Observation Deck

Post-acute Care Matters

HME providers’ role in the transformation of healthcare.

• By Dave Cormack
• Feb 01, 2014

The transformation of the healthcare industry from a volume-based model to a value-based model provides a significant opportunity for post-acute care providers to play a critical role in the overall healthcare continuum. As the industry continues to shift to more care being provided outside of the hospital or doctor’s office and into the home, home medical equipment (HME) providers are particularly well-positioned to add value by delivering cost-effective care, medication and supplies that result in better patient outcomes at a lower cost. In a collaborative environment, this is the key to financial sustainability.

In 2014, HME providers must look carefully at their organizations to identify their own processes and results to ensure that they match the goals of the collaborative care networks, such as Accountable Care Organizations (ACO) and Managed Care Organizations (MCO) that are forming in their community.

For example, hospital readmission is a significant concern for collaborative care organizations due to financial penalties the Centers for Medicare and Medicaid Services (CMS) has established for re-hospitalization of a patient within 30 days of discharge. One of the most prevalent reasons for readmission is patient non-compliance with therapy. HME providers can help address this issue by ensuring the delivery of the right supplies at the right time with proper education on the use of equipment. Two patient groups that exemplify how HME providers can add value to collaborative care organizations:

1. Chronic obstructive pulmonary disease (COPD). Currently, more than 20 percent of COPD patients are readmitted to the hospital within 30 days of discharge. HME providers minimize the risk of COPD readmission by providing oxygen equipment that fits patients’ lifestyles, which improves the likelihood of compliance with treatment..

2. Obstructive sleep apnea (OSA). Research shows that untreated sleep apnea results in increased risk of other chronic conditions, including diabetes. In fact, studies show that almost 50 percent of Type 2 diabetic patients have a sleep disorder. Continuous positive airway pressure (CPAP) therapy reduces glucose levels and improves morning glycemic control. However, therapy guidelines are often not followed due to uncomfortable or improperly fitted masks, or inadequate equipment education. HME providers improve compliance by ensuring the patient is using the equipment regularly and accurately. And because reimbursement is tied to the patient’s use of the equipment, continuous monitoring of the patient’s utilization is a “best practice” for many leading HME providers. Equipping physicians with detailed analysis on patient compliance not only reduces the risk of readmission or additional diseases, but helps the physician better care for the patient, which results in a stronger referral relationship with the HME.

That said, HME providers must overcome challenges in order to demonstrate how they can help care organizations meet financial and outcome goals.

Enabling Interoperability Across Care Settings

Collaborative care organizations have invested more in technology and datasharing solutions than post-acute care organizations, such as HME, home health and hospice providers. In fact, some analysts claim that for every $1 acute care providers invest in technology, post-acute invests 25 cents. As more hospitals and physicians adopt electronic health record (EHR) systems that eliminate paper and enable the sharing of health data electronically across care settings, these referral sources are now expecting HME providers to dynamically and electronically communicate between systems for such items as receiving referrals and updating patient status. HME providers lacking information technology personnel, infrastructure and systems required to enable this interoperability face a significant challenge. HME providers must have systems that let them connect with disparate systems used by referral sources and collaborative care organizations to remain viable contributors to the community.

These financial, staffing and technology challenges can easily be addressed by selecting a web-based, Software-as-a-Service (SaaS) solution that provides the interoperability necessary to communicate with disparate systems. HMEs should look for software systems that enable interfaces with third-party solutions and data warehouses that are essential to collaborative care. An advanced level of interoperability will make the HME provider an attractive business partner to collaborative care organizations.

HME providers also must demonstrate sustainable business practices that focus on cost-effective, quality patient care that match the collaborative care organization’s business goals. Documentation of proactive, strategic business strategies that enhance reimbursement and patient care demonstrates the HME provider’s ability to easily transition into the new care environment.

Taking steps now to streamline business operations and create efficient, cost-effective processes not only allows providers to meet day-to-day financial, regulatory and operational needs, but also forms a foundation for conversations with collaborative care organizations. Use of technology to support activities such as automated claims filings, inventory management, patient contact alerts and delivery management enhance provider operations by maximizing use of staff and resources. Also, routinely using dashboards to review data and analytics to identify opportunities for improvement proves an HME provider’s commitment to sound business practices required by these organizations.

Initiate Collaborative Care Conversations

As HME providers collaborate with referral sources, they should ask what changes are being made to enhance their collaborative care position; learn their plans for exchanging patient and provider data; and find out if they are creating a network with which providers can join.

Providers must be prepared to demonstrate additive value by referencing existing systems and processes in place that improve patient compliance. For example, in addition to providing outcome information on current or past sleep apnea patients, ask instead for sleep apnea referrals so the referral source can see first-hand how a disciplined approach and advanced technology can improve compliance.

Post-acute care can play a significant role in the transformation of the healthcare industry, but it is up to HME providers to demonstrate the valuable role they play in solving our nation’s healthcare crisis. By taking steps now to position your organization as the most efficient, highest-performing provider in your region and continuing to implement business and technology strategies that drive down costs while improving patient outcomes, providers can set themselves up to thrive in this brave new world of collaborative care.

This article originally appeared in the February 2014 issue of HME Business.