A new report, authored by Brian Leitten of Leitten Consulting and published by VGM & Associates, contends that the Centers for Medicare & Medicaid Services (CMS) has taken the wrong perspective of durable medical equipment (DME) for at least for the last two decades.
The 2003 Medicare Prescription Drug, Improvement, and Modernization Act gave rise to CMS’s national competitive bidding (NCB) program, which began in 2011. In its first few years, NCB did indeed slash the amount that CMS paid for DME. But NCB also reduced beneficiary access to DME, in part by driving many DME suppliers out of business or making it impossible for them to continue accepting Medicare patients.
Not surprisingly, the Leitten report now says NCB has likely reached its finale. In NCB’s first four years, the report said, Medicare saw “a 45% reduction in total spending on all the items that were included in the program over the first four years of the program.”
But access was slashed, as well. “The share of beneficiaries receiving DME dropped 11% over the same period,” the report noted. “Those decisions also reduced the number of viable DME suppliers.”
For certain DME categories, the number of DME providers dropped by nearly half. Which is where we pick up the story.
“Much of the evidence suggests that competitive bidding may have reached its natural end,” the report said, referencing “delays and failures” following the first two NCB rounds. “For over five years, CMS has been unable to cobble together even a single effective round of competitive bidding.”
And, the report added, CMS’s process was wrong all along: “The logic supporting continued investment in DME was and is that the cost of treating the injuries and illnesses incurred by beneficiaries who lack the critical DME far exceeds the cost of providing needed DME in a timely manner.”
Mobility equipment lowers health-care costs
The first example in the report highlights the ability of mobility equipment to reduce the risk of falls: “Annually, over 9 million seniors require treatment for fall injuries,” the report noted.
“For every dollar that Medicare spends providing mobility DME, CMS can avoid spending $62.38 on direct fall-related health-care costs, including ER visits, hospitalizations, doctor visits, rehabilitation care, and other related costs. Medicare beneficiaries and their private insurers, who shoulder copays that Medicare doesn’t cover, save an additional $15.59 [for every dollar spent on mobility DME].”
A July 2024 New York Times story tested 10 walkers and rollators. The top three — which varied in features and design — had an average price of $83. Using the report’s figures, an $83 walker/rollator would save Medicare $5177.54 (and would save private insurers/beneficiaries an additional $1293.97).
Cross reference that concept to Complex Rehab Technology (CRT), whose custom-fit, custom-configured, custom-built manual and power chairs justifiably cost much more — and require much more specialized, intensive service, training and provision.
Imagine how many doctors’ visits, hospitalizations, surgeries, medications, therapy hours and rehab admissions CRT prevents. Just the number of pressure injuries avoided must be impressive, not to mention the improved respiration, digestion, bowel and bladder function, bone density, reduction in orthopaedic injuries ….
In fact, prevention of overreaching-related injuries was one of the main reasons cited by CMS in agreeing to provide Medicare funding for seat elevation on power wheelchairs. That new coding that went into effect in April.
CRT stakeholders are now pressing CMS — continuing to press, as the request was filed four years ago — to start the coverage determination process for power standing. If CMS liked the prevention potential for seat elevation, the agency will love what standing can do for wheelchair riders. Great weight shifting and pressure relief! Improving/preserving range of motion! Better respiration, digestion and circulation! Potentially fewer urinary tract infections! Better bone density! And those CMS favorites: Reaching and transferring! Power standing on power wheelchairs does all this and more.
Today’s health-care best practices emphasize prevention and early detection, rather than much more invasive, painful, lengthy and expensive treatments and cures. That’s why we’re urged to schedule mammograms, colonoscopies, shingles vaccines, etc.
CRT deserves to be seen as an intervention, an investment, a best practice rather than just a cost to be saved. CRT and its professionals have earned it.
