OIG report on catheters: ‘Where are they getting their information?’

YARMOUTH, Maine – An Office of Inspector General report “understates” the actual cost of providing catheters, especially given the complexity of both Medicare’s documentation requirements and the needs of patients, say providers. 

The report, released in September, found that Medicare payments for intermittent urinary catheters were 3.4 times supplier acquisition costs in fiscal year 2020 and recommended that CMS lower its reimbursement rates. 

“I’d like to know where they are getting their information from,” said Chris Malcolm, president of First Source Catheters in Cumming, Ga. “They’re not taking into consideration the higher-priced items that cost more than half the allowable, they’re not taking into account the amount of time it takes (to serve beneficiaries).” 

Because urological products encompass thousands of specific products with varying sizes and features, it can take a lot of time working with patients to determine what best meets their health and lifestyle needs, says Mica Philips, director of urology at Aeroflow.  

“As a long-time supplier with extensive direct interaction with these patients, Aeroflow is acutely aware that patient needs can change over time,” he said. “Often, a high degree of trial and error and physician collaboration with the supplier can be required to not only establish initial compliance for a new patient with catheterization but ensure that patients experience positive health outcomes over what can often be a lifetime need. I do not feel that the methodology used in the OIG report adequately weighs the many soft and unquantifiable factors involved with providing exceptional patient care and support to this sensitive and diverse population.” 

Any reduction in reimbursement could impact beneficiary choice and access, says Philips. 

“For such a complex and sensitive population, with as many disparate health conditions and lifestyles, this can be a source of great anxiety,” he said. “I’ve personally heard our patients reduced to tears when changes in their insurance coverage have limited their ability to continue receiving a highly personal product that they have been using for, in some cases, years.” 

Both suppliers and manufacturers weighed in with the OIG and that process was “good,” even if the final results aren’t what the industry wants to see, says Kim Brummett, senior vice president of regulatory affairs for AAHomecare. 

“They did acknowledge there were other costs suppliers incurred outside of acquisition costs,” she said. “At this point, we have a group of folks on the medical supplies and regulatory councils formulating a response to send to the OIG, just to go on record with some points they might have missed. If it comes up on the Hill later on, there’s some ammunition anyone can use.”