Competitive bidding, audits, new payor requirements and changing payment models are driving many HME providers to look closely at their businesses as we move into 2015. Over the next year, many organizations will consider moving away from a predominantly Medicare-based business model to a more integrated approach that incorporates new payors and product lines, new business partnerships, and new challenges.
To navigate 2015’s rapidly changing landscape, providers must think differently about how they run their business. Fee-for-service payment models are quickly giving way to pay-for-performance models that require providers to share more data and demonstrate their role in improving the patient’s condition. Referral sources are under new pressures to coordinate care across care settings while keeping the patient out of the highest cost settings (the hospitals). Significant technology innovations from manufacturers, distributors, payors and software vendors open new opportunities to help providers thrive in this environment. Bearing that in mind, here are five key business strategies that providers can implement now to take advantage of these opportunities.
Use Data to Enhance Business and Clinical Performance
Although there are many resources to identify potential new services or approaches that can increase an HME provider’s revenue, new programs are most successful and sustainable if they address referral sources’ needs in the provider’s specific market. For example, hospital readmission penalties have put increasing pressure on providers to ensure patients receive appropriate care after being discharged from the hospital so that they don’t return to the hospital within 30 days of discharge. Thus, HME providers should identify best practices that improve patient compliance with therapy and discharge instructions by evaluating data from the devices used by the patients. This insight can be leveraged to develop programs that proactively address the most urgent needs of the community. For example, HME providers may note a particular referral partner has a higher incidence of chronic obstructive pulmonary disease than sleep disorders and, as a result, offer programs focusing on minimizing the risk of readmission with automated re-supply of oxygen supplies or enhanced education. HMEs that can demonstrate an understanding of a referral source’s unique challenges and needs will be viewed more favorably by those referral partners.
Improve Communication to Strengthen Referral Networks
Ongoing, effective communication is essential to strong relationships with profitable referral sources. In today’s collaborative environment, HME providers must share real-time information on a specific patient’s progress as well as trend insights derived from overall patient data. Doing so provides previously unattainable, actionable information to the referral source.
HME providers can accomplish this now by adopting technology that supports the collection, aggregation and analysis of patient data as well as financial data, demonstrating its commitment to sound operational and clinical practices. For example, many sleep manufacturers are finding new ways to share patient usage and compliance information with billing systems. Not only does this automate the flow of data from the patient directly into the provider’s system, but it also helps providers prove to referral sources how their compliance rates exceed the competition. Staying current with technology that bolsters data-sharing helps establish the HME provider as a partner of choice for collaborative health organizations.
Differentiate From Other HME Providers
In addition to deploying services that benefit a referral source’s patient populations, HME providers can stand out from the competition now by integrating mobile technology into their businesses. Mobile technology has evolved at record speeds, and placing some of these tools at the fingertips of your remote staff members can help create new efficiencies. For example, mobile tools can enable respiratory therapists and delivery technicians to more easily input information, review order histories, make notes about the patient’s environment and even capture payments while still in the patient’s home. This technology offers a better experience during the visit and ensures HME providers are documenting in a timely manner so that referral sources can be kept up-to-date on the patient’s progress.
Do More to Keep What You’ve Earned
As audits continue to be the number one issue on HME provider minds in 2015, providers must reconsider their business processes associated with document creation, distribution, collection and storage of critical documents that support the claims process – from intake through collection. Modern technology solutions that allow providers to set rules in the system that help staff members easily follow the myriad of payer-specific rules can help avoid pitfalls that increase audit risks and lead to delayed payments. Now that CMS allows for the electronic filing of documents for certain types of audits (esMD), having a system that allows providers to easily drag and drop the necessary files in an electronic packet and send to CMS without printing and mailing is not only a time saver, but also a great way to track the status of audit. Providers must determine where the gaps are that are creating the biggest risks for audits, and take advantage of technology innovations to help reduce the burden staff members face when trying to keep up with the rapidly changing and complex requirements payors are putting on them.
Manage Inventory to Cut Costs, Add Efficiency
A leaner approach to inventory management enables HME providers to invest less capital in shelf inventory, streamline purchasing, and more efficiently use staff to get the right product to the right patient at the right time.
For example, electronic purchasing from directly within your billing and business management system will become the norm in 2015, as it drastically reduces room for human error when orders are called or faxed in. Patient home delivery, also known as drop shipping, will also become more popular this year, as it helps eliminate wasted time and dollars associated with maintaining large warehouses full of inventory items.
While no one can accurately predict what the healthcare environment will look like in the next few years, HME providers can proactively engage in new strategies that help them differentiate their businesses and optimizing their operations. Technology is now delivering more innovative ways to help your staff work smarter and do less work to get claims out the door. Providers must embrace change and use technology to do so smoothly in their organizations to thrive in 2015 and beyond.
