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Case Managers & Medicare Patients Speak Out About Government Program Causing Access Issues

Home Blog Case Managers & Medicare Patients Speak Out About Government Program Causing Access Issues

Waterloo, Iowa - December 12, 2017 - In a nationwide survey, over half of Medicare beneficiaries reported problems obtaining medically needed home medical equipment (HME) such as oxygen and wheelchairs under Medicare’s Competitive Bidding program.

For years, clinicians and case managers have struggled to coordinate care for their Medicare patients who require HME, services, and supplies under the Competitive Bidding Program. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) reports that there are no issues with program and that access has been unaffected.

Esteemed health care research firm Dobson DaVanzo conducted an independent study of 1,064 Medicare beneficiaries, case managers/discharge planners, and suppliers of home medical equipment in 2017 who spanned 47 states. The report findings demonstrate that many of our nation’s elderly and disabled are experiencing issues in accessing timely equipment, are going without needed items or paying out of pocket, and/or are experiencing adverse health effects.

One of the survey participants is Katherine J. of Olney, Maryland, a 66‐year‐old Medicare beneficiary with pulmonary hypertension who depends on home oxygen therapy.

“It has almost destroyed my life,” she explains. “It has really affected my quality of life.” Katherine is not alone.

52.1% of beneficiaries reported problems accessing HME and/or services. And 56.9% of beneficiaries who receive home oxygen therapy like Katherine reported some sort of disruption or access issue related to their life‐sustaining oxygen therapy service.

An overwhelming 88.9% of case managers and discharge planners reported an inability to obtain medically necessary HME and/or services in a timely fashion, with 70.8% reporting hospital discharge delays of one to seven days as a result.

These survey results come on the heels of growing concerns about the impact of the Competitive Bidding Program for HME from Congress, consumer groups, and other stakeholders.

Opponents of the controversial program say that its faulty design coupled with unsustainable reimbursement rates are crippling the HME industry’s ability to provide HME and creating problems for Medicare beneficiaries. Preventable hospital readmissions, reduced options, and patients either going without needed equipment altogether or paying out‐of‐pocket for HME to avoid Medicare bottlenecks are central themes of the study.

Legislation has been introduced in the House of Representatives to claw back portions of the program to provide relief for many areas impacted by this program. Representatives Cathy McMorris Rodgers (R— WA) and Dave Loebsack (D—IA) introduced HR 4229, the Protecting HOME Access Act of 2017 in November to transition new payment rates for HME and supplies and update the Medicare budget neutrality for oxygen.

Katherine worries that she will be unable to get the oxygen equipment she needs under the Competitive Bidding program and noted that service changed significantly. Like many Medicare recipients, she is on a fixed income and unable to pay out of pocket to get the equipment she needs.

“I hope that [the survey] will change the way Congress and these officials think about home medical equipment like this,” Katherine laments. “It is ridiculous for them to do this; it’s almost like they’re rationing things for the elderly. I try not to get discouraged. I’m a fighter, and I will not give up!”

Advocate for Medicare beneficiaries’ continued access to home medical equipment by calling the Washington D.C. switchboard at 1‐202‐224‐3121 and sending a letter to your legislator. Visit People for Quality Care at www.peopleforqualitycare.org to learn more and to send a letter to Congress about this important issue.


Dobson DaVanzo Report
Executive Summary
Full Report

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