Medicare Reimbursement Cuts:

Be Proactive in Understanding How You May Be Affected

The Center for Medicare and Medicaid Services issued major reimbursement cuts in equipment and service that suppliers receive in 91 metropolitan areas of the country, effective 2013. With such cuts, access to quality equipment and regular service from a home care provider will decrease. The cold, hard facts include:image018-1

  • 41% Cuts on oxygen, oxygen equipment and supplies
  • 36% Cuts to wheelchairs and scooters
  • 46% Cut to walkers
  • 47% Cut to CPAP devices
  • 63% Cut to support surfaces
  • 71% Cut to diabetic testing supplies

Visit http://tinyurl.com/d62978q on the Internet to let your electedofficials know how your life will be affected!

The healthcare landscape in the U S is changing. With the implementation of change outlined in the Affordable Care Act, aka Obamacare, and recently announced cuts to Medicare reimbursements in 90+ metropolitan markets, there is much uncertainty as to how these changes will ultimately affect the entire healthcare industry. Yet the people most likely to experi- ence the most immediate impact of these changes will be the people the healthcare industry is meant to serve – the patients. It is imperative that you and/or people you know that are on Medicare and receive home care equipment and services be proactive in researching how changes in the healthcare industry will impact you.

On July 1 of this year, as a result of a recently com- pleted competitive bid process, Medicare will reduce the amount of reimbursement dollars given to DME providers (those companies who supply your oxygen equipment, as well as other equipment like CPAP machines, wheelchairs, prosthetics, etc.) by roughly 40% for oxygen-related equipment and services. A basic outline of these changes and what and who will be impacted can be found at the Medicare web site: http:// tinyurl.com/cabpkyo. As you’ll see in that document, Medicare has reasoned that the competitive bid program  helps keep costs low for Medicare and helps limit fraud and abuse. You’ll note that neither of these reasons is directly related to providing actual care.

The fact of the matter is that Medicare will not be paying DME providers what it used to. This extends beyond oxygen equipment, too. As mentioned above, DMEs provide CPAP equipment, wheelchairs and other products that are also facing significant cuts. As such, DMEs will need to make the necessary adjustments to their business models. For some, this will mean exiting the business altogether, sooner if later not For others, it will mean altering the equipment and services provided to their

patients.

 

Liquid oxygen (LOX) users are already being told by some DMEs that they will need to switch their equipment out as the DME willno longer provide LOX. LOX has a   of higher oxygen and weight-to-range

capabilities but requires regular refilling, which is a cost to the DME, and the cost may not be fully reimbursed. That said, some DMEs may still offer LOX as there is still a payment for content. Even though this payment is minimal, these DMEs may have an efficient LOX delivery model and can ably provide the service. If you are on LOX, you may want to contact your DME and ask if their services will be affected by the upcoming changes in Medicare reimbursement.

Reimbursement for all home oxygen equipment falls into three categories. Those categories are stationary equipment, portable equipment and oxygen content.

It will be in your best interest to seek out information as to how these upcoming changes in Medicare reimbursement will directly affect you, your family and friends who rely on Medicare and DMEs for home healthcare needs.

Delivery of home oxygen equipment and content, especially products requiring regular refilling like LOX and cylinders, is a significant cost to a DME as even the current reimbursement levels leave little room for profit margin. DMEs have reacted by seeking products that do not have an associated delivery cost but are similarly reimbursed, such as HomeFills and portable concentrators.image021-2

Regardless, many of the delivery dependent products that meet your clinical and lifestyle requirements should not be withheld from you based on the claim that Medi- care does not pay for that product. If your doctor has prescribed specific equipment that meets your needs, that is the equipment you should have.

It will be in your best interest to seek out informa- tion as to how these upcoming changes in Medicare reimbursement will directly affect you, your family and friends who rely on Medicare and DMEs for home healthcare needs. Unfortunately there is no single, universal answer for everyone – not every area will be affected, not every patient will be affected (for now, any- way). Those who will be affected will not be impacted in the same ways. Contact your DME and start asking questions about how your services and equipment will be affected. Follow web sites like medicare.gov and cms.gov to track implementation of new programs and changes in reimbursements. Make sure your doctor understands your needs and has prescribed for you the proper therapy and equipment you need to perform your day-to-day activities. If this is not happening, you, ideally with the support of a clinician or therapist, must investigate options available to you and ensure you have access to the clinically appropriate equipment. Contact local patient support groups and advocates to see how other patients are being affected and what they are doing about it.

The more you know now, the better you will be prepared for whatever may lie ahead in our changing healthcare system.