2016 Respiratory Survey

Preparing for National Expansion

Our Seventh Annual Respiratory Therapy Survey once again takes aim at the effects of competitive bidding, especially national expansion, which started rolling out Jan. 1.

Since its inception, competitive bidding has been a major focus of the yearly HME Business Respiratory Survey – and with national expansion implemented on January 1, 2016, this year’s summary of providers’ perceptions and opinions is no exception.

As part of the program, CMS took zip codes in the eight regions and classified them as rural or non-rural. An un-weighted average of all of the single payment amounts (SPAs) from the CBAs in each of the eight will be used to determine a regional single payment amount (RSPA) for each covered item, with claims in the rural zip codes receiving a 10 percent increase.

From Jan. 1, 2016, to June 30, 2016, reimbursement for affected product categories will be based on 50 of the current, un-adjusted fee schedule, plus 50 percent of the RSPAs. Then, on July 1, 2016, the rates will drop to fully implement the bidding-derived rates, HME billing firm MiraVista LLC said.

There has been an industry-wide push to reform the national expansion of competitive bidding via HR 4185 and S 2312, but the majority of respondents (49 percent) said the bills were not very likely to succeed, while only 14 percent said it was somewhat likely to succeed.

Respiratory Therapy Survey 

“Competitive Bidding and the subsequent rollout of CB pricing has been devastating to the DME businesses and the hospital systems and patients it supports, ironically, cutting the ability to provide a least costly service (home medical equipment) that will save most costly healthcare dollars (hospitalizations, increased doctor and specialist visits and in-patient stays),” said a survey taker. “Competitive bidding was quite simply a mistake that despite being pointed out by several experts in various fields could not be stopped, but for which efforts are needed to be reversed.”

Who are the survey respondents?

With survey respondents located throughout the United States, 56 percent hold RRT certifications, while 32 percent hold CRT certifications. Slightly more than 58 percent of respondents have 15 or more years of respiratory therapist experience and just under 10 percent have less than two years.

When it comes to competitive bidding, 16 percent said they were located in a competitive bidding area for Round One and 46 percent for Round Two. Approximately 53 percent are located in an area covered by national expansion.

Even though national expansion was implemented only about six weeks before respondents took this survey, 71 percent of respondents said that the national expansion of competitive bidding has impacted their oxygen business negatively, while 71 percent also said it is impacting their sleep business negatively.

“The national expansion is already affecting us,” said a respondent. “We are no longer accepting assignment on any items listed in the fee cut. If patients cannot afford to pay for them, then they have to go without. We are small, and we pay for our equipment about what the reimbursement is. It is no longer worth it to us. We would go out of business buying the equipment, and waiting months to be reimbursed. And then we are only being reimbursed at what we have in it.”

Staying the course from past surveys, respondents are very concerned about patient care.

“Competitive bidding and the expansion is killing DME companies,” a survey participant said. “It’s making it impossible to pay and hire good qualified personnel to take care of our patients. In addition the problem is Obamacare, which adds additional operating cost to the DME company. I believe all the cuts are destroying patient care by destroying the ability to operate an efficient DME.”


When asked what was the single biggest challenge facing the
homecare industry, 29 percent of respondents said a lack of reimbursement
for home respiratory therapy services and 29 percent said competitive bidding. Other main challenges includes:

  • Reduced funding resulting in reduced hands-on therapy/care visits with patients (14.5 percent)
  • Lack of understanding regarding homecare’s role in healthcare (7 percent)
  • Audits (6 percent)
Respiratory Therapy Survey 

One respondent pointed out another challenge: Excessive documentation requirements on doctors that result in delayed care that is reimbursed at a significantly lesser amount. And another said the industry has to turn challenges into opportunities.

“While the DME industry is undergoing significant changes and challenges, we are not alone,” said a survey taker. “The healthcare industry as a whole is undergoing major changes in reimbursement. However, we can choose to succumb to the changes, or turn these challenges into opportunities. Traditional DME companies must step outside of the box and not only diversify, but take a stand and show the healthcare industry what a valued healthcare partner we are. This is our time to push for even more change and prove our worth in the development of positive patient outcomes as it relates to population health.”

Patient Care

Patient compliance remains a significant challenge, especially in times of cuts, caps and competitive bidding. Here’s how respondents are addressing the issue this year vs. last:

  • Making follow-up calls to patients (91 percent/86 percent last year)
  • Distributing product literature (49 percent/46 percent last year)
  • Follow-up visits to patient homes (44 percent/46 percent last year)

There was only slight variance in what respondents said was the primary barrier to patient compliance for oxygen therapy this year vs. last:

  • Bulky burdensome equipment (35 percent/34 percent last year)
  • Lack of education about COPD/respiratory conditions (26 percent/32 percent last year)
  • Stigma of using oxygen 24 percent/21 percent last year)

When it came to the primary barrier to patient compliance for sleep therapy, the top barrier had a 9 percent variance from last year:

  • Difficulty with masks or interfaces (65 percent/56 percent last year)
  • Trouble adjusting to CPAP pressure (21 percent/18 percent)
  • Lack of education about sleep apnea (6 percent/8 percent last year)

With reduced reimbursement, HME providers have had to change their approach to clinical services. Almost 51 percent of respondents said they have reduced the frequency of in-person therapist follow-up visits, while 27 percent have cut in-person therapist follow-up visits.

Many providers have also increased their cash sales strategy to make up for lost revenue. According to respondents, the most popular cash sale itemsfor to their CPAP patients were CPAP mask wipe cleaners (54 percent), gel nose bridge protectors (25 percent) and nasal moisturizers (24 percent). About 27 percent of respondents said they do not recommend cash sale items to their patients.

When it comes to equipment and oxygen delivery for patients, the majority of respondents said reimbursement cuts have changed their business in some way, while 16 percent said they have made no changes. For those who have made changes, they have:

  • Reduced the frequency of oxygen deliveries (51 percent)
  • Transitioned to non-delivery models (40 percent)
  • Reduced oxygen delivery staff (28 percent)

This article originally appeared in the March 2016 issue of HME Business.

About the Author

Joseph Duffy is a freelance writer and marketing consultant, and a regular contributor to HME Business and DME Pharmacy. He can be reached via e-mail at joe@prooferati.com.


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