Over the past 13 years, the HME industry has found itself on a journey of self-awareness. Are HME providers simply equipment vendors with maintenance departments or are they true health care providers on par with pharmacies, long-term care facilities, and home health agencies?

Virtually every health care professional is required to have a certain level of education to practice. This may include an examination to become licensed, annual continuing education requirements, and/or peer review. On the other hand, an electronics salesperson or maintenance technician does not have to meet these requirements. So where should the HME provider fit in?

This is not just an academic, Zen-awareness question. Rather, this is a real-life, “meat and potatoes” question with dollar signs attached to it.

Justifying HME’s Professionalism
The bottom line is that government programs pay a great deal of money each year to the HME industry. For that reason, federal and state governments have taken notice of the industry. In particular, regulatory agencies have noticed that the HME industry is not subject to the education, licensing, continuing education, and peer review requirements of other health care professionals.

The government has expressed a need to “tighten up” its oversight of the HME industry in order to ensure that government dollars are wisely used and the needs of patients are met. Unfortunately, a common perception among government regulators is that the HME industry is not composed of health care professionals, but rather is comprised of business people more concerned with profits than with the clinical needs of patients.

It is critical for the HME industry to be seen as being in the same category as other respected health care providers, and to accomplish this the HME industry must proactively propose and facilitate implementation of regulatory guidelines. Otherwise, those who know nothing about HME may then impose such guidelines upon the industry

Certainly, it is in the best interest of the HME provider to obtain accreditation through national accrediting organizations. From a marketing standpoint, this improves the HME provider’s credibility with physicians, referral sources, beneficiaries, and government regulators. And increasingly, third-party payors require that the HME providers they deal with are accredited.

In addition, from an education standpoint, licensed health care professionals working for an HME provider (eg, nurses and respiratory therapists) will need to fulfill their continuing education requirements. It would be equally beneficial for all employees of the HME provider, clinical and nonclinical alike, to meet annual HME-specific continuing educational requirements, which might be established by an accrediting organization or state licensing board.

Legislating Standards
This brings us to licensure. If other health care professionals are subject to licensure, and if the HME provider wishes to be perceived as a health care professional, then state licensure should be supported. HME state associations have delineated a number of reasons for licensing statutes, including:

• Establishing credibility for the HME industry.
• Making clear that fraud and abuse in the Medicare/Medicaid program will not be tolerated, and reducing their incidence.
• Ensuring HME providers are fiscally stable and staffed and organized to ensure quality care.
• Removing the inducement for nonqualified companies to provide high-tech services, such as oxygen and apnea monitoring, without properly trained staff.
• Creating oversight so companies cannot go in and out of business leaving patients who need continuous ongoing support without backup assistance.
• Ensuring all companies offer a minimum level of service for off-hour situations.
• Eliminating product providers who let untrained staff or a carrier company, such as UPS, drop off equipment with no instruction and little or no billing assistance.

Currently, 17 states have licensure requirements. The licensing body is normally the board of pharmacy or the department of health. A review of the licensure statutes and implementing regulations shows many commonalties, such as:

• The HME provider must document staff training and adopt written policies and procedures addressing operations, including order intake; selection of appropriate equipment; delivery and setup; patient and caregiver education; service hours; emergency service procedures; retrieval, disinfection, and maintenance of equipment; maintenance of patient records; protection of patient rights; enhancement of quality assurance; and coverage by liability insurance.
• Freedom of patient choice must be maintained and bribes and kickbacks must be avoided.
• Before a permit or license is issued, the person in charge of the HME facility must personally appear before the licensing board.
• Before issuing an original or renewal permit, the licensing board must be satisfied that the HME provider has adequate qualified personnel; suitable facilities; accessible services; round-the-clock service for patients who would be in a life-threatening situation without the service; and written procedures for handling complaints; and is in compliance with Occupational Safety and Health Administration (OSHA) laws and regulations
• When a facility is to be closed, the licensing board must be informed and the equipment and patient records transferred so that the patients’ health is not jeopardized.
• The HME provider is subject to inspections and is liable for fines, penalties, and sanctions if the licensing standards are not met.
• The HME provider must provide and document continuing education for personnel.

By supporting these types of licensing requirements, the HME industry will send a strong message that it is serious about providing quality care and preventing fraudulent practice. If the HME industry proactively pushes for state licensure, then the industry can accurately argue that it is moving along the continuum to the same category as other health care professionals. State licensure requirements, when combined with supplier standards, will establish that the HME industry is adequately regulated. The final step in the process to squarely move the HME industry into the category of other recognized health care professionals will be to encourage, and perhaps mandate, accreditation. Once these steps are accomplished, the HME industry can state, with a great deal of conviction, that it is truly composed of health care professionals and not equipment vendors.

Jeffrey S. Baird, JD, is chairman of the health care group at the law firm Brown & Fortunato PC, Amarillo, Tex. Contact him at (806) 345-6320 or at www.jbaird@bf-law.com.