Providers: ‘It never seems to really work out in our favor’ 

YARMOUTH, Maine – HME providers in Georgia and North Carolina are finding it hard to see the benefits of participating in a new capitated agreement between Synapse Health and UnitedHealthcare.  

Synapse says providers in its network will benefit from not having to perform administrative tasks like collecting documentation and can, therefore, accept lower reimbursement. 

“Is there really that much administrative cost to be made up in this that you're willing to look at a subcontracting agreement with Synapse and still do the bulk of the actual work that costs us money,” said Tyler Riddle, president of MRS Homecare in Tifton, Ga. “(We’re still doing) the purchasing of the inventory, the maintenance of the equipment, the delivery and setup, and the service calls.” 

The agreement – for standard DME for UHC’s Medicare Advantage plan members enrolled in HMO and PPO plans in the two states – was announced May 1 and takes effect Aug.1.   

Provider Craig Rae went through the credentialling process for Synapse but says the proposed reimbursement is too low and, in some cases, won’t even cover his costs. 

“Many of the rates were up to 75% less than we receive from some other fee schedules, and they were also below our pre-Covid costs,” said Rae, owner of Penrod Medical Equipment in Salisbury, N.C. “I found a few where the reimbursement rates were nearly 40% less than my purchase costs. I couldn’t begin to break even if I provided the cheapest quality DME available – and I won’t do that – and if they doubled their rates.” 

Provider Chad McCrickard says the contract puts independent companies in a tough place. 

“A national company a lot of times will take it for the volume, and we kind of get stuck, so to speak, because we have patients that we want to continue to take care of,” said McCrickard, president of Petsch Respiratory Services in Martinez, Ga. “It never seems to really work out in our favor.” 

With the implementation date approaching, providers are trying to figure out what to do with their patients who will need to be transitioned. 

“I asked the question, ‘On July 31, do we go ahead and pick up all of our active rental equipment?’” said Frank Trammell, founder of Carolina’s Home Medical in Matthews, N.C. “I didn't really get an answer for that.”