I have been in the HME industry for 8 years, a mere drop in the bucket compared to many of the people I meet in the industry. Yet, I have noticed tremendous changes in the way we provide medical equipment and services. This has been directly related to the shifts in reimbursement dollars.

In the early 2000s, we were chomping at the bit to provide nebulizers with medications. We set up the nebulizer and medication (all insurances) in 2 hours, no matter what time the referral was called in. The average Medicare reimbursement for patients with a rental nebulizer with albuterol and ipratropium QID (in 2001) was about $361 per month.

In 2001, nebulizer patients’ experiences surpassed their expectations. We hand-delivered their medications, had a respiratory therapist educate the patients on how to use them, and then had a pharmacist follow up. We also had a respiratory therapist follow up after patients had some time to use the machine on their own.

We called patients frequently to see how they were doing and if they had any difficulties or questions. We were always there for our patients. If patients forgot to reorder medications and they were almost out, we would hand-deliver them the same day—even if they called at 8:00 pm on Sunday night. The reimbursement allowed us to pass on the highest level of service to our patients.

Today, the patient’s experience is much different than 5 years ago. For the same average order, Medicare’s reimbursement is $104.72. If you’re doing the math, that’s a 71% reduction in reimbursement! Our company (DASCO) could not continue to provide nebulizers and medications the same way and still be profitable. We still provide exactly the same products to patients, but we are no longer able to provide the same services. This is a great loss for our customers and all involved. A closer look reveals why.

No More Pharmacy Services
Several HME companies are no longer providing pharmacy services at all, and the companies able to keep their pharmacies open are often not able to provide same-day delivery. Many of the HME industry’s pharmacies (including ours) have experienced lay-offs.

Many one-on-one conversations with patients have been replaced by computers and automation. We are able to provide for about 65% of the patients we used to due to reimbursement changes (such as private insurance companies demanding patients go to mail-order pharmacies and reimbursement lower than our costs).

When our associates and patients ask why we made all of the changes, we tell them the truth: it is due to reimbursement reductions. If we continued to provide inhalation medication services at the level we did in 2001, we would not have a profitable pharmacy.

Rather than closing down our pharmacy, our passion continues to be to provide the best possible care for our patients, and we believe we do this better than mail-order and retail pharmacies. We still monitor our patient’s care with respiratory therapists and pharmacists; they are just not as hands-on as they used to be.

We still go to patients’ homes for re-education, but we are just not as prompt as we used to be. We still assess our patients and monitor their respiratory condition, but we don’t always do it face-to-face. Thus, the patient and the insurance provider are losing the one-on-one contact of an educated specialist that could prevent a trip to more costly hospitals.

I believe in what we do. Providing for people’s medical needs in their homes (rather than in institutions) is often better for all concerned. The patients are happier, the insurance companies pay far less, and small businesses are supported by providing these services. Everyone wins.

Alternative to Institutions?
In the past 5 years, I have noticed a shift away from looking at the HME industry as an alternative to patients staying in hospitals or other institutions. We used to be perceived as an alternative to institutional care, but now we are looked at as replaceable by a nonmedical retail store. This simply is not realistic.

We provide in-depth care and hands-on service that allow patients to stay in their homes, not in the hospital. We are there for our patients to make sure their HME needs are satisfied. We assess the safety and environment of their surroundings and educate them with caring and compassion. Should this ever be phased out?

If I had a nickel for every time I read something that asked, “How can a mega store provide a piece of equipment for so much less than an HME company?,” I would be a rich woman. Comparing HME prices to retail prices evokes frustration from everyone reading the statement. Readers from outside the industry are led to believe we are taking advantage of insurance companies by overcharging. Readers from within the HME industry are insulted that our level of care is being compared to someone who simply hands over a piece of equipment and accepts cash for it. Rather than comparing us to a retail store, we should be compared to institutional care. The question that makes sense is: “How many emergency room visits have been prevented by HME services?”

Nearly every week we get a call from someone who needs us immediately or he will have to go to the emergency room. For example, someone’s child may need more inhalation medications for an emergency treatment and the caregiver does not have any on hand. Back in 2001, we would have gone to that patient’s home immediately to deliver additional medication, but now we cannot. With the low reimbursement, we cannot justify the cost of having a pharmacist available 24/7 to fill orders. What do you think will happen to that patient if they cannot get medications in a couple of hours? They will end up in the ER to get an inhalation medication treatment. How much does that cost insurance companies?

HME companies continue to be patient advocates. Often, we are the only people fighting on our patients’ behalf, demanding reimbursement that offers the highest level of service. The level of service our patients receive is directly related to how much their insurance pays. But we also attempt to balance high service with competitive prices.

The changes over the past 5 years have been difficult for many HME companies, including DASCO, but we will adapt. As long as insurance companies change their reimbursement, our industry will have to change as well. The HME industry is the answer to rising health care costs, and to avoiding emergency room visits. DP

Rachel A. Mazur is the CEO of DASCO Home Medical Equipment, Westerville, Ohio. Mazur co-owns DASCO with her brother, Jason Seeley, and together they are third-generation HME company owners. Mazur can be reached via e-mail: rmazur@godasco.com.