(02-23-2015 08:19 AM)GeoffD Wrote:
(02-21-2015 03:07 PM)DVScott Wrote: Perhaps "scam" is too strong. I'm suspicious of caregivers supplying based on Medicare guidelines ever since a physical therapist charged me $800 for a wrist brace I can buy at Walgreen's for $20 because "That's what Medicare will pay".
I think the Medicare replacement schedule is somewhat excessive. I want a spare hose. I want a spare mask. I want a spare humidifier tank. I only need to replace filters every 90 days because I don't have dust/mold/pollen/animal issues. The nasal pillow and elastic headgear replacement rate is fine. I can really notice the difference between new nasal pillows and 30 day old nasal pillows.
This is such a difficult and convoluted problem and is not readily explainable by any one facet of our (US) healthcare system. I could write pages on this but here's a reader's digest of my impressions.
On the one hand you have competitive bidding. In 2009 Medicare decided that there were going to be companies that won contracts through the bidding process. If a DME company didn't did bid low enough they lost the Medicare reimbursement business. It didn't matter if they had been serving patients in a certain area for decades, they were out.
Now one might say that that's good. Bidding ultimately lowers cost to the government and discourages unreasonable profit. However, what happen was companies started bidding low ball bids even if they couldn't service the area they were bidding for. If they won an out of state bid, then they would then hire (contract) a local DME in the area the out of state DME had won to take care of patients and pay to the local DME a much lower payment then what the local DME would have gotten had they won the bid.
So you have a situation where the patient needs services, but because of the bidding program the local DME can't supply those services, in the manner they used to, at a price point that allows them to stay in business. That's why you see local DME business trying to retail more product (canes, walkers, smocks, etc.) in an effort to boost bottom line.
Another consequence of the bidding program was that a local DME would underbid the contract in order to garner more patients. Then, because having all those patients made them an attractive acquisition for a larger company, sell their business. If you look around your neighborhood I bet you'll notice that most of the DME companies are no longer local mom and pop operations but larger companies i.e. Lincare, Apria, bigger regional players, etc.
Aggravating this problem is the fact that not all localities are attractive to the big players due to population, regulation, or other concerns. So the small DME is constrained by the bidding process which if they win cuts their profitability and if they don't they have to create revenue streams to make up for the lose of patients. The system then becomes an impetus for the small player to look for ways to maximize their profits in any way they can.
In the mean time, the big boys are servicing many more patients and driving their efficiencies to service more patients with less resources. This impacts patient services and at times clinical outcomes. As they won't staff their operation adequately to handle the exponential increase in patient load, patients suffer that consequence. Reading virtually any health forum testifies to this.
Is it right that a DME will charge Medicare 800 dollars for a twenty dollar brace? No it is not. But that DME is operating in an arena where they either find profitability where they can or run the risk of going under. It's got to be a tough decision for a person that is up to their eyeballs in debt trying to survive in this environment.
To bring it to a personal view, our company has seen a huge decrease in the count of different companies with which we do business. We haven't seen a decrease in the equipment we repair, just the number of companies providing machines for repair. In other words the DME industry is rapidly contracting.
I know I haven't explained this completely and perhaps not even coherently. I won't pretend I have any answers or for that matter fully understand the problem here. But watching this industry for nearly 15 years this is just the surface of the changes that I have seen and the reasons I believe they have come about.