Business Solutions

14th Annual Big 10

COVID-19 continues to impact the industry as we roll into 2021. Our annual Big 10 list explains its impact, as well as other factors impacting providers this year.


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At the start of each year, we take some time to signpost 10 key trends or business factors that providers will need to deal with in the year to come and offer some insights that will help them make a plan. We’ve seen a lot of major trends play out over past editions — competitive bidding, audits, oxygen’s rental cap, retail sales, the increasing use of software, just to name a few — but we’ve never had a year where one trend has influenced the others.

Enter COVID-19. As we’ve seen over the course of 2020, the pandemic wormed its way into just about every protocol, procedure, plan and practice a provider could put into place. And, not surprisingly, that trend will play out in 2021. That said, it won’t be the only trend that will affect providers this year, but it will play a role in just about every trend impacting 2021.

So, for this 14th annual edition of the HMEB Big 10, we’ll examine:

1. The Vaccine Roll-Out
2. Business and Care Protocols
3. Telehealth
4. Virtual Events & Education
5. Accreditation Renewal
6. Provider Sales
7. Sequester Pause
8. Oxygen Supplies and Services
9. CMS’s Round 2021 Punt
10. Payer-Provider Convergence


The big question on everyone’s mind is exactly when will the nation get vaccinated so we can return to real life. If right now represents a “new normal,” every American, and every citizen of the world, wants to get back to the “old normal” that doesn’t involve masks, social distancing, and Zoom meetings.

There are dozens of vaccines still being developed and safety tested, but as of press time, there are just two vaccines approved for emergency use in the United States: the Pfizer-BioNTech vaccine and the Moderna-NIH vaccine.

At press time, the CDC’s latest data showed that 35.2 million total doses of the available vaccines had been administered and more than 6.9 million Americans had been fully vaccinated. So, 2.1 percent of the nation’s population has been vaccinated. Obviously, we have a while to go before life will return to normal.

And how long will that “while” last? Public health experts and epidemiologists say the population needs roughly 70 percent to 85 percent vaccination coverage before the virus will be contained and people can return to the way things were. According to the experts and the various online vaccine trackers, we can expect that the United States won’t get to that level of coverage until sometime in 2022. Moreover, we have yet to consider how other events, such as winter weather, natural disasters, or other issues might hamper distribution. What we do know is that the “new normal” will be here for much of 2021.


That means that all the business and care protocols that providers put into place to deal with the pandemic will need to remain in place for 2021. COVID-19’s spread was surprisingly fast. Since the first U.S. fatality was announced on Feb. 29, the United States has seen 27 million cases and 426,000 deaths from the disease (as this story goes to press).

But just as fast as the pandemic expanded, so too did the industry responded just as fast to help control and contain it while they ran their businesses and provided care. That quick response included shifting any back office staffers to working from home, changing how delivery techs documented delivery and conducted set-up, and how their team worked with referral partners.

For most of 2021, we can expect that HME providers will need to keep those policies and procedures in place in order to protect their employees, patients and partners. And, we can expect that CMS and private payer insurance will, in turn, keep their relaxations and waivers of various reimbursement requirements in place to facilitate providers as they have done in the past.

And, if anything, continuing to operate under those circumstances should help the HME industry continue to build goodwill and raise its reputation among payers, regulators and lawmakers by demonstrating its value as an integral, frontline component of America’s healthcare landscape.


One revised healthcare practice or protocol introduced into American healthcare due to COVID-19 that we can expect to stay is telehealth. Here in HME, we saw the waiver of the three-year established patient relationship requirement from telehealth provisions and the removal of the face-to-face exam requirement for items that otherwise require them due to NCD or LCD.

We also saw CMS waive any limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Now CMS’s telehealth list includes both two key clinical partners/staff for HME providers: Physical Therapists (PTs) and Occupational Therapists (OTs), for instance.

And when it comes to referral partners, similar policy changes have made it much easier for physicians to confer and consult with their patients via telehealth, rather than in person, to minimize contact. Now, doctors are just as likely to meet with patients on their laptops as they are in their examination rooms, especially given that they can get reimbursed.

And their patients like it too. Who wants to drive to the doctor’s office for a simple consult when you can do it sitting at your kitchen table?

