Insurer Reimbursements: Could Less be More?

I've been thinking about this recently, and wanted to throw it open for debate...
(excerpted from http://www.sleepguide.com)


If you haven't heard, Medicare and private insurers are putting the screws to the DMEs that provide our Sleep Apnea equipment in an effort to cut costs, much to the chagrin of DME providers. One aspect of the cost-cutting is to deny reimbursement to DMEs and other providers that cannot show that their patients are complying with CPAP treatment. While at first blush, this might seem like an adverse development for us patients, the problem for us might be that the insurers didn't do this sooner, and that they haven't yet gone far enough.

My thinking is this: for too long, DMEs could get away with giving out to patients the most basic, least effective and "dumbest" machines out there. These are the machines that cost the DMEs the least (and thus result in the greatest margins), but which also reduce the likelihood of us getting well with Sleep Apnea. With no feedback given to the patient on how the patient is doing, the patient quickly kicks aside the treatment altogether when something goes wrong, because there is no obvious path to fix the problem. As we know, data-capable machines provide this feedback so that we are not "flying blind," but rather can tweak our therapy if something is not working, and quantify the results of the tweak.

Now the reason the dumb machines were put out there in the first place was because the DMEs could get away with it. Not any longer. Insurers are saying you have to give out data capable machines, because there is no other way you can prove to us that the machines are being used and unless we have that proof, we're not going to reimburse you for it. And look what the result is: chances are slim that any newbie to this forum is being prescribed a machine that doesn't at least have some basic data capability.

But let's not rest on our laurels. That's a step in the right direction, but just a baby step. What we are really after with data monitoring isn't just knowing that the machine is on, but knowing that it is being effective. So I would advocate that the insurers make the DMEs reimbursement conditioned on efficacy data, and not just compliance data. My guess is after a little while with this regime in place, we'll see a big move forward in patient compliance rates, and in innovative technology designed to improve compliance.

Mike, I read that clause the same way you did at first. But go back and read it again. All that Medicare is requiring is the COMPLIANCE DATA, so the DME suppliers can continue right on providing compliance data capable only CPAPs. *sigh*