, both set to take effect Jan. 1 — home medical equipment providers participating in HomeCare's Salary & Benefits Survey say they are prepared for the future, or at least getting there.

That's not to say they are happy about the industry's circumstances. Far from it. And keep in mind the survey closed before Wall's Street's recent meltdown, so had they been anticipated, the prospects of tightening credit and other financial fallout might have influenced some respondents' answers differently. That's also not to say these providers haven't taken some hits in readying their companies for what is to come: Almost one in four (23 percent) laid off employees in the past 12 months at an average 11 percent of staff.

credit and other financial fallout might have influenced some respondents' answers differently. That's also not to say these providers haven't taken some hits in readying their companies for what is to come: Almost one in four (23 percent) laid off employees in the past 12 months at an average 11 percent of staff.

But of 289 HME providers ranging from small mom-and-pops to national companies, 68 percent added staff in the past year, and more than a third (36 percent) created new job functions, albeit mostly to deal with accreditation/compliance. Moving ahead, the majority indicate staffing will remain at current levels in 2009, although many respondents say they do expect increases in outside sales (40 percent); customer service reps and showroom help (29 percent); delivery personnel (29 percent); billing/collections employees (27 percent); and service/repair staff (17 percent).

It's clear, however, the industry's tumultuous conditions have taken a toll in some areas, salaries notable among them. With only a few exceptions, employees' pay has fallen when compared to the results of HomeCare's last survey in 2006. Salaries for billing employees, who averaged $30,465 in 2006, fell to $29,115 this year. CSRs who made $30,325 two years ago now take home $29,463. And outside sales reps, whose average salary in 2006 was $51,570, now average $49,606.

The difference in salaries for HME company management is more extreme. Salaries for titles at the CEO and president levels plummeted a whopping 38 percent for participating providers, from an average $134,621 in 2006 to $82,253 this year. Sales managers suffered another harsh blow, with average pay at $65,150 in 2008 compared to $80,841 in 2006, a drop of 19 percent.

On a more upbeat note about salaries, average pay for accounts receivable managers rose 7 percent, from $41, 260 in 2006 to $44,179 this year, possibly recognizing the value of employees' knowledge in this specialized and critical position. Similarly, pay for warehouse/operations managers, who have been pressed to drive out costs and come up with changes to help keep their companies profitable, rose 7 percent from an average $45,690 in 2006 to $48,773 this year.

Employees paid hourly also fared better, with most positions seeing an increase over wages in 2006. But other measures fell.

In 2006, the average raise given to HME employees was 5.6 percent, but that average dropped to 5 percent this year. (Even so, that beats the 3.8 percent raise for most U.S. workers projected by human resource consulting firms Hewitt and Mercer.) In 2006, 66 percent of the providers the magazine surveyed paid bonuses to all staff, but this year, only 41 percent say they do so. Explains one provider, “Times are too bad currently for raises and bonuses.”

These figures and others throughout the survey reflect the pervasive industry uncertainty about reimbursements and competitive bidding that has hobbled plans over the past two years, but there are strong drivers shaping the health care market at large that continue to buoy providers' outlook.

For one thing, according to the latest figures from the Bureau of Labor Statistics, wage and salary employment in the health care industry overall is projected to increase 22 percent through 2016, compared with 11 percent for all industries combined.

Projected rates of employment growth for the various segments of health care range from 13 percent in hospitals, the largest and slowest-growing segment, to 55 percent in the home health care arena. For example, over the 2006-16 period, BLS says, total employment of home health aides is projected to increase by 49 percent, reflecting a shift from in-patient care to less expensive care at home. And there's the fact that the growing population of elderly simply need more continuing health care and they want it at home.

Theoretically, these trends mean a big bump in coming business for HME companies. Drilling down, however, growth could be tempered by restructuring to reduce administrative costs and streamline operations in preparation for the very big “ifs” that remain: While competitive bidding has been delayed, the industry still must come up with a workable alternative to prevent the loss of thousands of existing companies. It must also weather another congressional stab at health care/Medicare reform that is shaping up for 2009.