Despite the homecare industry facing inadequate reimbursement rates, supply and staffing hurdles and, most recently, obstacles from a nationwide cyberattack, it still has a bright future.
That was the consensus of experts at the Medtrade Expo and Conference, the largest durable medical equipment (DME) tradeshow and conference in the United States, which was held March 28-30 in Dallas. The show drew a record crowd of attendees to informational sessions about industry trends and demos of new and growing products.
“We’ve got a lot of tailwinds that will be exciting for us from a demographic standpoint. It’s a great time to be in the industry,” said Tom Ryan, president and CEO of the American Association for Homecare (AAHomecare) said during the organization’s annual update at the show. “Running a homecare company is certainly not for the faint of heart.”
Some of the most pressing challenges include:
The Change Healthcare cyberattack, which resulted in about 40% of health care claims stopping overnight. “We probably all have risk mitigation tools in place, we’ve got business continuity plans, we’ve got redundancies built, but I don’t think any of us saw this coming,” said Josh Marx, CEO of Medial Service Company and AAHomecare’s board chair. Panel members said that it required businesses to manage a large outflow of cash without revenue coming in, and also brought the importance of good technology and other partnerships into focus.
Philips Respironics’ announcement that it will largely vacate the respiratory and PAP sector. In the long term, it could be great for the industry as the exit opens up space for new providers, panelists said, but in the short term, there’s much to be done in terms of educating patients—and diversifying risk. “I think Philips exiting is definitely going to be a gaping hole with regards to the space,” said John Cassar, CEO of SuperCare Health and a member of the AAHomecare board.
Ongoing DME fraud and federal efforts to block it. Panelists expressed dismay at the news of a busted catheter fraud scheme worth as much as $2 billion—especially given the fact that half that amount could enshrine 75/25% reimbursement relief for providers. Meanwhile, the Senate introduced S 3630, the Medicare Transaction Fraud Protection Act, which would set up a pilot program to use a risk assessment algorithm to prevent DME and diagnostic fraud.
There were wins on the books that experts and attendees at the show celebrated, including:
New power seat elevation coverage as an accessory to power wheelchairs in Medicare, which went into effect last year. The Centers for Medicare & Medicaid Services is expected to issue relevant coding and payment decisions this spring.
The enaction of the Lymphedema Act, which establishes new Medicare coverage for compression treatment items. A session for providers on offering compression items generated a great deal of interest. “Patients who suffer from lymphedema need every one of you to be a supplier,” Noel Neil, vice president of auditing and corporate compliance at ACU-Serve, told a packed session. “There’s an immediate need and there’s just not enough supply out there.”
The growth of value-based care offers new opportunities for providers—as long as they can document the outcomes and savings they can help payers achieve. One area for expansion in the future may include home modifications in accountable or value-based care.
New guidelines for physicians allow for broader standard written orders for CPAP supplies to give users greater flexibility on masks and more. This kicked in Feb. 1 and the Medicare Administrative Contractors are expected to provide more guidance soon.
There are also things on the horizon to keep an eye on, experts said at various educational sessions. Some include:
The Office of Inspector General plans to review payments for continuous glucose monitoring (CGM), which may affect future rates or trigger competitive bidding for CGM. A report is expected
in 2025.COVID-era telehealth waivers run through the end of 2024 but have not yet been made permanent. That may not happen until sometime in 2025.
A new final rule for Medicare refills (excluding CGMs and CGM supplies) went into effect at the beginning of 2024. It allows suppliers to confirm the need for a refill within 30 days of the end of the current supply—but states that delivery can’t be before 10 calendar days from the expected end of the current
supply.Competitive bidding, which has been on hold for some time, may be re-launched with a final rule this year, with bids occurring in 2025. For now, rates are still tied to 2015 bid-based payment rates with inflation adjustments that aren't keeping pace with prices.
