This may be a whacky idea, but do you have a better one?

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08/11/2010

Here's something I've been thinking about for a long time: Would it be totally off the wall to suggest that Medicare remove a bunch of HME products from the fee schedule?

I'm not talking about oxygen and power wheelchairs and some of the bigger more expensive items that some seniors (but certainly not all) might have trouble paying for. I'm talking about stuff that could be considered a commodity. Things like walkers, commodes, cane handgrips,  bed side rails, trays. That kind of stuff.

I suggest this because over the past weekend I went to two large family gatherings. One was a good old-fashioned family reunion and the other a memorial service. There were plenty of Medicare age folks at both, including my mother, 72, and my father, 75. I didn't see one person who could not afford some of this less-expensive HME. In fact, many if not all, could probably afford a power wheelchair if they really needed one. I know my parents could and they are not wealthy. They recently bought a big fancy flat screen TV. If they can afford that, they can certainly afford a scooter, and a commode would not even make them blink. I didn't ask them, but they may even think it's funny that Medicare pays for a cane grip. I know I do. A cane grip?  Come on.

Like I said, I could be way off base here.  But removing some of these inexpensive/commodity items from the fee schedule seems to make sense for two key reasons (and I'm sure there are more): 1. HME providers would see an immediately increase in cash sales and reduce their dependence on Medicare. 2. Medicare would see a corresponding decrease in utilization.

Isn't that what they call a win-win?

Please don't tell me that the majority of seniors, if they had to fork over their own cash and not Medicare's, would go without these products. We all know that would not be the case. It's certainly not going to be the case with baby boomers. If they want something, boomers are going to buy it. They may have to choose between a flat screen TV and a scooter, but life is full of such choices, right?

Right.

Mike Moran

Comments

In a perfect world your suggestion makes sense. Most of my clients are sitting in unairconditioned, 100 degree heat because they can't afford electricity. Purchasing a walker with extra cash seems out of the question particulary with an urban poor population. What you are getting to is identifying income strata that can afford equipment outside of CMS and who probably should buy it and those who can't and who can't afford co-pays or co-insurance. This is really important with the States' medicaid cutting back as well. Segregating benefits by income is not new and some aspect should be investigated. A concept to offer during an election, I doubt it.

A large percentage of our rural patient base can barely afford their LIS "extra help" copays on their medications. I have no doubt many would choose to forego the "inexpensive/commodity" items prescribed by their physicians, were they to be removed from the fee schedule, so that they can continue to pay for items such as groceries and their electric bills.

I think there are more people out there that can afford these items than we realize. It comes down to choice. If you can afford a 50 in flat screen and multiple computers then I think you should be able to pay for a 20 dollar cane. With the bidding process not far off we will have to think outside the box, I think providers would be willing to take a cut on items like walkers, bsc, and other things if the patient had to pick them up themselves.They will go get there medication, why not there equipment?

Current and future reimbursement reductions for DME will necessarily impact beneficiary access to DME and service levels. Reduce reimbursement quickly and significantly (i.e. competitive bidding or a big pay-for to eliminate competitive bidding, etc.) and DME suppliers will have no choice but to alter their operations to remain in business. Since the vast majority of the expenses associated with running a DME business go for things that directly impact beneficiaries (i.e. product acquisition, delivery costs, clinical staff costs, customer service/intake, etc.), any big change in operations will impact beneficiaries. The question is simply this: Who will decide how the beneficiaries are impacted? If CMS eliminates walker, etc. from the fee schedule then CMS is making the decision. If CMS does not “prescribe” changes through policy then DME suppliers will make the decision. DME suppliers may (for example) choose not to deliver anything the same day for new orders received after 1:00 PM, on weekends or on holidays. Is that better than eliminating coverage for walkers? It depends on the situation. But everyone would probably be happier in the long run if Medicare makes those decisions.

I like the idea but it seems to me that if Medicare removes those things from their fee schedule, other businesses better suited to retail (eg. Wal-Mart) will end up providing most of those items in a way we can't compete with. 

I agree with John. Once the "red tape" is eliminated, the mass discounters including the large pharmacy chains will eliminate the HME supplier in those areas. Sometimes providing walkers, canes, commodes, etc. to patients creates an on-going relationship that would be totally lost if the items you elude to are eliminted from the program. IMHO