Apria lands 'multi-state' contract

Thursday, July 21, 2011

LOUISVILLE, Ky. – Is Apria Healthcare’s “provider of choice” contract with Humana nationwide? Is it exclusive? What’s the reimbursement rate?

Rumors about the terms of the contract have been swirling ever since Humana announced on its website that it has established a “long-term relationship” with Apria and that it’s terminating relationships with “several providers.”

Lisa Getson, executive vice president of government relations and corporate compliance for Apria, told HME News the contract is “multi-state.”

“But it carves out certain areas where Humana operates different health plan models or contracts for these services differently,” she said.

Getson said the contract is not exclusive: “Members may still use an out-of-network provider, albeit at a higher cost,” she said.

As for reimbursement, Getson said “it would be inappropriate to share proprietary pricing information.” But she pointed out that comparing managed care and Medicare reimbursement rates is not an apples-to-apples comparison. For example, most managed care payers, including Humana, don’t cap reimbursement for home oxygen at 36 months.

“Suffice to say that we carefully considered all aspects of the contract and believe that we will be able to continue to offer Humana members high quality homecare services, as well as other value-added services, such as condition-specific programs, consolidated patient outcome data, electronic connectivity and administrative simplification,” she said.

All of this is of little comfort to the providers that have started receiving letters from Humana, asking them to turn over their patient rosters, so those patients can be transferred to Apria. The Kentucky Medical Equipment Suppliers Association (KMESA) has filed a complaint with the state commissioner’s office, arguing that the contract goes against the state’s any-willing provider provision.

“It’s being called a preferred provider contract, but it’s being enforced as an exclusive contract,” said Teresa Camfield, executive director of the association.

Providers also worry about the future. Will another large payer follow in Humana’s footsteps?

“This industry is made of hometown providers and this is a direct assault on them,” said Wayne Stanfield, executive director of NAIMES. “This is the biggest deal I’ve seen in HME, where patients are taken from one supplier and given to another.”

Getson pointed out that winning and losing contracts is part of doing business—for small and large providers alike.

“Our own Apria disclosers cite certain contract losses in the past year—contracts which were awarded to numerous small and independent providers across the country,” she said.