How to build an effective in-house DME program — Insights from two ortho practices

Operating an in-house durable medical equipment (DME) program can increase both patient satisfaction and profitability. Sustainable, successful programs are built on a solid foundation that includes compliance, streamlined workflows, documentation and reliable checks and balances.

Becker’s Healthcare recently spoke with three experts about best practices for developing DME programs that elevate patient care and simplify administrative processes:

  • Chris Braddock, clinical operations manager at University Orthopedics, headquartered in Providence, R.I.
  • Klarisa Devine, DME manager at Proliance Orthopedics and Sports Medicine, headquartered in Bellevue, Wash.
  • Eric Seeber, Impact consulting manager, Breg

In-house DME programs have a positive impact on both the patient and employee experience

There is significant variation in patients’ DME needs and concerns. By addressing all of these issues, practices can offer patients peace of mind. “About half of our patients are worried about the clinical aspect of their DME needs, while the other half are concerned about the financial aspect,” Mr. Braddock said. “We’ve set up our program to offer expertise around product fitting, as well as compliance and insurance. Our team members can give patients information on the clinical side and explain how their DME requirements will impact their insurance.”

Both University Orthopedics and Proliance Orthopedics and Sports Medicine have partnered with Breg to support their DME programs. Breg’s Vision® workflow management software streamlines key processes that contribute to a better patient experience.

“Our patient care has improved by having a system that enables us to give patients real-time information,” Ms. Devine said. “We can quickly enter an order and apply that to the Breg Vision system. The information is available in Vision and we can review it with the patient. Patients have a better sense of product costs and what to expect up front. Our staff also has more time to fit products and discuss them with patients, rather than spending time filling out forms or researching insurance information.”

From an employee perspective, decreasing the burden associated with administrative processes is extremely important in this era of healthcare talent shortages and high staff turnover. “The Vision system interfaces with the EMR platform to pull schedules and push documentation and billing,” Mr. Seeber said.

Automation allows staff to focus on what they enjoy doing most — working on clinical matters and answering patient questions. By reducing the amount of time required for paperwork, team members at University Orthopedics have more time to learn about products and advance in their careers.

“When we first started our DME program, we had about 25 products and now we are up to 80 throughout the organization,” Mr. Braddock said. “DME employees are excited to learn about new products. We have medical assistants who want to advance professionally and learn about another department, as well as orthopedic technicians who have done a lot of casting but want to get into durable medical equipment fitting. We started an initiative where DME team members select a product and then present to the organization how it’s used and how to fit a patient. It keeps people interested and gives them a sense of purpose.”

Successful DME programs go beyond product acquisition

When organizations are seeking vendor support for an in-house DME program, it’s important to assess more than just the product selection. “I think you need to ask what your support system will look like. You must assess things like the technology systems and the customer service,” Ms. Devine said.

Mr. Braddock agreed. “In a busy orthopedic setting, time is priceless. I wanted a vendor who could help us set up our practice to be as compliant as possible and to create streamlined workflows. Most of the vendors who came in were actually product reps trying to sell fancy devices. We’re running an orthopedic practice with over 100 providers and 12 locations in two states, so products aren’t the only things we’re looking for. We wanted the compliance piece and a program with a strong foundation.” Breg provides the support that practices need to successfully launch their DME programs and expand over time. After University Orthopedics merged with another organization last July, it was easy to onboard the new offices into its DME program. According to Mr. Braddock, “Now that we have established the foundation for the program, we find it much simpler to transition when we have mergers or acquisitions. I think most healthcare organizations are moving in the direction of consolidation, so having strong processes in place can make those transitions fairly seamless.”

Breg provides clients with comprehensive support related to documentation, coding and more. Competitive bidding, for example, can be a complex area for practices. “Physicians are exempt, but there are still requirements that physicians must adhere to for reimbursement,” Mr. Seeber said. “Specific codes and modifiers must be used that are related to time and place of service. These are little things which if not done correctly would mean either a recoupment or denial of a claim. That costs practices valuable time and revenue.”

Coding has also changed significantly over the years. When Breg works with new clients, it performs an initial coding assessment. “Sometimes we find that practices are still using code sets that are several years old and don’t reflect the most recent changes to regulations or LCD and policy articles,” Mr. Seeber said. “We do a complete evaluation of new customers’ workflows, coding, documentation and credentialing to help them ensure that all those components meet the mark, so they can provide efficient and compliant patient care.”

Best practices include program champions, phased rollouts and ongoing evaluation

As practices consider creating and managing an in-house DME program, one of the most important factors is identifying a project champion who will take ownership of the initiative and be accountable for its success. Mr. Braddock served as this individual at University Orthopedics.

“The starting point is finding someone who can be the captain or the driver of the bus,” Mr. Braddock said. “It’s helpful to find a person who is dedicated to orthopedics and someone who perhaps has experience with clinical workflows as a medical assistant or an orthopedic technician. It took me about three months to do my own research and I really became an expert.”

Initially, University Orthopedics went live in one location with around 10 products. The following month, two additional locations went live. As the team became more comfortable, it started looking at adding products.”

To further improve the performance of its DME program, University Orthopedics began running reports from its EMR to identify when providers were scripting devices out to other vendors. “We made an effort to move that business in-house, so patients don’t need to go anywhere else,” Mr. Braddock said. “As we did this, we felt confident that we were abiding by the regulations and using billing processes that were compliant.”

Breg’s Impact Consulting team offers customers biannual business reviews to evaluate the people, process, performance and profitability of their DME programs. “We explore whether employees are trained appropriately, as well as how the clinical and billing staff communicate with one another,” Mr. Seeber said. “We also assess whether policy updates are being handled correctly across the clinic, practice or health system.”

A one-stop shop for DME promotes continuity of patient care and contributes to top-line revenue  

Both University Orthopedics and Proliance Orthopedics and Sports Medicine have used their in-house DME programs to create a one-stop shop for patients. Patients can get their medical equipment on the same day as their appointments. The products are clearly explained and patients know they can come back and get devices replaced under warranty if problems arise.

“Our goal is to enhance patient care,” Mr. Seeber said. “Physicians understand what is and isn’t appropriate for their patients. When providers can provide the brace at the time of the visit, when patients need it, that’s very valuable. There’s continuity of care.”

In-house DME programs also serve as a cost center, which can drive significant profitability for practices and health systems. For example, Breg recently worked with an academic medical center to support its bracing program. The initiative has been thriving and now, five years later, it is generating over $2 million in revenue. This is helping to support the organization’s expansion into new markets.

“We’ve had our DME program for about six years, Mr. Braddock said. “It not only helps from a revenue cycle perspective; we’re employing more people and providing great patient care.”

Proliance Orthopedics and Sports Medicine’s three facilities have also greatly benefited from its DME program. “From a revenue perspective, we’ve continued to see growth year after year,” Ms. Devine said. “We have a system and a customer service team that helps keep us compliant with regular check-ins, documentations, mock audit assistance, billing help, training, the works. We have trained staff that give patients better care, product information and product options. Breg has paved the way and has been a right hand to our program’s success.”



1 Breg Vision is a registered trademark of Breg.

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