Interoperability gains traction with HME

Interoperability – the cyber pipeline for data sharing among various providers on the health care continuum – has been evolving over the past two decades since its launch during President George W. Bush’s administration in 2004. It was adopted primarily by large acute care organizations during its formative period, but it appears providers in the post-acute sector, including HME companies, are finally jumping on board. 

“Health care interoperability is essential for smooth transitions of care, ensuring that both treatment and reimbursement needs are met in a timely manner,” said Nick Knowlton, vice president of business development at Peachtree Corners, Ga.-based Brightree. “While the post-acute space, in general, and the HME world, in particular, have seen a slow adoption process compared to other care settings, this is rapidly changing.” 

Driving that change: The COVID-19 pandemic, which has emerged as a catalyst for technology adoption and has underscored the importance of connectivity between providers in the acute and post-acute sectors, Knowlton says. 

 “We have seen a large uptick in interoperability requests not just from HME providers, but also from referral sources and other stakeholders to improve connectivity on behalf of our industry and the patients being served,” he said. “In short, we are seeing rapidly increasing expectations and interoperability solutions delivered in our industry over the past 24 months. Combined with other trends, such as the rising importance of timely hospital discharge and payment reform initiatives, the pandemic highlighted the value our industry can deliver to patients at home.” 

Through interoperability, HME providers can use their business systems to interface and integrate with key partners for improved operational efficiency. Brightree offers interoperable services that allow for direct connections and messaging between providers, including those on popular electronic health record platforms; bi-directional connections with most ePrescribe platforms; interfaces to dozens of manufacturer and distribution systems; connection to patients in omnichannel modalities; and thousands of custom interfaces, Knowlton says. 

Outsourcing options 

While interoperability is gaining traction with HME providers, so is adoption of increasingly sophisticated business systems capable of managing a greater array of operational functions, especially as it relates to revenue cycle management, says Joey Graham, CEO of Charlotte, N.C.-based Prochant. 

“The No. 1 thing that we hear from providers is they’re struggling with staffing – hiring, training, retaining and managing to excellence takes a tremendous investment of time and resources,” he said. “Then, after dozens of hours of training, the employee leaves for $1 an hour more. Providers say they’re frustrated with leaving money on the table from low payment rates, high write-offs and too many denials. They need to get it under control, ensuring they are collecting every possible dollar.” 

Getting the most out of a business system requires a customizable, scalable setup that enables providers to focus on growing their businesses and serving their communities. With Prochant, providers can outsource to areas that need it most, including intake, prior authorizations, billing, collections and cash posting, Graham says. 

“We meet the provider where they need help,” he said. “Our team becomes a seamless extension of their in-house staff. We utilize workflow and analytic dashboards to provide clients with preferred services and outcomes.” 

Todd Usher, founder of Modesto, Calif.,-based Tactical Back Office Personnel, specializes in staffing, but maintains that “a lot of companies hire us to do their billing.” The need to be flexible with staffing is common with acquisitions, slowdowns, audits, accreditations, pandemic surges, local personnel constraints and "other crisis situations that we endure in health care," he says. Outsourcing billing and other operational functions offer providers various advantages with staff assignments. Among the multitasking capabilities are CMN and PAR processing, quality assurance, aging and even operational supervision, he says. 

“We offer value-based assistance to clients who know what they’re doing and want to keep their operations in-house,” he said. “We will do anything they need – if it’s a slow billing day, we’ll move over to intake or answer phones.” 

Further expansion 

Knowlton is encouraged by the HME industry’s growing interest in connective technology with telehealth, remote patient monitoring and patient-facing solutions, in addition to interoperability between health care entities. 

“We will continue to see the expansion of technology and disruptive innovators joining the field as HME and home-based care become more popular,” he said. “As more and more providers are expanding into the space and patients search for means to personalize their care journeys, there will continue to be ways to improve the solutions and relationships they foster. HME providers and patients have confirmed their interest in the best software systems and solutions, but that is just step one to providing the best experience.”