Retail as a lifeline: Apple Homecare’s answer to Medicare pressures 

STERLING, Mass. – The Centers for Medicare & Medicaid Services (CMS) has announced the return of its competitive bidding program for durable medical equipment (DME), a move that has stirred mixed emotions among providers like Joni Milluzzo, owner and CEO of Apple Homecare and Rehab Medical Equipment. 

Milluzzo, a respiratory therapist, vividly remembers the program’s initial launch in 2013 and the toll it took on her business, which at the time focused heavily on home oxygen, continuous positive airway pressure (CPAP) and ventilator therapy. Insurance contracts were the backbone of Apple Homecare’s revenue. 

But today, Milluzzo feels a sense of relief. Apple Homecare has transitioned to a retail-focused model, specializing in mobility equipment and relying primarily on cash sales. The company only bills insurance for complex rehab technology (CRT), which remains exempt from the competitive bidding program. Apple Homecare currently employs one assistive technology professional (ATP). 

“Medicare used to be our biggest payer 10 years ago, but ever since competitive bidding, we’ve chipped away at it,” said Milluzzo. “It has been a huge transition.” 

While Milluzzo is grateful for the changes that have helped her business survive, she remains concerned for other DME providers still dependent on insurance contracts. Many of her competitors in the region have closed their doors since the program began. 

“I used to have a lot of friends around me,” she said. “We were competitors, but we were friends. We worked together. We’re the only ones standing and I think retail has been key to that. It’s been our saving grace.” 

Retail, she says, is a completely different business model. Over the years, Milluzzo and her team – now nine employees, down from a peak of 26 – have learned how to navigate it through trial and error. 

“When I first said I wanted to do retail, people thought I was crazy,” she said. “But we’ve found that service is the biggest thing. If we can service these people – answer their questions – they really appreciate that and reward you with their business. People will say, ‘Even if you can’t help us this time, we always leave knowing more than we did when we came in.’” 

This year marks Apple Homecare’s 35th anniversary. Though the company looks very different today than it did in 1990, Milluzzo is proud of its evolution and resilience. 

“I found an article that HME News did several years ago about me being a woman owner,” she said. “Looking at the picture – I couldn’t believe it was me. It remains a battle to be in this industry, but after 35 years, we’re still here.”