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."