For years, the DME (Durable Medical Equipment) and HME industries have given away too much in the attempt to best service our customers. Our industry is comprised of caring individuals who want to make a difference in the lives of patient's we serve. What drives us is that we know at the end of each day, we made an impact, and improved the lives of the people we touched.
The DME and HME industries were created to help reduce the costs of Health Care. Research shows that getting a patient home from the hospital they heal and recover faster. Having a system where equipment and services are provided to the home reduces costly Hospital and Nursing Home Care. The DME industry is 1% of the Healthcare Budget, and saves a lot of money.
In the past few years, the pressures of insurance reductions, fraud and abuse, and increasing equipment costs have affective the way we conduct our service delivery. What started out as a noble profession of helping, has become a business of becoming efficient.
Caring for our customers, we created networks and groups to lobby the state and federal governments trying to avoid further reduction in access to wheelchairs, scooters, powered wheelchairs, standers, gait trainers and seating and mobility equipment.
What happens at CMS/Medicare is adopted by all other insurance carriers; so those who don't care what happens with Medicare are fooling themselves. Many of our customers cannot speak, many fear that if they complain and lobby that they could lose more than they already have, and others don't know how. Many providers have continued to give away services and equipment and now are no longer able to. We have failed to educate our customers, and now we are caught in an insurance system who isn't paying and customer's who are angry that they can't get what they used to.
Suppliers and Manufacturer's have commited time and resources to this battle; however since these groups profit from the provision of this equipment their voices are not heard as loudly as when it comes from the customers and beneficiaries of these insurances. Beneficaries will need to Advocate or Accept reduced access to quality equipment and services.
In the past few years, Medicare has instituted competitive bidding, where they forced providers to issue their lowest bid in order to stay in business. The first round of bidding caused hundreds of companies to go under, and 33% of the winning bidders closed within the first year. This program is being launched nationwide this year, and will certainly cause havock on beneficaries. As you may have seen the Scooter Store was raided and closed (for now), and all of their customers are stranded. Since they were investigated for fraud, providers are concerned. If a provider repairs and submits a claim for one of these customers, and that customer's paperwork is investigated and found that the Scooter Store did not complete their paperwork properly, that the funds for the chair and all services can be recooped by Medicare.
CMS/Medicare in the past two years had created a system where private companies are auditing providers in hopes to find missing or incomplete documentation so they can recoop money back to Medicare. These companies (bounty hunters) receive money based on this recoopment. Generally these recoopments are not because the customer/beneficiary didn't need the equimpent, not because they didn't get the equipment; but because their was a T-not crossed or an I not dotted.
Major insurance companies are following Medicare's programs, and it is affecting everyone needing durable medical equipment (DME). Many DME companies have stopped accepting Medicare as a payment sources as the risk of audits are too great.
There is still time to improve access to this life enhancing equipment. There are several groups looking for your and your voice to send a message that will affect the future of Medical Equipiment. I encourage you to research these groups and commit to sending emails and making calls to help reduce the future pressure. We cannot afford to lose more companies with the baby boomer population retiring and who will need access to these services. With the pressures from Insurance, the risks are too great for any new companies to invest in the infrastructure of a company to provide these services.
Important Pending Legislation
HR-942- House Bill to Separate Complex Rehab Technlogy Equipmentt from DME, an important step in ensuring Access
S-948- Senate companion bill to separate Compex Rehab from DME
HR-1717- Bill to Stop Competitive Bidding
Get involved:
NRRTS- National Registry of Rehab Technlogy Suppliers
NCART- National Coalition for Assistive and Rehab Technlogy
USREHAB- a Division of VGM
Users First- Voice of Consumers using Equipment
Any questions or comments can be directed to Carey Britton with Active Mobility Center, located in Pompano Beach, Florida.
Great post. A good timing for me to read it when I have just started my blog a couple of days before. Keep sharing the tips :)
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