To Protect Patient Access to Care, Medicare Must Up Its Reimbursement Rates
By Thomas Ryan
Inflation has soared to the highest level in four decades. Gas is roughly 40% more expensive than it was a year ago. Groceries are up about 10%.
Yet there's one sector of the economy where prices are growing much more slowly -- health care. And ironically, that's creating problems for patients who rely on home medical equipment like power wheelchairs, ventilators, and home oxygen equipment.
The providers they depend on for their homecare are getting walloped by rising labor, transportation, and material costs. But unlike other businesses, they can't simply raise prices to compensate. Their prices are effectively set by Medicare. Those reimbursement rates are based on a seven-year-old formula that barely covered providers' costs before inflation took off.
Unless Congress intervenes to raise reimbursement rates soon, many homecare providers could go under. Millions of Americans would no longer be able to get the care they need at home. At best, they'd have to move into nursing homes or other clinical facilities. At worst, some could go without care altogether.
The double whammy of inflation and supply chain snags has hit homecare companies hard. Key supplies -- like replacement parts for power wheelchairs and tubing for home oxygen machines -- have been hard to come by. When the equipment patients and homecare providers need is available, the price of shipping and transportation is almost prohibitive. Labor costs are soaring, too.
Add all these factors up, and some homecare companies are struggling to keep their doors open.
That's a potential disaster for the elderly and those with chronic conditions or disabilities who rely on home medical equipment.
Imagine a senior with chronic obstructive pulmonary disease, or COPD, who is dependent on home oxygen. If her homecare provider scales back service in her community or exits Medicare entirely because of stagnant payment rates and rising costs, then she may have to seek care more frequently in expensive clinical settings -- or may end up in the emergency room.
Or consider someone who relies on a wheelchair to live independently. If the homecare provider they rely on to service their wheelchair disappears, possible consequences include impaired mobility at home, the need to bring on a part- or full-time caregiver, or even a transition to an assisted living facility.
Scenarios like these are already happening. And the problems will multiply if home medical equipment reimbursement rates remain unchanged even as inflation spikes.
Thankfully, a bipartisan group of lawmakers in the House have introduced legislation that would address this looming crisis. The DMEPOS Relief Act would raise payments for many providers of home medical equipment by an average of 9%. This would provide a lifeline to local home medical equipment providers burdened by inflation -- and more importantly, the patients who rely on them for care.
It's also inexpensive, relative to Medicare's budget. Home medical equipment accounts for less than 2% of Medicare spending. More importantly, home-based care can keep people out of higher-cost environments like hospitals and nursing homes.
The current inflationary spiral is a national crisis. Homecare providers and the patients they serve are finding that out the hard way. It's time for Congress to ensure these patients can get the care they need -- by updating Medicare's reimbursement rates.
Thomas Ryan is president and CEO of the American Association for Homecare (www.aahomecare.org). This piece originally ran in Medical Economics.
