Non-rural providers feel sidelined

YARMOUTH, Maine - HME providers located in the “no-man's land” between rural areas and competitive bid areas say they are nearing the breaking point.

“I think the bid areas may find some relief before we do,” said Kevin Hill, owner of CPS Medical in Tyler, Texas. “When they passed the original Cures Act (in 2016), that made things survivable for six months, but now we are left out in the cold.”

A final rule on the competitive bidding program, released in November, did not include a hoped-for extension of the 50/50 blended reimbursement rates to all non-bid areas.

For provider David Chesnut, the lack of relief has meant cutting back on products, services and assignment.

“We've had to cut out delivery on most items, and if they need equipment serviced, we ask customers to bring it to us,” said Chesnut, owner of Pennyrile Home Medical in Cadiz, Ky. “We had to cut out a lot of the basic and most common items we used to bill for. It's strictly on a cash basis.”

It's the same story in Vermont, which is not included in any CBAs, says Chris Henry, owner of The Medical Store.

“It's frustrating to look and see that I am getting paid less in Burlington than in some of the bid areas,” he said. “If the scales don't tip in our favor that will cause us to have another move and decide what we are going to do next.”

In June 2018, The Medical Store exited the complex rehab business, largely due to CMS's decision to apply bid rates to accessories for complex rehab manual wheelchairs.

“The complexity of delivering CRT in a rural state is challenging, and with the lack of relief specifically related to accessories and repair of that equipment, we could no longer do it the way it needs to be done,” he said.

Relief for non-rural providers is a top priority, says John Gallagher, vice president of government relations for VGM, who says he hopes to see legislation introduced this spring.

“It's just getting that score (from the Congressional Budget office) and getting the language finalized,” he said. “We're talking to lawmakers about how 45% of all Medicare beneficiaries are in non-rural areas.”