The proposed home health care rule had received more than 5,100 comments one week before the close of the public comment period at the end of the business day on Aug. 29.
And while the restart of Medicare competitive bidding has understandably been grabbing most of the headlines, a significant portion of comments submitted by durable medical equipment (DME) and home medical equipment (HME) professionals focused on the proposed rule’s recommendation that accreditation be made an annual requirement.
“The current three-year accreditation cycle provides adequate oversight and compliance while allowing suppliers to focus on patient care and business sustainability,” said one comment. “Moving to an annual renewal requirement would drastically increase administrative burden and operational costs, especially for small and mid-sized providers. There is no data to support that this change would improve patient outcomes or reduce fraud, and it would instead divert critical resources away from service delivery.”
Another HME business owner said, “As a small provider, I find having accreditation every year would be more expensive and cumbersome. We survived the first rounds of competitive bidding and COVID-19. We are just getting back on our feet again, and now Medicare wants to add more expense and cut reimbursement with the next round of competitive bidding. It is like Medicare is trying to put the small businessman out of business.
“This model is not sustainable for the smaller companies. When is enough is enough? Medicare cut our rates since 2008 and made DME providers jump through more hoops and expenses. Meanwhile, customer service has gotten worse across the board, and businesses are cutting staff or small businesses are closing down.”
Greater survey frequency, no additional reimbursement
One commenter noted that CMS is proposing annual accreditation — and significantly more administrative work for providers — without mentioning additional reimbursement to support those new requirements.
“As the operator of a small, locally owned DME company, I strongly oppose the proposed shift from a three-year to an annual accreditation requirement for suppliers,” the comment said. “This change would impose a significant financial and operational burden on small providers like ours. Accreditation surveys are already expensive, and requiring them every year — without any increase in reimbursement or allowance adjustments — is simply not sustainable.”
That commenter noted that providers are already under strain due to falling reimbursement rates, rising costs of products and supplies, increasing costs of fuel and vehicle maintenance tied to making HME deliveries, and the need to raise wages to hold onto quality employees.
“While quality and accountability are important, the proposed rule does not provide a realistic path forward for small businesses,” the commenter said. “If CMS [Centers for Medicare & Medicaid Services] is concerned about ensuring compliance, there are other avenues — such as random audits, digital compliance checks, or enhanced reporting — that could be explored without adding overwhelming cost. We urge CMS to reconsider this proposal or provide alternate solutions that do not threaten the viability of small, community-based DME suppliers who are essential to patient care and accessibility.”
“These rules effectively and unnecessarily increase the costs to O&P [orthotics and prosthetics] providers by incurring additional costs passed down by credentialing/accreditation organizations that are required to increase their site inspections annually instead of every three years,” said another comment. “Additionally, unannounced site surveys are an unnecessary waste of surveyor resources and also put an unnecessary strain on provider staff, as not all patient care sites are designed for walk-in patient availability or are staffed full time. These visits, which are aimed at protecting the consumer, do nothing to further protect their interests and only serve to strain limited resources available, especially for smaller companies or those growing their service areas in new markets/locations. These visits can easily be scheduled and accomplish similar goals.”
A certified mastectomy fitter and owner of a cancer recovery boutique said, “We have been an accredited DME provider since 2008. From opening in 2008 up until four years ago, I had no employees and operated [the business] entirely by myself. Even now, I have only three employees; this is common among mastectomy boutiques. We are small, entrepreneurial operations doing our best to serve breast cancer patients and survivors while meeting all the bookkeeping regulations required by CMS.
“As it is, we cannot afford staff and make enough profit to cover our overhead with the extremely low and unrealistic Medicare reimbursement rates that commonly make up from 70% to 90% of our revenue. We do not have the profit margins of large, multi-product DME/HME providers, and this proposed change would put an unfair, undue burden on our ability to operate.”
Visit the Federal Register page to view additional comments or to post your own comment by Aug. 29.
