Business Solutions

The New ... Normal?

2020 has been the year everyone would rather forget, with COVID-19 presenting the industry with a murder hornets' nest of complication in particular. What do the next few months hold for the industry?

• By David Kopf
• Oct 01, 2020

Back in April, as everyone already realized the COVID-19 pandemic meant serious business, we were subjected to another terror: murder hornets. Sure, the infectious disease that was rampaging throughout the world was the primary threat, but murder hornets became the mascot for the year everyone was already wishing would go far, far away. The avian peril defined the tone of what we strained to call the “new normal.” (A ridiculous description given that nothing about 2020 has been normal.)

But the HME industry’s experience with COVID-19 has shown that at least for the time being, normal is going to be anything but normal. Providers have had to adopt all-new protocols and procedures; they’ve had to totally reorganize their businesses and workforces; they have had to develop all-new ways to coordinate and communicate with patients and referral sources. Moreover, the variety of funding and regulatory changes, as well as aid programs has been tough for providers to monitor. In short, it’s been the new abnormal since March.

And COVID-19 is going to color at least the next several months ahead. So, for our annual roundtable interview with members from HMEB’s Editorial Advisory Board, we looked at the public health emergency, as well as other factors that will impact providers. Let’s dive in:

WHITHER ROUND 2021?

Cara Bachenheimer, Lobbyist/Government Affairs for Brown & Fortunato, P.C.

At the time of this interview, we’re in the third week of September, and we have no information from CMS about whether or not the bidding program is actually going to start when it is scheduled to start on Jan. 1, 2021. There’s obviously, been a huge amount of lobbying to get CMS to push the pause button on the program, given the pandemic and given the significant role that oxygen is playing in taking care of COVID-19 patients. But this is a time when we would normally expect the CBIC to be issuing information about the single payment amounts, and in another month to two months, we’d know who the bidders are. But it’s been, literally, radio silence from CMS in terms of next steps. And in conjunction with that, we don’t have a proposed payment rule.

This rule was originally finished by CMS and was sent over to the Office of Management Budget (OMB)
in March, right before the pandemic. And we were expecting a proposal to come out early July. Then we’d
have a 60-day comment period. And then the government comes out around Nov. 1 with a final rule.

We still don’t have any kind of rule, and the interesting thing about that is whether that’s related to Round 2021 being paused beyond January 2021, or if there’s difference in the payment rates. Now, obviously, the CARES law payment rates — the higher rate that Congress legislated early this year at the end of March — are in effect for the duration of the public health emergency. So any payment rule that CMS puts out is essentially, overridden. The statute takes precedence over CMS, so CMS don’t necessarily have a say in the matter as long as the public health emergency is around. But we don’t know how long that’s going to last.

At this point, it’s really too late for CMS to put out a proposed rule with a 60-day comment period. If they even came out with it today, the 60-day comment period would be end of November. They could do a 30-day comment period, which they did for some of the rules that they were laid off, but that means end of October. And then they would have to turn around a final rule to make it effective Jan. 1. Or, they could do an interim final rule. So there are processes, but right now it’s a big question mark.

KEEP ADVOCATING FOR H.R. 2771

Tom Ryan, president and CEO of the American Association for Homecare

We continue to work with Congress and pressure CMS delay competitive bidding. As of late September, we reached out to CMS again, and they still have not made a decision regarding the payment rule or delaying Round 2021. Basically, we’ve been in a gap period right now for two years. The last rule that came out continued with the 50/50 blended rate, which was relief we had in previous legislation, and an interim final rule. Now with competitive bidding ready to start again in 2021, although we are advocating for them to delay it, there’s going to be some kind of rule that should be coming out that would tell us what the rural and non-bid rates would be.

We’ve got pressure in the House and the Senate to delay competitive bidding. We had a House initiative with 101 members signed off on, and we’re working with Senate leadership, not only to pressure CMS to delay it.

We’re working with the House and Senate to pressure OMB to release the rule. And once that rule comes out, depending on what is in it, then we have to continue to work with Congress to get relief for the non-competitive bidding areas.

Obviously, we have H.R.2771 out there, which gives relief in the non-CBAs, and we have to continue to advocate that. We have relief and a public health emergency now for both non-CB and rural areas, the 50/50 and the 75/25. We certainly believe the public health emergency is going to last through the end of the year. But if the rule does not come out, and it does not appropriately address rural relief. That’s something we will have to focus on through H.R. 2771.

Advancing H.R. 2771 continues to be a grassroots effort. The more co-sponsors that are garnered, the better. Now, with a new Congress that will lapse, and then you have work with the new Congress to drop the bill again. So when you’re looking out over the next several months, this bill still exists in Congress. We have to be prepared that, when that public health emergency relief ends, that there’s a legislative vehicle to get us some relief in the non-bid areas, and that exists in 2771.

