Ostomy supplies: Pay now or pay later, stakeholders say

WASHINGTON – With reimbursement declining from a variety of payers, stakeholders are banding together to advocate for better pricing and access to innovative ostomy products. 

“They are lowering reimbursement – and some already have pretty low reimbursement to begin with – to the point where only certain products are able to be provided,” said Laura Williard, vice president of payer relations for AAHomecare. “(For example), there are managed care organizations out there that are not paying anywhere close to even the Medicaid fee schedule.” 

So, AAHomecare has partnered with the United Ostomy Association of America, Inc., United Spinal Association, the Wound Ostomy and Continence Nurses Society, and the Wound Ostomy and Continence Nursing Certification Board to produce a white paper providing an overview of ostomy and addressing the variables going into managing each person’s needs. The white paper also reviews the role of the HME provider, the risks of improper management and the value of managing ostomy with sustainable reimbursement.  

When reimbursement isn’t sustainable, it’s the patient who suffers, say providers. 

“Using the wrong ostomy products impacts ostomates’ quality of life, affects their mental health and greatly increases their utilization of care, driving up costs for payers and patients alike,” said Naama Stauber Breckler, CEO of Better Health. “Payers need to understand that limited product options might provide cost savings in the short run but can dramatically increase their costs in the long run in the form of significantly poorer mental and physical health for their ostomate population.” 

The primary “ask” from stakeholders: a fee schedule floor that will prevent Medicaid, private insurance and managed care organizations from paying fees lower than Medicare’s, says Williard. 

“This will be a topic of conversation at those meetings (with payers) where the fee schedule is not meeting the needs or not paying appropriately,” she said.   

AAHomecare also plans broad, state-by-state outreach to its members, state associations and consumer groups. 

“We will be sharing this with our members and state associations,” said Ashley Plauche, director of member and public relations for AAHomecare. “(We need) all these voices to come forward collectively to paint a thorough picture.”