Patient and physician accustomization to telehealth also means providers need to work within that context. No, providers can’t expect to get reimbursed for implementing telehealth, but then again, neither can they expect to get reimbursed for having a telehealth line. It’s a new normal that will be the ongoing normal because it simply makes sense, and providers will need to support it if they want to remain relevant.


Speaking of doing things at a distance, everyone loves in-person expos, conferences and networking events, and is eager to get back to them. (Lord knows I am.) But the industry’s educators and media companies’ efforts to still deliver the kernel value of those types of events in an online milieu has been encouraging and sometimes eye-opening.

In 2021, we saw both Medtrade East and VGM Heartland take their events online and serve up both expo- and conference-style content online. We also saw the American Association for Homecare host a virtual Standup for Homecare, and we saw members from 18 state HME associations pull together to attend a Midwest Association for Medical Equipment Services & Supplies (MAMES) Virtual Conference and Exhibition that was a well-received replacement for the various individual state association meetings.

Here at HME Business, we extended our long-running webinar series to include DemoCasts, which are free-to-attend collections of short product demonstration videos from various vendors, followed by audience Q&A with representatives from the companies providing the videos. Those were so well received that we wound up doing several in 2020 and have even more slated in 2021 (see to learn more).

And in 2021, we can expect more virtual events. We have dates slated for the big events, such as VGM Heartland (June 14-16), Medtrade West (July 12-14), and Medtrade East (Oct. 18-20), and at press time, AAHomecare is working with its members to develop the best approach for its annual Washington Legislative Conference lobbying event. It is likely that we can expect the trend toward virtual industry events and education to continue in 2021, and it’s likely that all these events will feature a virtual component. That’s a good thing as it gives people options.


Another key 2021 trend that COVID-19 is already impacting is accreditation renewal. Per the 2003 Medicare Modernization Act, any provider that wants to bill Medicare for DMEPOS claims must be accredited by an approved accreditation organization. The Act gave DMEPOS suppliers a deadline of 2009 to get accredited, and since then then providers must renew every three years, which means 2021 is an accreditation renewal phase.

A key element of the accreditation process is a site survey, which the accrediting organizations are conducting online and will need to conduct in-person in the future when HHS officially declares the public health emergency over. Also, when it comes to policies and procedures review, an emphasis is being placed on infection control.

The net-net is that most providers are renewing their accreditation this year, and that process will get more complicated. To read more about this topic, turn to “Game Changes: Accreditation in 2021,” starting on page 8.


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Another key business process that COVID-19 will continue influencing in 2021 is their referral and patient sales. Providers had to completely revise how they work with their customers as well as referral sales.

In-person customer service incorporates far more over-the-phone customer service, more social media and online outreach and education, telehealth (for those providers that are using Zoom, etc.), and practices such as curbside pickup. Of course, these are all ways of doing business that all sorts of retail and in-person businesses have had to add to their sales and service.

For referral sales, providers have had to learn how to work in a reality where most hospitals and other facilities-based care providers don’t want outside people anywhere near their premises. That’s been a big obstacle for providers to hurdle.

That said, providers have learned several lessons in that regard during 2020 and can apply them in 2020. Furthermore, the industry’s sales experts are helping them to set a selling stage in 2021 that will help them not just survive but thrive. To that end, read “The Essential Stand-Out Sales Approach for 2021,” on page 30, from Ty Bello, CEO of HME sales consulting firm Team@Work. Also, go to to watch “The New Sales Approach for 2021 and Lessons from 2020,” a free, PlayMaker Health-sponsored educational webinar from Bello that goes even deeper into HME sales planning and management for 2021.


A key funding issue related to COVID-19 that must get resolved is the extension of the pause on 2 percent Medicare sequester cuts until the end of the COVID-19 Public Health Emergency.

The 2 percent cut has been in effect since the 2012 Sequestration Transparency Act, which was part of a deal to get out from under the debt ceiling at the time. The CARES Act put a pause on those cuts to help DMEPOS suppliers and other Medicare fee-for-service providers and suppliers during the COVID-19 public health emergency. However, the suspension only impacts claims with dates of service between May 1 and Dec. 31.

Congress has since extended this relief for an additional 90 days, but given that the pandemic will last well past the end of March, the industry urging members of Congress that they extend the pause. The best way to do that is to incorporate the language of H.R. 315, legislation launched by Reps. Brad Schneider (D-Ill.) and David McKinley (R-W.V.) would continue that pause through the duration of the PHE.

