Patient Access: Identify gaps in access

Q. How can HME providers impact patient access? 

A. In this post-pandemic world, patient access to home medical equipment continues to be threatened by increasing costs. Significant inflation (7.2% in 2022), shipping and supply chain costs, coupled with stagnant reimbursement, may pose challenges for providers to supply the high quality HME preferred by patients and prescribed by clinicians. Providers may assume an active role in improving patient access by actively reviewing payer contracts and approaching payers when reimbursement rates fall short. The time is now for HME providers to educate payers about their critical role during and after the pandemic. 

To identify gaps in patient access, HME providers should perform a comprehensive review of all commercial contracts to identify where rates do not support access to a variety of products and features. For upcoming contract renewals, identify key contract dates and develop strategies to engage with payers. For longer term contracts, HME providers may consider scheduling a business performance review to illustrate the value to the plan and request a pre-term rate review for products where margins have deteriorated. 

Strategies for payer engagement have been detailed in recent webinars, like “Negotiations in a Post Pandemic HME Industry” by AAHomecare & Coloplast. HME providers may take advantage of these resources, as well as those developed by AAHomecare. Examples of resources include: The Value of HMEs for Payers, Supply Chain Strain and Market Pressures Letter, Critical Need to Provide Intermittent Catheter Supplies Specific to Patient Need to Improve Health Outcomes, Critical Need to Provide Ostomy Supplies Specific to Patient Need to Improve Health Outcomes and Order Flowcharts for Common DME & Supplies. 

By leveraging resources that articulate to payers the value of HME providers, the rising cost pressures of doing business and where access is limited by rates, HME providers may create meaningful change for patients.

Kathryn Vaughn is director of Market Access for Coloplast. Reach her at uskva@coloplast.com.