Medicare cuts will force seniors to pay more for home equipment

July 17--Purchasing medical equipment and supplies is now more costly.

Earlier this month the Centers for Medicare and Medicaid Services (CMS) further cut reimbursement for home medical equipment and supplies, called competitive bidding areas. Through this program, medicare beneficiaries are limited in whom they can get their equipment and supplies from and often experience delays in getting what they need. This results in them either paying for the items out of pocket, or going without.

CMS claims these reimbursement cuts will reduce beneficiary out-of-pocket expenses and save the Medicare program money.

Lelia Wilkerson, director of Heritage Medical Equipment and Supplies, disagrees and said costs are going to be passed onto beneficiaries.

Data provided by Wilkerson showed any kind of equipment ranging from a power wheelchair to hospital bed has taken at least a 20 percent cut in reimbursement costs. Some equipment, like an oxygen concentrator, received a 55 percent cut. Plus, Wilkerson said there's no reimbursement for having staff on call 24 hours a day to service the machines when needed.

"We have to service it, and there's no reimbursement for that," Wilkerson says. "I have people on call 24-hours a day because it's a life sustaining drug. So I pay overtime to go out at night if yours malfunctions or the power goes out in a storm. Not reimbursed, any of that."

For CPAP machines that treat sleep apnea, there is a 61 percent cut in fees. Wilkerson said a respiratory therapist spends an hour with a customer in store to explain the equipment, how to use it and fit them with a mask. Then, they follow up multiple times and use a program to track the usage and report to insurance companies. All this is at the expense of the company. "What we're going to do, and I would never think of doing this, but when someone comes in to get a CPAP, we need a credit card on file to pay their monthly bill and it's automatically paid," Wilkerson explained. "Then we will charge them today the full cost, and Medicare will send them a check later. So when CMS said they don't see this as being a problem and that it's not going to cost a beneficiary any more, yes it is. They will be paying out of pocket, or going without." Wilkerson will be starting a petition that will be turned into CMS explaining how many beneficiaries had a CPAP prescribed but was refused because they couldn't afford it.

She anticipates a lot of names going on the petition.

"Simple products like arm slings are not covered by insurance," Wilkerson said. "I was out at our store at the hospital the other day and a guy came in with a prescription for a sling. We explained insurance doesn't cover slings, and he said 'I'm not getting it.' That's $6, compared to $100. I think people will go without, and going without oxygen or CPAP, that's very detrimental to your health." Wilkerson said one day spent in the hospital for a patient on oxygen is what Wilkerson is reimbursed for keeping them at home on oxygen for a year. "All they are doing is cutting part B benefits, and paying out of part A benefits," Wilkerson said. "It's going to be hard for me to say that to a beneficiary that they will have to pay us and a check will come to you. We are here to take care of these people, not to charge them more money. It's not right."

Wilkerson said the home medical equipment industry is less than 1.25 percent of the Medicare spending budget. In 2014, Medicare spending grew 5.5 percent to $618.7 billion or 20 percent of the National Health Expenditure, which was $3 trillion in 2014.

"They want to stay home, they don't want to go to a care facility," Wilkerson says. "We're their step to staying at home, we have the products that can keep them there as long as possible. And it's going to cost them now. I just want people to know what's coming and it's going to effect them. It's frustrating, our elderly people should not be rested like this."

___

(c)2016 The Hawk Eye (Burlington, Iowa)

Visit The Hawk Eye (Burlington, Iowa) at www.thehawkeye.com

Distributed by Tribune Content Agency, LLC.