When I filled my last prescription, I, like most consumers, never thought about how the pharmacy knew my insurance would cover the prescription. The ability of computers to put once-hard-to-get information within a few keystrokes’ reach is now so commonplace one hardly wonders about it any more. But from an information technology (IT) standpoint, the everyday act of getting a prescription filled is really quite remarkable.

As Gregory Taylor, vice president of business development for Brightree, Duluth, Ga, explained to me, when I filled my prescription the order was sent electronically from the pharmacy to my insurance company in just 16 seconds. My insurer then checked to see if I was covered for the medication and then immediately sent back an electronic authorization to dispense the medication and an electronic payment to the pharmacy. A few minutes and a small co-pay later, I was on my way, none the wiser that the time I had spent pulling money out of my wallet and making the pharmacist get me change was probably the most time-consuming and arduous part of the whole transaction.

Now imagine that I then went across the street and tried to fill my prescription again at another pharmacy. That pharmacy would instantly know I had already had my prescription filled by another provider because when it sent the prescription to my insurer, my insurer would deny it.

Wouldn’t it be wonderful if HME worked the same way? Imagine if wheelchairs, walkers, or hospital beds could be preauthorized before they were ever delivered and you were paid the minute the patient or caregiver signed for the equipment.

It is more than possible, Taylor says. The technology exists to do this now, but we must first change the way we think about home care reimbursement. “The chief barriers to changing the existing procedures are human and institutional, not technological,” he said in a presentation given at the American Association for Homecare (AAHomecare) Leadership Conference and IT Summit held February 25-28 in St Petersburg, Fla. (For more details on the conference, see Industry News starting on page 14.)

Unfortunately, those barriers can be substantial indeed. And it is not just real-time payments that are impacted, as our article “Digital Revolution” starting on page 23 makes clear.

Simply trying to survive with today’s shrinking Medicare and Medicaid reimbursements and crushing paperwork burdens can be challenging enough. Who has time to think about tomorrow? But if home care hopes to be the efficient and low-cost way to deliver care in the future, it behooves the industry to think about these issues now.

AAHomecare is already on the case. “We must figure out ways to get our costs as low as possible and part of that is working together on IT issues,” Thomas A. Connaughton, president and CEO of AAHomecare, told me.

He is right. Home health care could be the country’s last, best hope for saving Medicare and Medicaid, but only if the industry can deliver care more efficiently than anyone else. With the right technology, I believe it can.

The HME industry has an exciting future ahead and whatever tomorrow may bring, Dealer/Provider will be there to cover it. Stay tuned.

Lena Lindahl
llindahl@medpubs.com