Washington

Last month brought national attention to a debate that has been simmering just below the surface of Congressional notice for nearly a decade.

Based on a June 11 report from the U.S. Department of Health and Human Services' Office of Inspector General, major news organizations such as USA Today and NBC Nightly News have suggested that Medicare pays too much for durable medical equipment, prosthetics, orthotics and supplies.

The report, which the OIG prepared at the request of Sen. Tom Harkin, D-Iowa, and chairman of the Senate's Subcommittee on Labor, HHS and Education, compares what Medicare pays for DMEPOS to what other government health care programs, such as the Veterans Administration and Medicaid, pay for the same equipment. Pointing to discrepancies of as much as 88 percent between what Medicare pays and what the VA pays, the report concluded that “Medicare and its beneficiaries pay more than they should for certain medical equipment and supplies.”

But home care industry representatives said the report is fundamentally flawed. “Comparing the VA to Medicare is like comparing apples to oranges,” the Alexandria, Va.-based American Association for Homecare wrote in testimony it submitted to the subcommittee.

Similar to the OIG's previous studies on the subject, this report “fails to account for the structural differences in the programs and the additional administrative costs of providing DMEPOS to Medicare beneficiaries,” AAHomecare said. Not only must DMEPOS suppliers document the medical necessity of each claim, but they also must obtain a prescription from physicians, document proof of delivery, incur the expense of billing Medicare co-pays and deductibles, and bear the risk of bad debt, the association explained.

Additionally, DMEPOS suppliers provide services that Medicare does not reimburse directly. “Transaction costs for servicing Medicare beneficiaries are higher than they are for VA patients because of the significant cost of complying with Medicare program rules,” AAHomecare insisted.

For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.