Round 5: Independent vs. hospital-affiliated HME providers

I had no idea of the lightning that would strike when we wrote a story about the increased competition between independent and hospital-affiliated HME providers (HME News, October 2010).

The lay of the land

Following that story, we wrote about a bill introduced by Rep. John Dingell, D-Mich., that would allow hospital-affiliated HME providers in competitive bidding areas to continue providing products and services to their patients at the winning bid amounts regardless of whether or not they won contracts (HME News, October 2010); and about a provision tucked away in the Medicare Improvements for Patients and Providers Act (MIPPA) that states hospitals, whether or not they have been awarded a competitive bidding contract, will be able to continue furnishing walkers and “related accessories” to their patients (HME News, November 2010).

(A note about the bill and provision: They differ in that the bill names hospital-affiliated HME providers specifically, not just hospitals, and it applies to all the product categories included in competitive bidding, not just walkers.)

We've also polled our readers to get their thoughts on hospital-affiliated HME providers. A clear majority of them, 88%, say, when it comes to competitive bidding, hospital-affiliated HME providers shouldn't get any breaks. (See story in HME News, December 2010.)

These stories continue to spark debate. Here are comments from three independent HME providers who contacted me this month, while I'm working on the December issue:

'This isn't the horse and buggy age'

Hospital-affiliated HME providers argue that they're more motivated to take care of a discharged patient's needs quickly, because they're trying to free up a bed for their hospital. One provider who called me said that's nonsense and that he can get the job done just as fast.

“Listen, this is the day and age of fax machines; this isn't the horse and buggy age,” he said. “If a doctor faxes us an order for a bed, it's in our best interest, too, as a business, to take care of that as quickly as possible. It kills me to hear (hospital-affiliated HME providers) say they're the only ones who have the incentive to make sure nothing goes wrong.”

'What's illegal for me is encouraged for them'

The recent stories on hospital-affiliated HME providers opened old wounds for one provider.

“I'm a respiratory therapist,” he said. “I can't test my folks, but if I work for a hospital, I can. I put my hospital hat on and test them, and then I put on my HME hat and set them up. What's illegal for me to do is encouraged for the hospital to do. They're self-referring. If they want to talk about fraud, that's the perfect setup to bilk the system.”

Are they held to the same standards?

One provider wonders if hospital-affiliated HME providers are held to the same standards as independent HME providers.

“Where's the sign on the hospital that says ABC DME?” he asked. “Do they have a person sitting in office space or are they running it out of the RT department? We see it a ton where the patient gets the equipment quickly, but the same guy handling that has to run to the ER to handle whatever's going on there. Is there someone there day-to-day to cover the patients?”

Liz Beaulieu