SUPPORT INDUSTRY ADVOCACY EFFORTS AND ASSOCIATIONS

Steve Ackerman, CEO of Spectrum Medical Inc.

Advocacy on behalf of the HME industry is facing interesting times. Operating in the COVID19 pandemic and a long-awaited announcement about when and how competitive bidding moves forward are the prevailing issues on the minds of most suppliers.

The election and what can only be described as a mess in Congress has presented a number of challenges for the industry’s leading advocates at AAHomecare.

Finding moving legislation, to which we can attach industry-specific bills, is the no. one priority. There is hope that later in the year, the opportunity will present itself to move forward the four current bills affecting the industry. (They can be reviewed at aahomecare.org.) The legislative team at AAHomecare is in touch with lawmakers and regulators on a daily basis moving the needle for all of us.

If individual providers do nothing else, please take this opportunity to support AAHomecare efforts by joining. The industry is finally speaking with one voice and needs everyone benefiting to be on the team and involved.

EXPECT REGULATORY CHANGES

Jeff Baird, Esq., chairman of the Health Care Group at law firm Brown & Fortunato, P.C.

Because of COVID-19, the legal landscape for HME suppliers during the latter part of 2020 and moving forward is littered with uncertainty and possibility. There exist continued negotiations regarding additional government aid and relief programs to assist providers/suppliers during the pandemic. There is uncertainty surrounding how long existing waivers and regulatory relaxation may last. The inevitability of investigations and criminal charges for those defrauding the government and patients has already started. HME suppliers need to be aware of each of these issues and prepare for a 2021 that will likely be anything but normal.

We know that Congress is continuing to debate and politicize additional business relief programs, like an additional round of PPP funding. What seemed likely to occur a few months ago is a great unknown now as the U.S. has shifted to presidential election mode. While there are still efforts at additional programs, cooperation and compromise may be impossible during what will likely prove to be one of the most contentious election cycles ever seen. Consistent with this theme, HHS has further delayed the reporting requirements of the Provider Relief Fund, now pointing to an early 2021 reporting date. Unfortunately, at this point, it seems likely that additional programs will also be delayed in favor of election cycle political brinksmanship.

HHS, Congress and President Trump (via executive order) provided an unprecedented number of waivers and regulatory framework changes to allow new and existing health care providers/suppliers to continue to do business during the pandemic. One example of these changes includes the rapid expansion of telehealth, including the types of providers who may provide telehealth services, the types of telehealth services that may be billed, the technology that may be used during a telehealth visit and the locations where both patients and providers may be located during a visit.

It is not yet clear how many of these changes may be rolled back or when such a rollback may occur, but all providers/suppliers should be on the lookout. Other important waivers that are already seeing regulatory drawbacks include procedures for new provider enrollment as well as requirements for surveys and audits. If the pandemic subsides, we can expect increasing surveys and audits moving forward.

CONSIDER CURBSIDE SERVICE

Rob Baumhover, Director of Retail Programs for VGM Group Inc.

One sales trend that the majority of providers have seen increase tenfold over the last six to eight months is phone orders requesting and expecting curbside pickup and home deliveries, as well as their e-commerce business.

I believe providers need to analyze how they sold to their customers six to eight months ago vs. the way they do today and spend some resources on making their current way better, as I feel it’s going to be the norm for quite some time and well into the future.

We need to make it as easy as possible for customers to purchase from us, so update and add to your e-commerce site, train sales staff to treat phone transactions like in-person transactions by qualifying the customer to add on sales for the customer. If our customers can’t get to us, then let’s make it easy to get to them.

REENGAGE REFERRAL PARTNERS

Ty Bello, president and founder of Team@Work

Providers need to be focused on gaining access to the referral community and getting their sales team back in the game. There will be pockets of referral sources that will continue to refer sight unseen, but there are others who could be approached and engaged by the competition and might transition their referrals elsewhere.

This means the HME provider needs to proactively and effectively develop a strategic sales plan that gets their team in front of the referral community. Access referrals with a message of service, compliance, ease of referral, and convenience will differentiate a providers business from the competition.

Providers should also increase the number of sales calls required today, because access is still limited. Sales Professional may need to make 20 plus attempts to get 15 calls. Also, providers need an in-service plan and strategy for both virtual and face-to-face in-services.

