medical equipment access issues within the medicare population

Medical equipment access issues within the Medicare populationLALAINA RABARY – PEOPLE FOR QUALITY CARE

Alicia Boyd – Medicare Patient • COPD patient, grandmother, primary caregiver for

her husband• Supplemental oxygen was limited to approximately

34 hours per month• Oxygen company said they would no longer service

her due to reimbursement cuts• Luckily, another company is taking her on

Read Alicia’s story here

Sandra De La Cruz - Caregiver• Caregiver for parents who are Medicare

recipients • Mother fell and had to coordinate a

wheelchair order for her• Wheelchair order took months due to

audits

Sandra’s story can be read here

Jordan Jonker – Healthcare Provider• Rehab aid at Capitol View Transitional Unit

– St. Paul • Discharging patients difficult – takes 2-3

weeks to get walkers and wheelchairs• Delays caused by limited pool of HME

providers and added documentation requirements

“Our main focus is about how we are going to get the patients home. Occasionally, that has resulted in discharging patients with rental equipment if their equipment hasn’t arrived in time.” 

Jordan’s story can be read here

3 of 3,590 people we’ve spoken to who have struggled to access medical equipment

Alicia, Sandra and Jordan are just…

Their stories are the reason we exist.

Medicare equipment access stories at www.peopleforqualitycare.org/map

Our interactive map shows access issues in real-time.

We believe…• Home medical equipment is a critical part of

homecare• Quality HME allows people to live

independently in their homes• We must work together to pursue health care

reform that benefits America’s seniors and people with disabilities

Pictured above: Tim Ascherl- Wheelchair user, advocate and former HME provider. Check out our story with him!

Medical equipment access for 44 million beneficiaries is threatened by…

•Flawed bidding system

•Reimbursement rate cuts (particularly harmful for rural America)

•Tightened documentation and face to face requirements

•Predatory audits

Big issues now and in the future. By 2030 more than 20% of U.S. Residents are projected to be aged 65 and over, compared to 13 percent in 2010.*

*Source: An Aging Nation: The Older Population in the United States, (Ortman, Velkoff, Hogan), May 2014

Some perspective…HCPCS Code Region (*) Previous

Current 7/1/16 rate E1390 (O2 concentrator) Mideast $180.92

$135.55 (-25%) $90.18 (-50%)EO470 (BiPAP) Rocky MT $236.78

$175.96 (-26%) $115.14 (-52%)K0003 (standard wheelchair) Great Lakes $93.72 $66.65

(-29%) $39.58 (-58%)K0823 (standard PMD) New England $577.42

$428.48 (-26%) $279.55 (-52%)Effects of reimbursement cuts on Medicare population… - Decreasing pool of local providers – more nationals- Longer wait times- Further distance from provider - Decrease in quality of service- Quality of equipment decrease- Patient safety can be compromised

What we’re doing…Garnering support from Congress for legislative fixes –Current effort: Freeze on July cutsPartnering with condition groups – COPD, NCART, ASAAGetting patient stories to Congress and state legislatorsConnecting patients with caring providers

Primary Goal: Move public policy forward that protects access to quality medical equipment and care for seniors and people with disabilities.

Challenges we face in creating systematic change

• More data needed to identify and recognize patient challenges in accessing HME• New ways needed to motivate people to improve health care system and take active

role in health care (apathy abounds) • Lack of awareness about HME and it’s importance • Constant expansion of patient needs (growing spectrum of illnesses)• Difficulty cutting through the noise to reach the grassroots • Difficulty keeping patients engaged for the legislative long haul• Shifting health care policies and leaders • Silo culture in organizations

We need your help! Please work with us to advance quality

care for seniors

• Refer Medicare beneficiaries, caregivers and health care providers to our Complaint Hotline

• Send a message to Congress about protecting equipment access at www.peopleforqualitycare.org/takeaction

• Connect us to other senior groups so we can spread more awareness about this issue

• Contact us to discuss ways we can partner

Problems accessing medical equipment? Call us at 1-800-404-8702

Contact InformationKelly TurnerDirector of Advocacy Kelly.turner@peopleforqualitycare.org866-642-6643

Lalaina RabaryCommunications and Marketing SpecialistLalaina.Rabary@peopleforqualitycare.org 866-544-7913

Follow us on social media@QualityCare14Facebook.com/PeopleForQualityCare

Visit our websiteswww.peopleforqualitycare.orgwww.dearmedicare.com

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