HMEs mull service sacrifices

YARMOUTH, Maine - Free home delivery, equipment checks, top quality service - HME providers traditionally have offered these benefits to the full gamut of their patient roster, yet changes being enacted by the nation's payors may force providers to consider the financial downfalls of this system. Responses to last month's HME News Poll indicate overwhelmingly that a high, all-around standard of care is still the norm, yet some providers said they were feeling the pressure to make service sacrifices for the sake of their bottom line. “At one time I envisioned myself as a healthcare provider whereby the ‘quality of mercy is not strained,'” said Kevin Fly Hill, president of CPS Medical in Tyler, Texas. “More recently, with draconian price cuts, I see that I am a business owner providing a service/product and in the ‘real world' when you play less you get less.” Selective patient servicing has been brought forward as an option to the reimbursement crunch. For example, HME advisers have suggested charging for delivery, using third-party couriers or creating a service matrix that offers free delivery for some patients while requiring others to pick up their products. For many providers already running lean, such a service matrix is showing itself as a last chance to keep their heads above water. Kent Craven, president of ApneCare Sleep Lab in Bakersfield, California, said changing service levels is becoming an imminent possibility for his company. “We would have to reconsider providing sleep services to Medicare patients if reimbursement was cut,” he said. “At best we would have to push for some type of less costly modified sleep study, such as an unattended sleep screening test.” “Given the amount of cuts I will have to cut the quality of my product which in turn cuts the quality of service each patient receives,” said Paul Judia of AAA Family Medical Supply in Galveston, Texas. Tailoring service levels to patients depending on their insurance coverage, however, places the provider on the edge of a slippery ethical slope. “It is very difficult to implement different levels of service in home care without running into ethical as well as logistical pitfalls,” said Gregory LoPresti, chief operating officer of Upstate HomeCare in Clinton, N.Y. “Any reduction in beneficiary service levels would be applied across our patient base as a result of policy changes.” Given the difficulties and concerns, poll respondents said they would choose cutting whole programs for Medicare patients over revising service levels, which could wreak havoc on access. “If we provide a service to a patient, we are going to do everything in our power and within good reason to provide the highest levels of service that we possibly can,” said Morgan Porter, general manager of Tyler-Texas-based Good's Pharmacy and HME. “If Medicare decreases their reimbursement to a point where we cannot make a profit, then we will stop offering that product or service to Medicare beneficiaries.”