Heartland Sneak Peek: HME Industry SWOT Analysis

Published in Government Relations on April 22, 2022

By Craig Douglas, Vice President, Payer and Member Relations, VGM Government Relations

The types and quantity of changes that have occurred within our industry over the past two years are unprecedented, and the majority of them have been driven by the COVID-19 pandemic. Some changes are legislative, some are regulatory, while others are payer policy/reimbursement related. Regardless of the type of change, they all impact your overall business strategy in some manner. These changes have made a profound impact on the DMEPOS industry as a whole, and most likely on your individual business as well. 

In the last 2 years, we’ve seen a Medicare competitive bid program that, for all intents and purposes, didn’t really happen for most of you, increased demand for certain products, policy changes from both CMS and private payers, reimbursement changes, supply chain issues, and product recalls that have impacted many DMEPOS providers.

From a cost perspective, several manufacturers have implemented either temporary surcharges or permanent price increases. These price increases are not limited to just a few manufacturers or a few products, but rather impact a large percentage of commonly requested DME product categories. In addition to the product cost changes, there have also been sharp increases in labor, shipping, fuel, and other overhead costs. There have also been new costs that weren’t there before, or that were previously minimal but are now much more substantial, such as PPE, temperature scanners, plastic barriers in the office, etc.

On the flip side of that, there have also been changes on the reimbursement side of things for many providers. Government program money (think Paycheck Protection Program, HHS Provider Relief Fund, etc.), as well as price increases from Medicare/Medicaid/private payers which helped offset some of the price increases providers were experiencing. Was there enough assistance? Was there too much? Many of those pricing changes are temporary, and there is still quite a bit of uncertainty surrounding the long-term reimbursement direction from the industry’s largest payer, CMS.

With all that has happened and that is yet to come, you may feel like you have more questions than answers in terms of what this looks like when ALL the dust settles.

At this year’s Heartland Conference, please join Craig Douglas, Ronda Buhrmester, Mark Higley, and John Gallagher from VGM as they discuss these topics, answer questions, and propose best practices and potential solutions to help your business thrive. Learn more and register at vgmheartland.com.   

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1. billing & reimbursement
2. cms
3. heartland
4. vgm government