Caregiving: 'Convenience' is now 'value' in health care

Monday, January 4, 2016

“The vast majority of health care is actually provided by families, not by healthcare professionals,” according to a 2014 Family Caregiving Alliance report. The U.S. healthcare system functions with a key presumption: Family caregivers will re-arrange their lives to care for their loved ones. Yet, the 40-plus million people in the U.S. supporting their aging/ill loved ones actually have little influence over the healthcare system that so heavily depends on them.  

Under the still-dominant fee-for-service payment system, family caregivers wait for hours for a patient discharge, facing under-appreciated mental and financial uncertainty as they learn painful lessons about long-term care reimbursement, or lack thereof. They quickly learn that equipment that would help them with caregiving is considered to be “convenience” and is not covered by Medicare or Medicaid. When they do decide to buy the equipment themselves, they are unfamiliar with manufacturers or suppliers and are overwhelmed with a plethora of undifferentiated products. 

Their interests are represented at the “system-level” by national organizations like the Family Caregiving Alliance and AARP. These advocates play an important role in public policy debates, highlighting the vulnerability of family caregivers as a population. Yet, they have been unsuccessful in challenging the basic undervaluation of the family caregiver role across the acute care system: It is simply taken for granted. 

The home medical equipment sector shares this “second-class” status: Accounting for just 3% of the $2.9 trillion healthcare spend (per the Centers for Disease Control statistics), HME suppliers and manufacturers find themselves buffeted by competitive bidding strategies as Medicare moves to consolidate the number of vendors under contract. At the policy-setting level, the plight of an individual supplier is meaningless, just as the plight of a given individual family caregiver is insignificant.  

Against this background, CMS has simultaneously been challenging hospitals, seeking to move them to a value-based payment (VBP) system. In April 2016, CMS is launching the Comprehensive Care for Joint Replacement (CCJR) in 67 geographic areas. Unlike other VBPs, this one is mandatory: Acute-care facilities are being held responsible for the post-acute care spend associated with each of more than 400,000 hip and knee replacement cases.   

On behalf of family caregivers, I ask owners of local HME companies to see this VBP as an opportunity to bring their skills and knowledge to this conversation. Under the CCJR, patient harm arising from delayed delivery of equipment, or the wrong equipment, will no longer simply mean another billable admission. Instead, hospital systems will be penalized in a variety of ways, hitting their bottom line.  

HME providers can begin by investigating the degree to which their local hospitals and home health agencies are grappling with “care transition” challenges. If you have relationships with your local hospital-based occupational/physical therapists, talk to them: They are likely to sit on committees charged with streamlining the handoff of patient from acute care to home. They will also be developing coordination/communication protocols for continuity of care for patients with complications and co-morbidities.

One important thing to find out as quickly as you can: What post-acute care software programs are the facilities in your market using? For example, Northwell (formerly NorthShore-LIJ) in the NY metropolitan area is expanding a 30-patient pilot with to cover 300 patients in the next few months; Hoboken Medical Center is piloting You might be surprised to find that they are willing to use an application program interface that connects to your website or IT program used by your company. Such interoperability presents an opportunity to quickly get the right assistive devices and supplies to patients/family caregivers. 

VBPs also present an opportunity for health systems to reconsider the “medical necessity” standard. It may be more cost-effective to relax the assessment rules for assistive devices and provide “convenience” equipment, charging a monthly rental fee that recaptures their purchasing cost. Such a solution enables a patient to age/recover at home who otherwise would have been discharged to a more costly skilled-nursing facility; reduces caregiver stress and strain; and/or keeps someone at a more affordable assisted living level of care. 

HME providers: Leverage your inherent competencies to make assistive equipment more accessible to patients and family caregivers!

Peg Graham, MBA, MPH, is semi-retired after 40-plus years working in healthcare advocacy and hospital administration. She holds the patent for The PPAL, currently in Stage 4 of assessment by Edison Nation Medical. She can be reached at or on LinkedIn.