For durable medical equipment (DME) providers, reimbursement for oxygen has taken a hit, leaving providers with a revenue void. In order to make up for the loss, many DME providers have turned to sleep therapy and have instituted more aggressive follow-up programs for patients to replace CPAP masks, filters, and tubing, according to a Wells Fargo Securities, LLC sleep survey conducted in partnership with HME Business. With DME providers having a shaky reputation for patient follow-up among some in the sleep industry, more follow-up seems like a move in the right direction. But with competitive bidding knocking at the door of many DME providers, what type of service will patients receive? If money is the only thing on the minds of DME providers, patients will be on the losing end.
According to the same Wells Fargo Securities survey, “In reaction to competitive bidding, HMEs [home medical equipment providers] appear most likely to stick with their existing suppliers but either to attempt to negotiate lower prices or to move Medicare patients to lower-end masks and flow generators.” CPAP machines and masks have been refined over the past years in order to increase compliance. To switch to low end masks simply as a reaction to profit margins rather than patient compliance concerns will not be doing any good for the patient.
If DME providers want to meet the CMS compliance criteria for continued coverage (Medicare recently added a requirement for a data report showing that patients use CPAP for at least 4 hours per night for 70% of nights during a consecutive 30-day trial period), it’s best to stick to the right mask and right machine for the right patient. Perhaps, in this instance, CMS has managed to strike a good balance in its policymaking.
—Franklin A. Holman,