Poll: Providers exit Medicare; others 'like the challenge'

Sunday, September 20, 2009

YARMOUTH, Maine - Twenty-seven percent of the 316 respondents to the most recent HME NewsPoll said they'll stop doing business with Medicare this year. The reason: They're either sick and tired of the program's flurry of regulatory and reimbursement challenges or they don't have the financial wherewithal to weather those changes or both.

"I have decided that I can no longer serve the community that I have for over 30 years because every year there is a new rule coming down that affects my ability to earn a living," wrote Anita Ferris of Ortho-Medics in Philadelphia. "It has become obvious that the community of DME providers is not going to have a place in the future Medicare program."

For providers like Ferris, who plan to dump Medicare, 30% blame the accreditation and surety bond requirement, and 46% declining reimbursement. Twenty-four percent answered "other."

"We withdrew from Medicare this year because we wanted to stay in business," said Marie Drake, owner of Chattanooga Mobility in Chattanooga, Tenn. "Five DMES in our metropolitan area have gone out of business in the last year and all but one was because they tried to continue accepting Medicare despite declining reimbursement, mounds of ridiculous paperwork and documentation requirements and insistence by Medicare that the provider educate doctors on all the never-ending changes and requirements."

Of the providers who intend to continue doing business with Medicare, many say they have no choice: Medicare accounts for too big a slice of their business. Instead, these providers have begun to expand their cash sales, diversify their payer mix away from Medicare, limit product options for beneficiaries and sell more products unassigned.

"We are in a market that is saturated with seniors, and our referral sources would be very disappointed if we exited," wrote one provider. "We also make many more decisions with the ABN (advanced beneficiary notice). That is what they were designed for. It is a very good way of telling seniors that Medicare reimbursements are not adequate."

Many providers say they continue to do business with Medicare out of a sense of responsibility to their customers.

"We cannot turn our backs on people in need," said another provider.

Finally, a number of providers take Medicare's regulatory and reimbursement hits as a challenge. These providers don't plan to give in, no matter what Medicare throws at them.

"I like the challenge," wrote Carolina Ferreiro-Diaz of Pharmacy-Express in Miami.