COVID-19 WILL CONTINUE IMPACTING RESPIRATORY

Joseph Lewarski, MHA, RRT, FAARC Senior Vice President and General Manager, Global Business, of Clinical Care & North American Manufacturing for Drive DeVilbiss Healthcare

It is hard to discuss any prevailing trend in 2020 without starting with COVID-19 and its impact on the healthcare systems. For homecare providers, it’s clear the pulmonary complications associated with COVID-19 infections have created an unprecedented, global demand for stationary oxygen concentrators.

While the data and science are still evolving, there is an obvious, direct correlation between spikes in COVID-related hospitalizations and demand for home oxygen therapy. This pattern is similar but appears significantly more pronounced than a typical respiratory season (influenza, RSV) but complicated to forecast because COVID-19 doesn’t appear to follow any seasonal pattern. As we head into Fall and Winter, COVID-19 will be joined with influenza to create a potential for causing an increase in severe pulmonary infections, especially for high-risk individuals with chronic medical conditions.

While no one has a crystal ball, and this year has been difficult to predict, it seems likely we’ll see another spike in COVID-19 related hospitalizations this Fall and Winter that will be compounded by influenza, which will continue to stimulate demand for oxygen therapy and other respiratory services and equipment. This should drive planning for staffing, PPE and oxygen therapy devices and supplies.

LEVERAGE TECHNOLOGY IN NEW WORKFLOWS

Rob Boeye, executive vice president of HME for Brightree LLC

Our bi-monthly intra-company Coffee Talk webinars with providers have shown how we could help them implement new workflows and protocols early into the COVID-19 situation, such as contactless delivery.

We initially made some changes to our mobile delivery management platform, including updating delivery tickets with the infectious disease indicators ensuring the delivery agents wore the appropriate personal protective equipment.

We still had providers either dropping off at the curb or dropping off on the patient’s doorstep. So, we added the capability within the mobile delivery application for pictures at delivery to show a delivery was made in lieu of a signature.

Looking at remote set-up, I think it’s still in the infancy stages. People are saying, ‘Okay, I have a complex system here. How do I do the training: via videos or online?’ Then they have to figure out the logistics of setting up that training and getting patients on board. Certainly, companies are looking into that, but that’s not a direct Brightree application. Those applications would come more from the manufacturers … but I know providers are pushing for it.

In working with referrals, I think right now the HME industry is showing our referral sources and payers what can be done with remote monitoring, scheduling, training and repair work. We as an industry are cutting down the operational costs right now and really putting a focus on virtual care and virtual repair.

Plus, apps such as Patient Hub that help patients interact with HME providers and take charge of their homecare and equipment, as well as get training on their equipment, also help providers demonstrate their value to referrals.

COVID-19 MEANS ACCREDITATION ADJUSTMENTS

Sandra Canally, RN, the founder and CEO of The Compliance Team

The most important thing impacting accreditation is COVID-19 and the public health emergency has altered day-to-day operational practices. That’s directly related to accreditation, because we’re looking at not only what’s in HME providers’ manual with their policies and procedures, but whether they’re actively performing those processes, according to the written policies and procedures. And certainly what we found over this period is providers have had to alter not necessarily what they’re doing, but how they’re doing it.

If providers are coming up for renewal, The Compliance Team has a real-time, remote virtual program that we’re utilizing for the survey process as long as the public health emergency exists. Once the PHE is dropped, we still have to go out and perform an on-site within a certain time period for these same providers. But that said, right now, they’re submitting their policies and what plans they put in place, which we’re then reviewing. And then, using technology, we’re actually doing a survey looking at their warehouse, talking to staff, etc.

Also, we already have an accreditation backup due to the PHE, but now we’re going into a heavy, three-year renewal cycle year that is typically double the amount of on-sites that we have in the off years. Also, CMS has given us a timetable that says it needs to be either done six months from the date of the virtual, or within a calendar year, or six months from when the public health emergency is lifted, or within a calendar year of the virtual site survey.

So you can see accrediting organizations have all these people that we’ve had to extend. That’s not even counting the new people that have come into play that got their numbers without accreditation.

MAXIMIZE THE STRATEGIC VALUE OF SLEEP DATA TO

Gary Sheehan, MBA, President and CEO of Cape Medical Supply

Sleep providers of all shapes and sizes should be seeking ways to manage and model their data into actionable insights. We are drowning in information and data points, but too few providers are taking the time to translate that data into process improvements or using it as a tool for enhanced and targeted patient communications.

The information we have within our systems offers sleep therapy providers the power to better manage cost, compliance and patient experience, but it takes a concerted effort to use it effectively to map how your organization is performing on a macro level and how individual patients are performing on a micro level.

Data management is the key to building a differentiated sleep therapy practice and remains the difference between building real solutions and simply selling PAP devices and accessories.

This article originally appeared in the Sep/Oct 2020 issue of HME Business.