New Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, M.D., has listed four goals to “Make America Healthy Again,” per the mandate from President Donald Trump.
Goal #4: “Shifting the paradigm for health care from a system that focuses on sick care to one that fosters prevention, wellness and chronic disease management.”
Truly pursuing that goal could be good news for the home medical equipment (HME) industry, and even more importantly, could positively impact the lives of Medicare and Medicaid beneficiaries with a wide range of disabilities, illnesses and other medical conditions.
An emphasis on prevention and disease management
The keynote speaker at last month’s International Seating Symposium — a Complex Rehab Technology (CRT) conference hosted by the University of Pittsburgh’s School of Health and Rehabilitation Sciences Continuing Education — was Peter W. Thomas, J.D., managing partner at law firm Powers Pyles Sutter & Verville PC, and co-coordinator of the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition.
Thomas pointed out that new Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. is prioritizing the management of chronic illnesses, which explains the fourth goal on Oz’s list. And Thomas wondered if disabilities qualified as chronic conditions whose management would be emphasized under the new administration.
During his keynote, Thomas — who uses prosthetic limbs as well as a wheelchair — focused mostly on disabilities involving seating and wheeled mobility. But it’s easy to extrapolate that premise to the larger home medical equipment segment, which absolutely supports patients with long-term conditions, from chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) to sleep apnea.
Think of how HME not only keeps patients out of institutions, but also helps to keep many patients’ conditions from progressing or causing secondary problems:
— Mobility aids, including canes, walkers, rollators, and standard wheelchairs: Reduce risk of falls, which can result in fractures, surgeries, hospitalizations, and admissions to rehabilitation facilities. The nonprofit American Geriatrics Society’s Health in Aging Foundation noted that up to half of older adults who sustain hip fractures have difficulty performing mobility-related activities of daily living, such as bathing, dressing, and feeding themselves. That’s one of many reasons to prevent as many falls as possible.
— Hospital beds: Can provide weight shifting to relieve pressure that could result in pressure injuries. Position changes can be helpful to patients with edema or patients with respiratory or circulation issues. Position changes can help to prevent contractures.
— Diabetic supplies, including continuous glucose monitors (CGM): Track and support diabetes management at home to reduce emergency department visits and hospitalizations, and to reduce risks for complications such as amputations.
— Wound supplies: Support and promote care and healing of chronic or slow-healing wounds in the home to reduce the need for institutional care.
— CPAP and BiPAP and supplies: Respiratory support for patients with sleep apnea; BiPAP can also support patients with COPD.
— Compression supplies: For patients with edema, including edema caused by lymphedema.
HME is a responsible investment
The list goes on and on. As the HME industry has been saying forever, home medical equipment doesn’t just maintain the status quo; it can prevent disease progression that would be costly to both CMS and to patients. Using HME to its fullest potential could lead to Medicare and Medicaid programs spending less on pain medications. It could reduce the number of surgeries, hospitalizations, rehab facility admissions, and admissions to skilled nursing and other types of residential facilities.
And HME could reduce the risks of that chronic conditions will lead to additional serious injuries — which could happen, for example, if a Medicare beneficiary with arthritis falls and fractures a hip.
As evidence of HME’s preventive powers, the industry can point to research published in peer-reviewed journals. One recent study demonstrated better outcomes for diabetic patients who received their CGMs from HME providers vs. from pharmacies. Another recent study that showed noninvasive ventilation can reduce hospitalizations and emergency department visits for patients with COPD with chronic respiratory failure.
Of course, to guarantee access to HME products and services, funding policies need to move beyond the “penny wise, pound foolish” thinking that HME providers have been laboring under for decades.
Rather than cutting HME funding to the bone and beyond, only to see other costs such as hospitalizations skyrocket, CMS should start funding HME for what it is: a cost-effective investment. Dr. Oz could find great allies among HME providers and manufacturers as he works to prioritize disease prevention and management for the benefit of patients as well as CMS itself.
