28 Aug 2020 by Bob Floro, MS, RRT
DMEs in More Demand Amidst Challenges
The current COVID-19 pandemic has presented unusual and extraordinary challenges to our health care system. As this virus continues to spread and hospitals reach capacity, we will see an increased need for home treatment for a number of health issues, including those directly and/or indirectly related to COVID-19. As hospitals discharges become more prevalent in an effort to manage existing resources, the resultant strain on durable medical equipment (DME) providers (particularly for suppliers of home oxygen and ventilators) will significantly increase. It is critical to have a strong, well-supported and financially viable DME infrastructure to allow patients to recover at home during this crisis and beyond.
The federal government has created an untenable situation for the DME industry through draconian cuts in both the Medicare and Medicaid programs. DMEs have been systematically decimated by a Medicare system that has systematically eliminated its number of DME providers. Over 40 % of all DMEs have closed throughout the U.S. in the last 8 years due to the reimbursement cuts imposed by the Medicare competitive bidding program. Additionally, in January 2018, federal law 42 U.S.C. § 1396b(i) (27) (the 21st Century Cures Act) placed a limit of the amount of federal reimbursement that states may receive for certain items of DME. Specifically, if any state’s annual Medicaid spending for certain DME items, in total, is more than what Medicare would have paid (at its lowest price, including its Competitive Bidding Program), then the Centers for Medicare and Medicaid Services (CMS) is required to take back federal matching funds for any amounts more than what Medicare would have paid., as well as the CURES ACT to the Medicaid programs in each state.
Availability of Respiratory Equipment and Supplies Have Been Limited Due to COVID-19 Pandemic
Ongoing chronic home care patients and their loved ones worry about receiving life sustaining equipment from DMEs that allow them to stay at home. This untenable situation is no more evident than expressed in this heartbreaking statement by the parent of an 8-year-old ventilator-dependent patient:
“Ventilator circuits and other respiratory supplies are on a major global supply crunch. The DME industry does not have the purchasing power to compete with the federal government, state governments and big hospital systems to get supplies. Medicaid reimbursement rates for home ventilator patients is stunningly low, and the patient pool of home ventilator patients is served by an exceedingly small pool of suppliers due to the complexity of patient care and low reimbursement rates. If home ventilator patients cannot receive the supplies they need to live safely at home, they will either die at home or be forced into overcrowded hospitals, where they will be exposed to unintended infections, including COVID-19. I do not fear that the ventilators will be rationed and that someone will come to our house and take our son’s ventilator away from him. But I do fear that the system we have in place to take care of home ventilator patients is underfunded and strained during normal times, and COVID-19 will break the homecare supports that many patients need to live safely at home.”
As a result of this, and many other anecdotal reports, patient families are washing and reusing disposable supplies, repairing systems with super glue and duct tape, replacing human medical supplies with veterinary supplies, and exchanging supplies with strangers on the internet. In many instances, oxygen tanks returned to suppliers for refill have been diverted to facilities and emergency rooms where there is a perceived greater need.
To learn more about the role of DME for those who require CPAP, Oxygen, and Non-Invasive Ventilation, see our distance learning courses for Sleep Technologists and Respiratory Therapists in the U.S. and Canada:
The information contained in this article is offered for educational purposes. The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of The American Academy of Cardiovascular Sleep Medicine.”