The 2014 HME Handbook: Support Surfaces
How to Re-approach the Business of Providing Support Surfaces
Considered a cornerstone of many HME providers businesses, support surfaces have seen considerable change. Already Medicare has been winnowing down reimbursement across the board for DME, including support surface, but it also added Group 2 support surfaces to the list of categories for Round Two of competitive bidding, which caused a major market shift. Also, as other providers try to diversify their businesses, some are adding support surfaces to their product and service ranges, increasing the level of competition.
Bearing all that in mind, many providers of support surfaces have to re-approach how they do business — and that is a tricky proposition because the existing clinical concerns still weigh heavily in the equation. Those providers must balance how they can continue to work to ensure that patients get the right therapeutic surface so that they experience the best possible outcome, while also keeping one eye looking out for new market opportunities and the other eye on the bottom line in order to survive these massive marketplace changes. Needless to say, striking that balance isn’t all that easy.
The key is to understand the challenges and the opportunities. Let’s examine what market factors are causing providers to reshape their support surface strategies and look at how they might be able to drive new revenue.
Competitive Bidding
The biggest factor to force providers to reconsider how their support surface businesses would work is the addition of Group 2 support surfaces to Round Two of competitive bidding. This includes alternating pressure and low air loss mattresses, which make up a considerable percentage of the therapeutic surfaces being provided to patients. The population patients that need a support surface that either helps prevent or treat wounds and pressure sores is sizable. Fortunately Group 1 surfaces, such as non-powered mattresses and overlays, and Group 3 surfaces, which are air-fluidized surfaces, but the volume of patients needing Group 2 support surfaces is vast.
For providers that didn’t win contracts, they lost a significant amount of business and are in the process of trying to reinvent their businesses. For providers that won contracts, the reimbursement rate cuts were substantial (see “Learn More” for a link to the Round Two single payment amounts organized by category and competitive bidding area. And for providers that aren’t part of Round Two? They still might be impacted, as CMS is considering taking the program national by 2016.
Price and Quality
Of course, “winning” is a subjective term. Many support surface providers holding a Round Two contract are wondering if they truly won. Given the low reimbursement rates, they have had to drive increased efficiency in their businesses, and for many that means reducing inventory overhead; they must drive down the cost of their support surfaces. This creates a major challenge: finding support surfaces with a low enough price point that they can turn a profit, while also having something that is durable and will generate the right patient outcomes. Moreover, once they settle on a support surface, those providers must ensure that the manufacturer will be in the business for the long haul.
Reaching New Markets
For providers not holding Round Two contracts, pursuing new referral and reimbursement sources is a must — and there are a lot of people who are not Medicare age that need a Group 2 support surface. This means that providers need to focus on opportunities such as hospice, worker’s compensation and private payor insurance. Another possibility is the sizable nursing home market, which doesn’t require providers to have to deal with Part B. And let’s not forget retail sales. While there are many patients that will want their funding to cover the mattress, there are patients that will want the best possible therapeutic surface for their loved ones, and that is an important market opportunity providers should not ignore.
ACOs
In addition to here-and-now patient markets, support surface providers must look to the horizon for how they can expand their business. In that regard, they should carefully monitor the development of accountable care organizations (ACOs). By their definition, ACOs are looking to ensure optimal patient outcomes while keeping costs down. This plays to support surface providers’ business mandate in terms of being about to source quality products while working within razor-sharp margins. They can establish themselves as key resources for these new healthcare entities.
Moreover, ACOs will have a similar impact on the entire healthcare landscape. As other payors and healthcare entities watch ACOs, they will aim to accomplish the same goals: ideal outcomes at ideal prices. This means support providers can expert more of the same from their other business sources and referral partners — and given the challenges they are currently facing, those providers should be in a prime position to serve them.
Points to Remember:
- Support surfaces have traditionally served as a key product/service line for many HME providers, but many market factors are forcing them to re-shape their businesses.
- A key market change has been Round Two of competitive bidding, which incorporated both Group 2 support surfaces and mattress overlays.
- For providers that won, they must determine how they can provide decent service and product quality despite razor-thin margins.
- For providers that didn’t get contracts, they must tap into new market opportunities, such as hospice, worker’s compensation and private payor insurance.
- On the horizons, ACOs will be a key business opportunity and market influence.
Learn More:
- Obviously, Round Two’s impact on Group 2 support surfaces and mattress overlays was considerable. But, for providers that weren’t part of Round Two, CMS’s recent solicitation for comment on a plan to take the program national by 2016, means all support surface providers could well be facing the same rates. Check out Round Two’s single payment amounts for these products at bit.ly/1jsNC7H.
This article originally appeared in the June 2014 issue of HME Business.