Updated data, CMS’s central office and The Circus Ship

 - 
09/26/2017

We go live with 2016 data for our HME Databank on Oct. 1. I’ve been playing around in a test site this week, and let me tell you, the data ain’t pretty.

Take E1390, stationary oxygen concentrators. Total Medicare spend on this code in 2016 was $620,708,743, according to data obtained via a Freedom of Information Act request from CMS. In 2015: $903,973,456.

Before we move on to declines in spending in other DME, let me say that obtaining the data this year was more difficult than in past years. Our request for county-level data for total Medicare spend had to be forwarded from the Pricing, Data Analysis and Coding Contractor, which usually fulfills our requests easily and timely, to CMS’s FOIA office and then to the agency’s “central office.” It took months. But I’m glad to say that once it hit said “central office,” the data was released promptly. Thank you!

How about E0601, CPAP devices? Total Medicare spend was $115,903,964 in 2016 vs. $150,060,612 in 2015.

For E0260, hospital beds, semi-electric with mattress: $48,239,698 in 2016 vs. $65,522,841 in 2015.

A4235, blood glucose strips: $179,812,476 in 2016 vs. $222,324,155 in 2015.

K0823, standard power wheelchair: $32,579,043 in 2016 vs. $43,227,808 in 2015.

It goes on and on and on.

Another aside: The line above reminds me of the kid’s favorite book at the moment: “The Circus Ship” by Chris Van Dusen. Long story short, a circus ship crashes off the coast of Maine and the 15 animals aboard make their way to an island, where they surprise, and initially horrify, its human inhabitants. There’s a tiger in the tulips, there’s a lion on the lawn, there’s a python in the pantry, it went on and on and on. I highly recommend it.

Speaking of horrifying, when you combine this data with other data, such as the aging population (the number of Americans ages 65 and older is projected to more than double from 46 million today to more than 98 million by 2060), the increasing awareness and diagnosis of OSA (it’s estimated 75% of severe sleep disordered breathing remains undiagnosed), etc., it’s hard to make sense of any kind of declines at all.

What is going on here? That’s more of a rhetorical question, of course, because we all know what’s going on here. And something’s gotta give.