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.
- By David Kopf
- Feb 01, 2021
Image © mraoraor/depositphotos.com
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
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
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 VACCINE ROLL-OUT
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.
BUSINESS AND CARE PROTOCOLS
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.
VIRTUAL EVENTS & EDUCATION
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 HME-Busines.com/webinars 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.
Image © sdecoret/depositphotos.com
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
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 HME-Business.com/webinars 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
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.
OXYGEN SUPPLIES AND SERVICES
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.
CMS’S ROUND 2021 PUNT
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
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.