AAHomecare has launched a new initiative to survey medical professionals and other individuals in the caregiving continuum to measure the impact of recent Medicare reimbursement cuts on seniors, as well as people with disabilities and chronic conditions. This survey comes in response to requests from home medical equipment (HME) companies for a comprehensive program to better document new challenges medical professionals face in getting equipment for their patients due to HME reimbursement rates falling precipitously under the Medicare competitive bidding program.
Ask your referral sources to participate in the survey! They may either take the survey online or they can complete a printable version
Millions of Americans rely on home medical equipment (HME) such as home oxygen therapy, wheelchairs, hospital beds, and respiratory devices to maintain their independence at home. On July 1, 2016, the Centers for Medicare and Medicaid Services (CMS) implemented changes to reimbursement for HME, affecting all traditional Medicare beneficiaries across the nation. Case managers, discharge planners, and others referring HME from across the country are participating in a national survey to measure the impact these changes have made in their ability to order HME for their patients. Your referral sources' participation in this important initiative will provide essential input to help Congress assess what’s happening to Medicare beneficiaries and make meaningful changes to preserve access to HME across America.
BACKGROUND ON JULY 1, 2016 CHANGES
Urban Area Impact
110 of the largest metropolitan areas of the country have been participating in a government auction program for health care services called “Competitive Bidding” where companies that supply HME submit bids to win one of the few, exclusive contracts to serve Medicare beneficiaries in those areas. The program awards a limited number of contracts to those with the lowest prices with little regard to quality, service, experience, financial health, or presence in the community.
On average, 75% of suppliers are excluded from the program, leaving only a fraction of what previously served the community. With the average distance of contracted suppliers often being hundreds of miles away, case managers & discharge planners have few local resources to meet their community’s needs. For example, effective July 1, the closest contracted company that provides nebulizers to Boston, MA patients is located in Alabama.
Rural Area Impact
On January 1, 2016, CMS began a six-month phase in of applying these bid-area prices from “Competitive Bidding” auctions in densely populated areas like Atlanta and Los Angeles into rural and non-urban America. These non-bid areas did not have an opportunity to submit pricing that would account for the distinct costs of accessing and caring for medically fragile Medicare patients in rural and remote locations. On July 1, the final phase was implemented nationwide into all non-bid areas, reducing reimbursement by upwards of 50-80% for medically necessary HME.
DIFFICULTY DISCHARGING PATIENTS
With the greatly reduced payment rates and decreased number of suppliers able to serve Medicare consumers, case managers and discharge planners are having a harder time finding local HME companies to meet their patients’ needs. These irrational, unsustainable prices are causing many companies that provide HME to restructure their service & delivery policies, reduce their product offerings, stop accepting new Medicare patients, or shutter their businesses entirely.
It is feared that there may be problems with referral sources coordinating for their patients to receive HME as result. CMS is informing Congress that there have been no disruptions in patient access, yet stories are coming in from across the country that prove otherwise as clinicians have difficulties coordinating HME, and patients are either going without or paying out of pocket to get their HME.
HOW YOU CAN HELP
Your referral sources' voices are critical so that Congress can hear what is happening in your community and take immediate corrective legislative action. Help ensure your patients have access to medically necessary HME by:
1. Asking Your Referral Sources to Participate in Case Manager Survey
A national initiative is underway to measure the impact this has had on Medicare patients’ access to medically necessary equipment. All referral sources are encouraged to participate in this important survey. To participate, please have your referral sources complete the survey, available online here. A downloadable version is also available here that may be printed, completed, and faxed back to 202.835.8306, Attn: SURVEY DEPT.
2. Sharing Patient Access Stories with People for Quality Care
People for Quality Care is a consumer advocacy group that specializes in HME access issues. Clinicians, family caregivers, and patients are encouraged to call them to share their challenges in obtaining HME so that these messages may be shared with Congress.
To contact People for Quality Care, have your patients and clinicians call 800.404.8702 or visit www.peopleforqualitycare.org.