Focusing on just a handful of significant challenges is a tall order in 2025, a year of tumultuous policy and funding issues.
But that was the opening question of the Oct. 21 webinar “The HME Executive Outlook: Navigating an Evolving Industry,” hosted by HME Business.
Answering that question (and many others) were panelists David Chandler, vice president of payer relations for the American Association for Homecare (AAHomecare); Jim Grady, president and CEO of U.S. Healthlink, based in Orlando, Fla.; Lane Ham, CEO of AZ MediQuip, headquartered in Scottsdale, Ariz.; and Erica Thomson, director of operations for Commonwealth Home Health in Danville, Virginia.
Grady said U.S. Healthlink is “starting to see the pharmacy benefit side tick up from a CGM [continuous glucose monitor] perspective, as well as even insulin pump supplies. We’re starting to see the manufacturers really dialing in to try to get that pharmacy benefit side covered, because they realize the obstacle of getting patients not only on intensive therapy, but staying on intensive therapy, is a lot less expensive in a calendar year under the pharmacy benefit than it is under traditional medical benefits or in some cases, Medicare.”
Grady also mentioned the still-rising popularity of Medicare Advantage: “We see in Florida a transition of traditional Medicare [beneficiaries] over to Medicare Advantage plans.” He added that traditional Medicare is “just really scrutinizing chart notes, documentation, making sure that things are buttoned up in the way that they’re supposed to be.” U.S. Healthlink is seeing “more audits through Medicare, which is fine, because we’re great with audits. We’re very clean at what we do, and our paperwork is great. But they are scrutinizing a lot more.”
And while Grady said “automated” systems that enable providers to add information to pre-made forms to comply with Medicare guidelines are helpful, “I do think that Medicare has taken a hard look at this. I don’t think they like the uniformity of those documents, that every patient is similar in the way that that’s set up. So I think they’re looking for uniqueness in different cases from patient to patient.”
2025 from a policy perspective
AAHomecare’s David Chandler agreed with Grady’s Medicare Advantage assessment, saying, “We continue to see enrollment grow in 2025. We long surpassed the 50% threshold; we’re seeing somewhere around 55% of Medicare enrollees covered under Medicare Advantage plans. However, the need for reform has not changed.”
Chandler shared that in a recent Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) press conference, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, M.D., “secured a pledge from the top health plans in the country around prior authorization reform.
“The pledge includes things like standardizing electronic prior authorization, reducing the scope of claims subject to prior auth, ensuring continuity of care when patients change plans, enhancing communication and transparency on determinations, expanding real-time responses, and ensuring that there’s a medical review for any non-approved requests. While most of these pledges are already outlined in existing regulations, I think the fact that the health plans came together and publicly made this pledge is encouraging.”
Retail HME spending tied to the economy
Lane Hamm pointed out that AZ MediQuip is a retail HME provider that does not work with insurance companies, “and so I think our business is largely driven then by how people feel about their stock portfolios: ‘Do I have money, or do I not have money?’ So I think when the threat of tariffs hit back in April, I certainly felt that impacted the business. As the stock market has continued to go up, certainly we’ve seen better spending through the summer.”
As for the specter of Medicare competitive bidding, “What we saw last time, I believe, was a contraction in the space of providers,” Hamm said. “If we see the same thing here, it makes it harder for people to get the DME that they need, potentially. And that certainly helps our business.
“What David was talking about as far as pre-authorizations or getting insurance, that benefits my business, because people get tired of waiting. So they’re going to come and buy it, or they’re going to rent it while they have to wait for the product that they need. My business is driven by, again, how people are feeling about their money and how they feel about the space. And then in many ways, it’s also impacted by not wanting to accept what they’re going to get through their insurance providers.”
AI’s promise, challenges
Asked to recap a big challenge or change this year, Erica Thomson spoke about Commonwealth Home Health’s recent introduction of artificial intelligence (AI) to the provider’s day-to-day processes.
Bringing AI into the business, Thomson said, was expected to positively impact operations. But it also affected existing team members in a very human way.
“I thought it was going to be easy, fantastic for everyone involved,” Thomson said. “But once you bring those different technologies in — for example, with our CPAP compliance program and the different mask-fitting programs out there, our therapist’s first thought is, ‘You’re replacing me.’ And you have to explain to them, ‘No, we’re not.’”
Even after having the discussion that AI is about improving the patient experience, not about replacing employees, there were further learning curves, Thomson said. “Once the therapist started using it, they found that the programs, the algorithms, weren’t always right,” she said. “And we’ve had a really difficult time with that.”
While the AI introduction hasn’t been without its bumps, Thomson said, “Once the therapist did realize that it’s becoming a little bit better for us to deal with, it’s been a little bit easier. And introducing AI into our intake process: We all know that’s going to happen. But as we’re introducing it, the programs aren’t transferring the data over correctly, like the program was meant to. So my staff is very frustrated. They’re like, ‘You’re supposed to make our lives easier, and you’re making us work harder.’ Those challenges, I’m hoping, will get better as the year goes on. I think it’s necessary that we have them in place and we try to incorporate them into our workflow as a day-to-day process.”
And Thomson pointed out the people-centric nature of HME provision.
“We still need that human one-on-one contact,” she said. “That’s never going to go away, thank goodness.”
Editor’s note: Stay tuned for more coverage from the HME Executive Outlook webinar. Register for free to see the entire session on demand.