At press time, AAHomecare was calling on providers to contact their Senators and Representative healthcare staff and ask that their lawmakers include H.R. 315’s provisions in the COVID-19 relief package. Given how expensive providing HME is during the pandemic has grown, that extension will play a critical role in their cost structures and profitability.


One of the key categories of HME that is facing COVID-19 is oxygen services. Throughout the pandemic, providers of oxygen have had to develop all-new care and service protocols in order to ensure that they continue to support patients that need liquid oxygen, oxygen concentrators and portable oxygen concentrators for long term oxygen therapy for treating COPD and similar conditions. They’ve had to do that in such a way that they put a premium on infection control, social distancing and similar practices. That’s one way oxygen providers have had to contend with the PHE.

Another issue is the supply side of oxygen care. In order to contend with COVID-19 and treat patients that contracted the disease, many hospitals are ordering oxygen concentrators for use in the hospital, or sending home with patients that had COVID-19, are safe to discharge and receive care at home but still need temporary supplemental oxygen therapy.

Providers can still make reimbursable claims for this thanks to waivers — and it will be interesting to see how that lasts — but it has put a strain on the oxygen equipment side. Fortunately, the supply issue appears to be regional and inconsistent for now. Much depends on how hospitals are handling the disease and how bad the outbreak is in their area. It’s safe to say that supplies are getting tight, and providers need to be judicious in that regard.

To read more about the current state of oxygen services, turn to this month’s cover story, “Breathing Easy?” starting on page 20.


At the end of October, CMS announced that after originally taking bids for 16 product categories in the 130 competitive bid areas of Round 2021 of its competitive bidding program, it was only awarding contracts for the off-the-shelf back and knees braces categories.

As for the 13 remaining categories (CMS had already removed the non-invasive ventilator category due to the COVID-19 public health emergency), CMS announced it would not issue contracts because it “did not achieve expected savings.” In other words, CMS decided to punt.

That means that given the last competitive bidding contracts expired on Dec. 31, 2018, and that the bidding program has since been dormant, DMEPOS providers can continue to provide these 13 categories without contracts. That’s an attractive prospect to providers, but they do so knowing that DMEPOS reimbursement is essentially frozen at 2018 rates.

Will the HHS and CMS under the Biden Administration steer back toward competitive bidding? It’s tough to say. It’s clear that CMS realizes it has reached a bid floor. It also knows that it’s more expensive for providers to deliver care and products during COVID-19 and that HME providers have demonstrated they are an indispensable component of American healthcare. Whenever and if ever competitive bidding makes a return, the pieces on the board will need to be reset if CMS wasn’t the game to be sustainable.


Back in the 2019 Big 10 list, we talked about the convergence of payers and providers being a key trend to watch, and highlighted the fact that major deals such as United Healthcare and dialysis giant Davita, pharmacy chain CVS and Aetna, and Humana and Kindred Healthcare would change how healthcare is delivered.

Well, back in July 2019, CVS announced its plans to transform many of its locations into what it has dubbed HealthHUBs, a sort of a mix of a pharmacy, a clinic, and a DME provider. A customer can get treatment for common illnesses, meet with nurse practitioners, physician assistants, licensed practical nurses and pharmacists, and pick up DME items. CVS company rolled out 50 HealthHUBs in 2019 and aimed to cut the ribbon on 600 HealthHUBs in 2020. The company’s stated goal was to create 1,500 locations by the end of 2021.

Also, in August, and Aetna announced a plan that would let its members access appointments at its parent company’s HealthHUB locations with no copay and get discounts on items at those CVS locations.

Clearly, the convergence is coming into focus, and it’s a little scary looking. The HealthHUBs are offering supplies for two heavily used DME categories that are funded both through private payer insurance as well as Medicare and other public payer sources. Also, a September 2020 survey from the National Community Pharmacists Association showed 79 percent of community pharmacists complained that patients’ prescriptions were transferred to another pharmacy in the last six months without their patients’ knowledge or consent (a practice known as “patient steering”).

But the limited offerings from HealthHUBs or the need to engage in patient steering also underscored the value HME providers, local DME pharmacies and community pharmacies offer to their local marketplace. The kind of service and care offered by those businesses can’t be replicated by a large, big-box chain. Providers will need to make their service and expertise a primary messaging point in their patient- and partner-directed marketing and communications.

This article originally appeared in the Jan/Feb 2021 issue of HME Business.

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