Editor's Note

A Shifting Landscape?

Distant market forces could move the earth under providers' feet. How should they react?

• By David Kopf
• Mar 01, 2019

I will never forget when I felt my first earthquake. My parents and I had moved from Northern Ohio to California when I was 11-years-old, and while I had gone through punishing blizzards, pretty wild thunderstorms, and even a small tornado that passed near my neighborhood on the same day that Elvis Presley died (no kidding), I had never felt anything like an earthquake.

And like most people who move to the Golden State, I had this perverse urge to experience one. Honestly, who actually wants to undergo such an event? Still, you’ll hear recent California transplants say things like “I still haven’t felt an earthquake, yet” all the time. I get it: there’s a morbid curiosity. You want to know even though it’s bad.

Most earthquakes are so mild that you never feel them, or at the most, they feel like a truck rumbling past your house. It’s not until you get to the larger ones where you actually feel it.

The sensation varies. Sometimes you feel a rolling sensation that’s akin to waves. However, most of the time, the closest sensation to which I can approximate it would be the sudden, shuddering you experience when you’re stopped at a streetlight and someone behind you accidentally rear ends your car at your low speed. Only that shaking keeps going after the initial, jarring contact. But, it’s not your car being shaken; it’s your house. Also, it’s not a car hitting your house; it’s an incomprehensibly huge tectonic plate.

The fives and sixes on the Richter scale that you feel from a few counties over are surprising and mildly invigorating in the same way a nearby lightning strike can be scary but make you feel alive. But when earthquakes are close or larger, they are pretty terrifying. I’ve been through a couple significant ones, and they put you in your place. Simply put, feeling the earth shift underneath you is scary.

If you’re a provider with even a few years in the industry, then you probably thought “been there; done that” after reading that last sentence. The ground is definitely shifting beneath the entirety of post-acute care, and the shaking appears to be getting more pronounced.

Most HME providers are already aware of the increased competition for retail HME from online giants such as Amazon, Walmart, Target, Alibaba and CVS. And that shake-up is getting more intense. Last June, Amazon bought online pharmacy PillPack. That gives Amazon a toehold in the $560 billion prescription drug industry, as well as the ability to bill Medicare and other insurance for prescription items.

More recently, ride-sharing company Lyft hired Megan Callahan, formerly the chief strategy officer for Change Healthcare, which merged with McKesson in March 2017. Both Lyft and Uber have announced services that let healthcare professionals order rides for patients going to and from non-emergency appointments.

Stories like that can feel like far off tremors, but they could signal larger market shake-ups for HME providers. The question is, are they actually bad?

For instance, let’s examine the Lyft announcement. On the face of it, the news is relatively benign — it creates a new non-emergency transportation layer that today’s health market needs. But is Lyft or Uber going to stop at that? There is a considerable amount of non-human medical transportation that also takes place. Why not get in on that market, too?

That could actually mean good things for providers. Imagine if there were a competent service that allowed providers to outsource the delivery and set up of HME to trained firms that were certified in such a way that providers still passed muster in terms of billing, accreditation and licensing requirements? That could let providers off-load a whole slew of sizable operational costs.

Who knows if Lyft or Uber or any other company would function in such a way, but we’re already seeing Amazon Flex let individuals deliver for the e-commerce giant in the same way people chauffeur for Lyft.

And that’s just one example of how the earth is trembling under our feet. We’re just not sure of where it’s going to go. They key is to think flexibly and try to see the upsides instead of upheaval.

This article originally appeared in the March 2019 issue of HME Business.