CLEVELAND, OH – In the spirit of the snow temporarily melting in Ohio, I find myself embracing the change of the season. It’s a reminder that while many things persist, change is always upon us.
But despite a new season, we continue to have similar headwinds from a similar cast of characters. Insurances don’t value our services, competitors continue to provide products with less documentation requirements, and a new round of bidding is once again upon us.
With the change of the season, I am challenging myself and others to change the narrative and perspective. A wise man once said, “change is inevitable, except from a vending machine.” Not only do the things around us change, but our attitudes and perspectives have the ability to change too. Here are a few things we are talking about at Medical Service Company to make sure we take Spring head on.
Instead of complaining about managed care “challenges,” we are seeking to collaborate with them. These payers are truly our largest referral sources. What we have found is so many of our payers don’t have a great handle on what DMEPOS providers do and the impact we can have on the total cost and care. Making the invisible visible for them has been our starting point. None of this is groundbreaking, but it needs to be done at a grassroots and treetops level.
While we don’t think of the color grey in the Spring time, we sure do as it relates to the Medicare Local Coverage Determinations (LCDs)! The grey area between an LCD, National Coverage Determination (NCD), and your own interpretation can be pretty drastic. Some organizations are more conservative and others more aggressive in these interpretations.
Our goal is to make the coverage criteria as clear as possible through our own team of experts along with outside resources. In addition to that, the reality of audits constantly tests our own interpretations. The goal is to ensure we are consistent and not wavering for ‘better’ or ‘worse’ referral sources, thus creating trust internally as well as in the communities we serve.
Don’t forget that in the Spring, you can expect some showers. I guess that is where competitive bidding round 2021 comes in. Kamikaze bidding has never served our industry well, and I certainly understand the concerns as we begin to embark on another voyage through a bidding program. The new program is not perfect. We see critical flaws, such as including high-touch therapies such as ventilators into a price-sensitive bidding program.
But, with every April shower, we expect a few May flowers! The reality is that the upcoming round of bidding will be vastly improved. Bidding rates will be determined from the clearing price vs the median price. There are more specified product categories, and the actual bidding is simplified through a lead-item pricing approach. This is quite an improved recipe.
As I spring forward, I’m excited to see familiar faces at many of the upcoming industry events, starting with Medtrade Spring (April 16-18, 2019, with Advance Rates in effect until April 6), followed by AAHomecare’s Legislative Conference in late May. Each of these events present unique access to key partners, as well as important industry information. With these events all jam-packed into Spring, I hope you can take the change of the season as an opportunity to Spring Forward with your company and improve your strategies.
Josh Marx is managing director, Sleep, and vice president, Business Development, for Medical Service Company, Cleveland, Ohio.
