Fernando Echeverria, RRT; NJSRC Director at Large
When a patient exits those hospital doors and they step outside into the fresh air, they’re bombarded with all the sensations that were missing during her hospital stay. The bright colors, the sounds, the smells, everything just looks more alive at that time. I know this from my own personal experiences, but I also know from what my patients tell me they experience, finally being able to come home. As a respiratory therapist working in home care it’s our goal to make these patients as comfortable as possible and to provide them, not only with the equipment and technology, but also the education, to improve their quality of life.
As I head to a newly discharged patients home, I know that the outcome of our meeting will have a profound impact on how that patient will improve their quality of life. It is with this thought in mind that we begin to prepare for these meetings and try to anticipate any challenges we may face, that would interfere with the quality of care we can provide. These challenges can come in many forms; they can be language barriers, cultural differences, or disabilities, which would impair a patient’s ability to follow therapy recommendations. While these challenges get in our way and don’t make our job any easier, they are things we’ve been trained to deal with and overcome. We know how to spend time with our patients and their families, and explain to them the purpose of the therapy and how it’s going to improve the way they live day to day. We’ve developed methods and techniques to help people understand and remember how to do things, even when they have disabilities. We can educate friends and family who will be helping the patient, so that they too know how to maintain and use the equipment. All of these obstacles are overcome through training and experience, and while it is no easy task to convince the elderly COPD patient that using their oxygen is good for them, and that they won’t become addicted to it, it pales in comparison to the Mount Everest of obstacles we face in home care today.
The Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program has been implemented by Medicare in an attempt to save money and reduce fraud. The program mandates that Medicare uses a competitive bidding program for providers instead of their previous fee schedule (Services, C. f. M. a. M. (2014)). What this means is that if a provider wants to provide services, they must place a bid on that service along with other providers. The problem with this program is that it potentially takes patients away from quality suppliers and puts them in the hands of the “lowest bidder”. Imagine the elderly patient who is using a CPAP device with oxygen. Now imagine that that same patient, who’s been provided with quality care and service for the past several years, now is forced to switch to another provider because their current one didn’t win the bid. Now that patient may find themselves in the hands of a company who doesn’t even operate within their state. They subcontract, and drop-ship equipment. Now, when this patient receives their new supplies, they find that the mask they’ve been sent doesn’t fit properly. They called the new company to ask for help or to have someone come out and fit the mask for them. However, because this new company is out-of-state it is not able to send a respiratory therapist to the patient’s home and instead, they send another mask for the patient to try on their own. This continues until finally after several masks the patient’s doctor intervenes, and provides a mask fitting through their office. That doctor, now annoyed and confused, calls the patient’s previous provider and asks what is happening. It is explained to them that because of the competitive bidding program the company can no longer provide supplies or services to his patient. The doctor asks what he can do to get Medicare to accept the previous provider again. My response, “write your congressman!”
Each and every day, despite obstacles like competitive bidding, we continue to get out to our patients because, like our brothers and sisters in the hospitals, we know what a difference we make in each and every life we touch.
References
Services, C. f. M. a. M. (2014). DMEPOS Competitive Bidding – Home. Retrieved 4/8/15, from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/index.htm
