Missouri HMEs fight to derail cuts

JEFFERSON CITY, Mo. — Could a $200 a month oxygen concentrator save a state $2,800 per month in health care costs? Absolutely, says one provider battling to keep DME reimbursements from being axed from Missouri's Medicaid budget. Brady Vestal, director of Citizens Memorial Home Medical Equipment and chair of the Midwest Association of Medical Equipment Services (MAMES), testified before Missouri's House Appropriations Committee in February to try and educate legislators on the benefits of durable medical equipment. During his five-minute speech, Vestal talked primarily about the lifesaving benefits of oxygen concentrators for COPD patients, a benefit that is facing extinction. “I explained that Missouri pays DME providers approximately $200 per month for an oxygen concentrator,” he said. “I compared that cost to the cost of an emergency room visit, a three-day hospital stay, and then eventually a nursing home stay, which costs the state an average of about $3,000 per month.” Keeping with this theme, Vestal also explained that a $114 standard walker with wheels could prevent injuries and save the state “tens of thousands” of dollars in hospital visits and rehabilitation associated with a broken hip. “I equated DME to paying for immunizations,” said Vestal. “We know immunizations prevent illness, and I argued that DME prevents injuries. The more injuries we can prevent, the more money we can save.” The state's budget proposal released in January called for the elimination of adult medical equipment coverage under Medicaid. The program took a hit because of the budget crisis the state faces and its high utilization. One million of the state's 5.7 million people are in the Medicaid program. Adults with Medicaid as their primary insurer would not have access to these benefits if the budget passes as is. The state would continue to provide payment if the person had Medicare as a primary payer and Medicaid as a secondary. “I think it's a safe estimate to say that providers would see a 10 to 25% loss in revenue,” said Vestal. “That's probably a conservative estimate. Providers in more rural parts of Missouri could be facing as much as a 50% loss in revenue.” MAMES has launched a grassroots effort among its 49 members from Missouri to prevent the cut from going through. Providers are being asked to call their local representatives to talk about the impact of the proposed cuts. Vestal said he has also scheduled a private meeting with the chairman of the House and Senate appropriations committees. “We will hopefully be making some recommendations with the state DME subcommittee about some policy changes that would hopefully bring Medicaid into the 21st century,” Vestal said. “Many of the policies were written in the early 1980s and have not been updated. They have not grown with the technology. We need to update those policies so there is still a fair reimbursement that also allows for fairness to the taxpayers and to the Medicaid program.