Medicare Cuts of More Than 50 Percent for Home Medical Equipment Forces Many Seniors to Pay More

Jan. 1, 2016, Medicare phased in the first of two cuts to home medical equipment and supplies, such as oxygen, hospital beds, walkers and wheelchairs. The second phase of cuts began July 1, 2016. The average cut for the providers of these items is 56 percent in urban areas and 53 percent in rural areas, according to a fact sheet from The Centers for Medicare and Medicaid Services (CMS).

Also beginning July 1, 2016, CMS further cut reimbursement for home medical equipment and supplies in metropolitan areas, called competitive bidding areas. In this program, Medicare beneficiaries are limited in whom they can get their equipment and diabetic testing supplies from. They often experience long delays in getting what they need, which results in them either paying for the items they need out of pocket or going without the home medical equipment they need.

CMS claims these reimbursement cuts in home medical equipment and supplies “will reduce beneficiary out-of-pocket expenses and save the Medicare program money while ensuring beneficiary access to quality items and services.”

“Unfortunately, it has had the opposite effect on Medicare beneficiaries,” says Rose Schafhauser, executive director for the Midwest Association for Medical Equipment Services (MAMES), a regional association of home medical equipment providers. “In urban and rural North America, home medical equipment providers have been forced to make radical changes to stay in business and survive these drastic cuts. Home medical equipment companies throughout the country have already shuttered their doors. The radical changes and businesses closures are affecting Medicare beneficiaries’ access to home medical equipment and supplies.”

According to a membership survey conducted by MAMES, all nonparticipating providers plan not to accept assignment on Medicare claims. This means that Medicare beneficiaries will have to pay for their items up front, and Medicare will pay the beneficiary the minuscule reimbursement.

“Charging the Medicare beneficiaries up front is the last thing our members want to do, but they are left with no choice,” Schafhauser said. “Home medical equipment providers have already cut everything they can to survive in business, and this is their only option.”

The home medical equipment industry is less than 1.25 percent of the Medicare spending budget. It has proved to be the most cost-effective form of health care by allowing Medicare beneficiaries to have the home medical equipment and supplies they need to remain in their homes and out of costly hospitals and long-term care centers.

CMS continues to push Medicare cuts generated by a flawed program making it impossible for providers to continue to serve beneficiaries in the fashion our most vulnerable citizens deserve. These cuts often make it impossible for providers to stay in business, limiting access to home medical equipment, supplies and services for Medicare beneficiaries.

An Act of Congress is the only fix for this problem. The providers of home medical equipment have been strongly voicing their concerns with Medicare officials and members of Congress to show them the impact this program is having on Medicare beneficiary’s access. Congressional action is now the only way to reverse these drastic cuts.

Medicare beneficiaries and their families are encouraged to contact their members of Congress and let them know that they need Congress to protect their access to home medical equipment, supplies and services in your community by stopping the drastic Medicare cuts. They should call the Congressional Switchboard at 1-866-338-1015 or go to http://www.contactingthecongress.org.

MAMES is a seven-state regional association representing more than 200 durable medical equipment, prosthetics, orthotics and supplies providers, manufacturers, distributors, consultants and other service providers in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota. MAMES members are integral to saving money in health care by enabling people to stay in their homes. For more information, call 651-351-5395 or email info@mames.com.