A group of provider and patient stakeholders has developed a white paper to educate payers and state Medicaid programs on intermittent catheters and underscore the need for home-based patients to have access to these items and their related services.
The white paper, The Critical Need to Provide Intermittent Catheter Urological Supplies Specific to Patient Need to Improve Health Outcomes, was developed by the American Association for Homecare; United Spinal Association; Wound, Ostomy, and Continence Nurses Society (WOCN); Society of Urologic Nurses and Associates (SUNA); and Wound Ostomy and Continence Nursing Certification Board.
The document addresses the variables going into managing patients’ urinary retention needs, the role of HME providers; the risks of improper management; the challenges of limited HCPCs codes for a variety of products; and the value of managing urinary needs with sustainable reimbursement.
The paper requests that payers ensure rates for intermittent catheters and services are no less than the current corresponding 2021 Medicare fee for service rates for these products. Partnering organizations will use this resource in outreach and education to payers, state programs, and legislators to preserve access to catheter supplies and services.
Obstacles to Care
Intermittent catheters are the preferred method of bladder management among individuals with urinary retention and are clinically shown to have a lower risk of catheter-associated urinary tract infections (CAUTI).
HME providers aim to work closely with the clinicians and patients to deliver appropriate supplies and provide education and services to people requiring intermittent catheterization in a cost-effective, homecare setting.
However, there are reimbursement obstacles that can prevent that:
- Codes with unsustainable reimbursement rate reductions limit both the services provided and the types and brands of urological supplies offered.
- Current Medicare codes for intermittent catheters are fairly generic and do not distinguish the wide range of products with differing features classified within a single HCPCS code.
- Those issues can restrict end users’ product and care access as well as lead to hospital readmissions that can exacerbate co-morbidities and ultimately increase the total cost of care for catheter patients.
“The importance of having the correct catheter for the individual’s particular medical and physical needs is key to successful urine management, bladder, health, and vital for quality of life,” explains Kate Lawrence, MSN, RN, CWOCN, the Public Policy and Advocacy coordinator for WOCN
“Home medical equipment providers are doing their best to provide the specific catheters that best meet an individual’s unique medical, anatomical, and lifestyle needs within the constraints of the payer’s reimbursement,” said Laura Williard, vice president of Payer Relations for AAHomecare. “By working with payers to ensure that these benefits adequately cover the cost of providing these products and services, we can remove barriers to care, save the payer money overall via better health outcomes, and increase end user satisfaction.”
“It is imperative that individuals with bladder dysfunction have a choice of catheters, as prescribed by their physician, to ensure the best health and quality of life for every catheter user,” added Alexandra Bennewith, vice president of Government Relations for United Spinal Association.
