08 Aug 2020 by Bob Floro, MS, RRT
Durable Medical Equipment suppliers are faced with significant challenges due to the COVID-19 pandemic as well as a hostile reimbursement environment that has existed over at least the past 20 years. Cash is tight, deliveries are incumbered by access issues and PPE use, and business is down.
Respiratory Therapists (RTs) are considered an expensive luxury, rather than a necessity for many DMEs who can no longer afford to provide uncompensated overhead for the care component in order to stay in business. Yet, respiratory therapists have become, by default the home care respiratory case manager, especially when 80% of all the DME caseload no longer has a licensed entity (home health, hospice, hospital, etc.) as the caregiver of record. There is an overwhelming emphasis on documentation and audits to retain reimbursement. Functioning as a case manager, time spent by the RT has been redirected, and is actively competing with the much-needed priority of patient care and support. And that’s part of the problem. The National Supplier Clearinghouse, Medicare, Medicaid, and most third-party payors view DMEs as medical equipment suppliers, and not really caregivers. This unfortunate philosophy is specifically articulated in the CMS Provider Manual, evidence of the Federal government’s approach to the DME industry.
DME’s and the patients served deserve reimbursement rates that make it possible to meet the needs of their patients. These rates must also acknowledge and pay for the professional support provided by respiratory therapists. One step would be to incorporate a reimbursable code and fee schedule for specialized professional services provided by respiratory therapists who are either contracted or employed by DME’s. This would be especially beneficial to patients receiving PAP and pressure support therapies.
The next critical process should include a reevaluation of the Medicare (and resultant Medicaid) reimbursement systems for DME. This would most certainly include the engagement of legislators and federal decision-makers. It is an unfortunate historical reality that a catastrophic loss by a family member of a political figure would be the only significant precipitating factor in moving such legislation.
One can only hope that effective DME reimbursement and payment for respiratory therapist professional services will no longer be considered an expensive luxury, but an essential part of providing quality of care and quality of life.
To learn more about the history and changing role of Respiratory Therapists, visit our web site at AACSM.org and click on the “CEU Courses” dropdown in the “Courses” tab.
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.”