The worst that I have seen it

After serving our community for the past 170 years, Gulick's Illiana Medical Equipment and Supply will be closing its doors for good by Nov. 1.

That's correct, we've been serving our community since 1846! My great grandfather owned three drug stores in the Depression. To see the full history on our company, please visit http://www.gulickhhc.com.

Our decision to close was not an easy one for us to make. We have been taking care of families in our community for a long time. Some families we have been taking care of for several generations.

The decision to close was pretty much made for us in these last rounds of cuts made by Medicare—24% in January and another 24% in July. We did not think we could provide a quality service or provide quality equipment at these payment rates. There was no way we could survive delivering hospital beds for $75 a month, oxygen concentrators at $90 a month, just to name a few examples. And once Medicare establishes these payment rates, the private insurers are right behind them cutting their reimbursement by more than 48%. At those rates, we could not pay our staff, the workers' compensation, the liability insurance, the fuel, the vehicle insurance, let alone the power bill!

Our patients are very confused and frightened about where and how they are going to get the same kind of quality service and quality of equipment somewhere else. These patients have come to depend on us for advice when they become ill and advice on where to get other services they may need. I am asked on a daily basis, “What am I going to do when you are closed?” I really don't have answer for them.

Personally, I have been in the HME business for 38 years and this is the worst that I have seen it. Our Medicare system for HME is very confusing and burdensome for us to navigate, let alone an 84-year-old patient or caretaker or case manager at the hospital. Providers are not sure if we have enough information that supports the medical need, the doctors aren't sure what to dictate into their notes for equipment—Medicare has made the guidelines too hard to understand, let alone actually get the information in the right format to support the medical need for the equipment. Take the oxygen guidelines, which require copies of the test signed and dated, chart notes with the test results signed and dated, the initial order with the right information signed and dated! Trying to get all this information on a Sunday afternoon is impossible.

Many patients are getting discharged from the hospital with no equipment because the HME provider is being up front with the patient telling them, “I can't guarantee you that your oxygen or your hospital bed will get paid for.” The patients can't afford the rental so they go home without the equipment and then 10 days later they are back in the hospital for the same reason they went in. But now the hospital can't get paid for the re-admit because the patient hasn't been out for 30 days. So now everyone is losing—the patient is still sick not getting better, the HME provider isn't getting paid   because there is not enough medical documentation to support the need, and the hospital is not getting paid, either.

As we move forward, the case managers will be calling not one but several HME providers trying to find out which one provides which services and which ones will actually take Medicare as a payment source.

Service will be a thing of the past and quality equipment will also be a thing of the past. Walkers will be falling apart not long after they are issued, beds will start breaking just months into rental, and wheelchairs will have arms breaking and tires falling apart.

We are not the only HME provider closing its doors. Small providers all over the country are closing. These small providers are the backbone of the industry and provide quality care and quality equipment, but soon we will be a thing of the past.

As we close our doors, it truly is the end of an era.

Steve Gulick is the owner of Gulick's Illiana Medical Equipment and Supply. He has been working in the HME industry for 38 years. You can reach him at stevegulick@sbcglobal.net.