YARMOUTH, Maine - Industry stakeholders are trying to gauge whether patient access to HME and services has been affected by recent policy changes and reimbursement cuts. What they've found so far: It doesn't look pretty in some areas of the country, not for the Medicare beneficiaries and not for the providers left standing.

The National Association of Independent Medical Equipment Suppliers (NAIMES) reported last week that in Montana, for example, CMS officials have admitted Medicare beneficiaries are experiencing problems accessing HME, particularly oxygen, enteral and parenteral nutrition, and power wheelchairs, in eight counties.

"When you only have one provider in a whole county, like Musselshell, and that provider doesn't get accredited, that's what happens," said Bob Sherman, past president of the Big Sky Association of Medical Equipment Suppliers and a respiratory therapist at My Family Pharmacy in Stevensville, Mont. "It's not that they're against accreditation. They just can't have that added expense when it's cut after cut."

If they wanted to continue serving Medicare beneficiaries, HME providers had to become accredited by Sept. 30 and obtain a surety bond by Oct. 1. Industry stakeholders don't have much hard data yet, but they suspect the requirements have significantly reduced the number of Medicare providers in some areas, impacting patient access.

Since learning of the issues in Montana, NAIMES has asked providers and associations to share what they know about patient access issues in their own states.

"What's happening in Montana has to be happening in at least 15 other states--parts of Kansas, Nebraska, North and South Dakota, Wyoming, Nevada," said Wayne Stanfield, NAIMES's president. "It's critical that we find this out."

Providers like Rob Brant have been mining the provider directory at www.medicare.gov to determine whether the number of Medicare providers has dropped, impacting patient access. Brant believes the number of Medicare providers supplying oxygen in Miami-Dade County, where his company is based, has dropped about 50%, from 401 in March 2008 to 205 today. Brant blames not only the accreditation and surety bond requirements but also the 36-month cap and the 9.5% reimbursement.

"It's everything in general," said Brant, executive director of the Accredited Medical Equipment Providers Association (AMEPA) and president of City Medical Services in North Miami Beach, Fla. "Some providers have been trying to hold out as long as possible, thinking, 'Let's just see if I can survive this or that.' They're just beginning to realize they can't."

Scott Lloyd, president of ExtraKare in Norcross, Ga., believes the number of Medicare providers supplying oxygen and CPAPs has remained steady in his area at 123 and 58, respectively.

"(Patient access) seems to be a non-issue for us at this point, but I wouldn't be surprised if, in more rural areas, it is an issue," he said. "That wouldn't surprise me at all."

In the areas where the number of Medicare providers has dropped and patient access has been impacted, the providers that are left standing, like John Eberhart, are also struggling. In the past few months, Eberhart has picked up patients from several providers that are closing their doors, including a provider that has been in business for 40 years.

"It sounds like it would be a great situation for us, but honestly, we've been getting more patients than we can handle and maintain any level of service," said Eberhart, president of Eberhart Home Health in San Clemente, Calif. "I spend more time apologizing on the phone now than I ever have before to patients who are pissed off and understandably so."