Always the easy target

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11/01/2017

A Boston TV station recently ran an “I-Team” piece on a man who needed a brace after twisting his knee and who was charged nearly $700 for said brace by a local supply company because he hadn’t met his deductible.

In shock, the man Googled the brace and found it available through several online retailers for as little as $125.

Who do you think took the blame in this scenario?

You guessed it, the supply company.

It’s all become so very predictable.

There a number of things wrong with this, the first being the supply company doesn’t set fee schedules for DME, Medicare does, and more often than not, private insurers pick up those fee schedules, as appears to be the case here.

Why is the fee schedule for this particular brace nearly $700?

It might have something to do (though not entirely—I’m not naïve) with the second thing that’s wrong with this: There’s a big difference between getting a brace from a supply company vs. an online retailer.

It’s not quite apples to apples, but this reminds me of a graphic recently posted to twitter by the government relations team at VGM that compares the payment received for a pumpkin spice latte and the work involved in providing said latte, and the payment received for a nebulizer and the work involved in providing said nebulizer.

Like I said, not apples to apples, but the general idea is, being a supplier vs. an online retailer comes with additional burdens, including more often that not filling out and collecting cumbersome paperwork.

Of course, it wouldn’t be a piece involving DME without a mention of competitive bidding and how that has helped to rein in pricing (albeit, as the article points out, not for braces, which hasn’t been included in the program—yet), to which a provider responded, “Dear I-Team, interview oxygen and diabetic patients who can’t find providers due to Medicare allowables (that are drastically reduced due to competitive bidding), rather than one guy with a knee brace.”

Good point.

All of this is symbolic of the mess we’re in—a knee brace whose allowable is probably too high; an oxygen concentrator whose allowable is definitely too low.

It’s representative of the complicated problems with the healthcare system in the U.S. today, problems that go far beyond DME, which accounts for only a slim percentage of total Medicare spending.

So why is it DME’s always the easy target?