Payer relations: Have a game plan

Q. What can we do about a payment system that's failing DME suppliers?

A. Intermediaries and third-party administrators (TPAs) have become significant players in how durable medical equipment reaches patients. For DME businesses serving everyday communities, the burden is becoming difficult to sustain.

As the prevalence of TPAs supporting Medicaid Managed Care and Medicare Advantage payers trends upward, our industry needs a game plan to respond to an evolving model that, without proper checks, creates real hardship for suppliers and the patients who depend on them. Local relationships. Community accountability. Personalized patient care. These aren't abstract values — they are what core DME businesses have always delivered.

For DME suppliers: Steps you can take today

• Engage directly with the payers. Provide detailed information as to your concerns. Data helps tell your story in a meaningful way. Use readily available data to provide detailed information on your service metrics and key performance indicators (KPIs). Highlight the value you bring to the payer and ask to keep a direct contract.
• Engage your referral sources directly to share your concerns.
• Diversify payer mix strategically. Pursue payer contracts with more favorable terms, grow cash-pay and direct-to-employer relationships, and explore value-based arrangements that reward outcomes over volume.
• State associations and AAHomecare are here to support you in these battles. Suppliers who aren't actively participating in advocacy, showing up at state budget hearings, sharing patient impact stories with legislators are ceding the field.

For patients: Your voice carries real weight

• If your equipment has been delayed or your preferred supplier was bypassed, ask your insurer specifically why.
• File a formal grievance with your health plan, every complaint creates a record.
• Reach out to your state or federal legislators. Patient stories move policy in ways that industry data alone cannot.

The DME industry and the patients it serves are stronger together. All suppliers bring irreplaceable community value. With the right tools, advocacy and awareness, that value can be protected.

Cadie McGonagill is senior director of payer relations for AAHomecare.