Evaluation and Implementation of Durable Medical Equipment

Turning DME Implementation Challenges Into $750K in New Profit

Challenge

After several failed attempts at DME implementation, a 20-provider, multi-location specialty group asked TTG/Coker to evaluate and implement a Durable Medical Equipment program focused on bracing. After analyzing payor agreements, payor mix, workflows, and CPT, TTG/Coker designed and implemented a DME program, increasing EBITDA by $750K in year one of implementation.

Solution

TTG/Coker began conversations with providers regarding their general value of DME and the types of bracing they valued most for patients. Several DME suppliers were interviewed, and purchase rates were negotiated. TTG/Coker created a DME program that includes workflows and education for providers through a collaborative process to avoid past roadblocks. Monthly process meetings occurred for the first six months to tweak workflows and avoid team resistance to the additional work required. Ultimately, DME became the most profitable ancillary service line of the practice.

Approach

Step 1Review of Payor Coverage and Rates for DME
Conduct a comprehensive review of payor coverage and reimbursement rates for durable medical equipment (DME) by scrubbing payer agreements and fee schedules.
Step 2Understand Clinical Workflow and Patient Needs
Identify the patient journey from appointment scheduling through discharge to gain a thorough understanding of clinical workflows and patient needs related to DME.
Step 3Collaborative Creation of Workflow
Coker collaborated with the team to outline opportunities to introduce DME evaluation into the workflows by identifying patients and diagnoses who would benefit from conservative care.
Step 4Provider Education and Implementation
The DME Suppliers educated the providers on the appropriate diagnosis for each type of brace, including patient results and feedback.
Step 5Analyze, Monitor, and Communicate
The prescribing, authorizations, and billing submissions were monitored for compliance throughout implementation.

Conclusion

TTG/Coker helped this specialty group overcome years of stalled efforts and transform a previously unprofitable initiative into a high-performing service line by taking a strategic and collaborative approach to DME implementation. The team’s focus on aligning financial opportunity with clinical value, tailored workflows, provider engagement, and ongoing monitoring ensured adoption and long-term success. In just one year, the new DME program enhanced patient care and delivered a $750K increase in EBITDA, establishing DME as the most profitable ancillary service for the organization. This case underscores the impact of thoughtful integration and cross-functional alignment when introducing new service lines in complex care environments.

$750K EBITDA Growth in First Year

Results At a Glance

$750KIncrease in EBITDA during Year 1

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