Home medical supplies may be tougher to get
Haywood residents who need home health services such as oxygen tanks, machines to help with sleep apnea, or even a hospital bed, diabetic supplies or a wheelchair, should brace for changes.
Under new, cost-cutting Medicare requirements, those who supply such services now must win competitive bids to supply clients eligible for federal coverage.
Heath Sutton, owner of Mountaineer Oxygen Services, is one of the lucky ones who was awarded two contracts — one to supply oxygen to Western North Carolina residents who need to have their tanks refilled on a regular basis, and another to provide nebulizer therapy breathing machines and CPAP devices that address sleep apnea issues.
On average, the durable medical equipment allowances have decreased 40 percent, Sutton said. He only accepted the oxygen contract, something that makes up about three-fourths of his business, but decided the rate was so low on the other one it wouldn’t be worthwhile.
“They’ve basically auctioned off services to the lowest bidder,” said Sutton of the new rules that require competitive bidding for durable medical equipment. “Some companies that won the bids in the Asheville area have no physical presence there.”
While competitive bidding might sound like the best way to control costs, Sutton fears the opposite effect will occur — and the greater injury will be the loss of personal service, especially in rural areas.
“Competitive bidding is part of the master plan for Medicare services,” he said. “But companies that don’t get a bid are shutting down all over the country. With rebidding every three years, that means fewer companies attempting to bid. The law of economics is if you eliminate providers, it drives the cost of services up.”
More importantly, Sutton said, is that when smaller businesses in rural without the volume to purchase in larger quantities are turned away, it will negatively impact the service level in more remote areas. Sutton’s company has 12-15 employees who work in Western North Carolina counties.
“If equipment isn’t working, we go on calls at all hours, and I’m completely OK with that,” Sutton said. “But some of the companies that won competitive bids don’t even have a physical location in a region. Then it becomes a mail order business or something that is delivered on a certain schedule. There’s a service component to what we do.”
While the bid rates only apply to the federal reimbursements, the bulk of the durable medical equipment (DME) are provided to those over age 65 who qualify for Medicare. The provisions of the bids also have a downside for those who have two homes.
Sutton referenced a client who lived in Haywood half the year and Florida the other. Her DME provider was is Florida, and when she needed oxygen this summer, her choice was to return to Florida, get it by mail or pay out-of-pocket to purchase from a local supplier.
Using some of the home medical supplies, such as diabetes tests or oxygen, requires instruction — something that a video included in a shipment likely won’t satisfy.
Sadly, the end result could also raise the overall costs because it could make it harder for people to remain in their own homes for care.
“A patient with home oxygen costs the government $1,200 per year at home,” he said. “One overnight stay at a hospital averages $4,200. If a patient needs oxygen when they are discharged, and it takes two to three days for them to get it, look how much more is being spent.”
There’s a Congressional resolution, HR 1717, first pushed by former U.S. Rep. Heath Shuler, and now by Rep. Mark Meadows, to eliminate the competitive bidding process for durable medical equipment, Sutton said.
It’s a measure that would protect both small businesses and consumers in rural areas.
“It’s just a sad state that healthcare is in when the wealthiest country in the globe is rationing healthcare to lowest economic levels,” he said.
There are three companies in Haywood that handle durable medical equipment — Mountaineer Oxygen, Carolina Breathing Solutions and Kelley Home Services.
Carolina Breathing Solutions didn’t respond to calls, and the Kelley manager wasn’t authorized to speak for the national company, Florida-based Rotech. Representatives there also didn’t respond.