White Paper Explains CMS Effects on CRT, DME

A new VGM Group/U.S. Rehab white paper explains in chilling detail how cuts to Medicare funding have devastated beneficiary access to complex rehab technology (CRT) and durable medical equipment (DME).

The paper, authored by U.S. Rehab President Greg Packer, is available to industry stakeholders, including those who aren’t VGM members, as a downloadable pdf.

At seven pages long, the white paper serves as a digestible, but thorough examination of how funding reductions have forced DME suppliers to close their doors, lowered the quality level of reimbursable CRT available to people with severe and permanent mobility-related disabilities, and raised the risk of higher costs for other segments of the Medicare program, such as hospitalizations.

“In a one word explanation: comprehensive,” Packer told Mobility Management, in describing the white paper. “This is the biggest issue in D.C.: showing them a 30,000-foot view of an issue that goes to a micro level of a foot when you’re working with a patient who has ALS. Right now, today, they’re walking. But in six months, they’re going to be running a power chair with a head array because their movement has been lost.”

One goal for the white paper, Packer said, is helping “that Congressional person’s understanding, so they know there’s no need to buy five different chairs as the disease state changes. That I can rely on an ATP and a PT and an OT to understand that this deterioration is going to happen quite rapidly, because they’re professionals. I need to rely upon them, and this is how it should be done.”

Cost-Saving Programs

The paper is called, “The Delivery of DMEPOS Is in Jeopardy.” In the paper, Packer distinguishes DME from CRT, but also points out some commonalities.

“DME and CRT are cost-saving programs when administered correctly,” the paper states. “With a reduction in selection along with quality of products and services due to price pressure, there will be an increase of the ancillary cost to other areas of the system over time, mainly in hospital readmissions and premature disease-state deterioration.”

As an example, the paper points out that 42 percent of traumatic brain injuries are caused by falls. “If we treat them with proper equipment, we can reduce the comorbidity epidemic,” the paper says.

Packer also discusses what he calls “the rationing of healthcare in the DMEPOS market,” citing “reductions of the quantity of independent providers,” as well as national providers who have to be “more selective on what patient categories they allow to participate” due to razor-thin profit margins.

In talking to Mobility Management, Packer pointed out that funding cuts have led to some suppliers going out of business and have forced others to specialize, which can be a hardship on the beneficiaries they’re serving.

“A lot of these folks are multi-task oriented,” he said, referring to the products and services suppliers were formerly able to provide. “They got into this business for a purpose -- maybe a loved one or family member was involved in a disease level or state. They did multiple [services and products]. What’s happened is that the industry, with the consolidation and competitive bidding, has driven away that multiple accessibility for a patient. Now I have to go to three providers. If I have a respiratory issue, I’m in a chair and I have a wound issue, I have to go to three places to get what I need. If I’m diabetic, I have to work with four places, and one of them is a mail-order company. They’re going to ship me supplies all the time, and I really don’t need that much, so I’ll just throw it in the closet. The person I used to [work with] could tell I was getting oversupplied and could help me. Now we’re actually falling into a problem that we didn’t have before.”

The white paper makes several recommendations, including “a complete halt to the current practice of using Medicare-based rates and discounts for products in broad categories. Products that have multiple functions are currently being combined in one broad, general category and are given one standard price.”

Packer hopes all industry stakeholders, including manufacturers, providers and clinicians, will use the white paper as an educational tool and leave-behind document when talking with policy-makers.

“We try to work with [our legislators] daily, and I know our government relations department works state by state with issues that are happening across the country,” he said. “This paper will be something that they can use in any instance. There’s a lot of issues out there, and it brings them all to culmination so you can actually talk about them quickly and concisely.”

Download the paper HERE.

“Anyone can use it,” Packer said. “We have it on the open section of our site. We would ask with open arms for anybody who wants to use it, even if they’re not associated with our member service organization, even if they’re not a contract provider. That doesn’t mean they’re not friends and not in the same industry.”

Look for future white papers on other topics, Packer added: “We’re going to do a series. I’m going to identify specific topics — the K0009 upgrade, the titanium upgrade. I’m going to drill down into several areas before the end of the year.”

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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