HME News

AUG 2019

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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Page 9 of 32

HME NEWS / AUGUST 2019 / WWW.HMENEWS.COM 9 BY LISA WELLS T EN YEARS ago, while teaching at the HME Busi- ness Summit, I met a group of professionals who quietly asked me to come visit after the confer- ence wound down. As a happy coincidence, we all lived in Atlanta, so I made time to stop by. In our first meeting, the UroMed executives shared how much the unexpected death of their former president, Jim Weatherford, had shaken the com- pany to its core. His loss left the rest of the owners wondering if their families were protected in case anything happened to them, too. UroMed was founded more than 20 years ago by six people, four of them wheelchair users due to spi- nal cord injury. At the time, 20% of their employees had disabilities. People with SCI typically don't have the same life expectancy as the general population due to a variety of health fac- tors, so their fear was legitimate. (I knew what their pain and struggle was like. I lost my father in 2002 to cancer that also invaded his spine. After he passed away, I led the sale of our family-owned business in the dental industry, alongside my younger brother. Wouldn't you know it? My dad's name was Jim, too.) After listening to them speak about their goals for their families and employees, in terms of financial sta- bility and success, I agreed to leave my successful busi- ness to help them gain attention for theirs, with the goal of growing to the point of sale. I'm happy to say we succeeded! UroMed sold in 2014. The senior leadership team for the most part today is still active in the industry, continuing to serve people who depend on medical supplies. A large acquisition isn't the only good thing that came out of our work, though. Our team also made an imprint on the social support network globally for people with disabilities, through the creation of Life After Spinal Cord Injury (LASCI). The first of its kind, LASCI was a connection point for people who often became isolated after leaving rehab. Today, LASCI has 70,000-plus followers. At its peak, it was reaching more than 100,000 people every week. Another program we created: Wheels UP! accessible travel event, now hosted annually by SPORTS 'N SPOKES magazine. Originally named "Get Out, Enjoy Life," the program encour- ages wheelchair users to explore their world using examples of peers doing the exact same thing. Wheels UP! is going into its 10th year of empowering people with disabilities. I could go on for days discuss- ing the legacy impact that the original UroMed team has left on the HME world and the disability community. In fact, I created and sold my own business in the HME industry—Wheel:Life—due to LASCI's influence on my own life. Perhaps that's why it's often said all roads in the U.S. urology industry eventually lead back to Atlanta. The UroMed team played a large part in establishing that perception (along with Mentor and Bard), due to their work as a company and through their previous roles with early providers in the field. That's why I'm sharing this picture with you. The mirror behind me was part of the Jim Weath- erford memorial library at UroMed until they moved post-acquisition. UroMed founder and world-renowned Paralympian Bert Burns called me the day Jim's memo- rial was reduced to a filing closet. He quietly asked me to help clean out the items in Jim's library to find them a new home. I left work immediately to help Bert carry boxes and furniture, knowing how hard that process was for him. Bert never said a word, quietly packing, until he looked up to ask if I would take the mirror because it wouldn't fit in his car. I promised him I would cherish it. Over the years since, I've sent Bert pictures of Jim's mirror no matter where I was living—including today in Las Vegas. Jim's mirror now has a place of honor in my work office at Cure Medical. Doing business in the HME world can be a glory ride. Through the highs, everyone is celebrating their successes. Through the lows, you have to keep moving with com- fort in the knowledge that it will all work out for the best simply because of your skill and commitment in serving people who have health needs. That's why you and I are both still here working tirelessly every day. When you get hit with unexpected news, or close a chapter in your own business, know that the light is right there in your mirror, too. You're looking at it—it's YOU. Your success might change locations or names, but the heart of it depends your commitment and passion for serving others who need our help. I often look in Jim's mirror in my office. It's come a long way from Atlanta, and I have, too, thanks to the investment UroMed made in me more than a decade ago. I'm eternally grateful for the way this team changed my life in a positive, professional way, even though I fought the process tooth and nail. HME friends, the moral of the story is this: The mir- ror you reflect into our community through your ongo- ing service is the salt and light of the world. Please keep going through the highs and lows. Your gifts are so needed by so many. You have the choice to reflect light or to reflect darkness. It took me a long time to get here, but I have made the conscious decision to be the light for what is right and what helps people live longer, healthier lives. I hope you will, too. HME Lisa Wells is the vice president of marketing for Cure Medical. She can be reached at BY STEVE SELBST I T IS important to remember that payers are large com- panies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get con- tracted you need to identify the right department and right person to send your request to get contracted. This is usu- ally the payer contracting department and payer contracts' manager. Generally, you will be sending your requests to the payer contracts manager in your state. A common mis- take is to, instead, send these requests to provider relations or to another department. This brings us to our second tip. That is, figure out the approach the payer is using to establish its fee sched- ules and negotiate your agreements based on the payer's methodology. Some payers establish a percentage of local Medicare rates based on specific code groupings. There may be a pre-set rate for each code or perhaps the same rate for code groups. I have seen national payer fee sched- ules that price E and M codes at a specific percentage of Medicare and another rate for laboratory and pathology codes and several rates for various surgical code ranges. You want to be sure to negotiate fee schedules based on the methodology the payer uses to establish rates. Some- times there is also the opportunity to "carve out" codes. Carving out codes means requesting specific rates for specific codes. You will want to be sure you carve out high utilization codes. The third tip is to be sure to emphasize value from a payer's perspective. Payers generally value unique prod- ucts and/or services that reduce surgeries and in-patient hospital stays and are going to help the payer reinforce its reputation. I worked with a large and innovative HME company that distributed a special boot that prevented diabetic foot ulcers. The value benefits of this product were that the company selling this product was the exclu- sive distributor of the product. The product had dem- onstrated outcomes, which both prevented surgeries and limb removals. These outcomes were important to pay- ers since the alternative treatment methods were far more expensive due to increased patient stay days and surgical complications. This brings us to tip 4. Tip 4 is to work your way up the payer chain of command, bottoms up, not tops down. Bureaucracies work best when you follow the chain of command. In fact, if you don't and you go tops down, the likely outcome is that the senior executive will push your request down to the lowest level of the organization and, the unintended consequence is that you will not be able to escalate your way back up the chain, since you already started at the top. You will have inadvertently taken away your own negotiations' options of drawing higher-level attention to your value proposition by starting at the top. Another unintended consequence is that you will likely have alienated the lower level managers who have now been handed the power in the negotiations, which will make it harder to get results. Always start at the bottom and work your way up. The fifth and final tip is to use complementary networks to facilitate and expand your cus- tomer and patient base. There are many networks and products, including leased networks, Medi Medi plans, Independent Prac- tice Associations (IPAs), Admin- istrative Services Only (ASOs), etc., that can be used to supple- ment your direct commercial payer agreements. By contract- ing directly with commercial payers and supplementing with these other kinds of networks, you expand your patient/ customer base and do not lose or limit the effects of the direct payer contracts. Leased network agreements usually exclude the direct-payer contracts that you have already put in place or are going to put in place. A leased network will not get in the way of your direct agreements. IPAs present an opportunity for their members to "opt in" to specific payer agreements and opt out of others. It is often a combination of Medi Medi Plans, and commercial plans, including PPO and HMO plans. HME Steve Selbst is the CEO and co-owner of Healthcents Inc. You can reach him at 831-455-2174 or STEVE SELBST You have to keep moving with comfort in the knowl- edge that it will all work out for the best, because of your skill and commit- ment in serv- ing people, writes Lisa Wells. Look in the mirror, my HME friends Five ways to break down bureaucracies to get contracts Commentary

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