DMEs – a $300 dollar hammer?
Durable medical goods are items that your doctor would often dispense from his or her office. In other cases, durable medical goods might be purchased from a home health supply company. Examples of durable medical goods include a walking cast, a night splint, a bedside commode or a hospital bed. What’s the true value of these durable medical goods? How much should they cost? That’s often a very hard question to answer.
This question came to my attention recently while reading my hometown newspaper. One of my neighbors had written to the editor of the paper to complain that she felt she had been overcharged by a doctor in town. The doctor had dispensed a lower extremity night splint to her. She was upset that she and Medicare were charged $122 for the night splint. The reason she was upset was that a quick search on the Internet had found that you could buy the exact same night splint from Amazon for $29.95.
So what’s a plantar fasciitis night splint really worth?
The answer actually creates more questions. All DME goods are billed to Medicare via numerical codes called HCPCS (Health Care Procedure Coding System Codes). A search on Medicare’s 2017 DME supply reimbursement for 2017 shows that in Colorado (my home state), for a night splint (HCPCS code L4360), the allowed amount by Medicare is $159.94. That means that Medicare would approve to pay a doctor $159.94, 80% of which would be paid for by Medicare and 20% billed to the patient’s secondary insurance or the patient. These billed amounts are also subject to co-pays and deductibles.
A quick search on Amazon for ‘plantar fasciitis night splint’, finds night splints sold as low as $21.95.
How could these two charges be so disparate? Where does the true value of this DME lie? The doctor, I’m sure, would argue that he or she was providing personalized instructions for use of the splint. But again, we’re assuming that this is exactly the same device found on Amazon – apples to apples. So how could you find this same device for $138 less on Amazon?
Health care delivery and health care economics is a lumbering juggernaut that desperately needs to be improved.
Traditionally controlled by government agencies and insurance providers, the delivery of health care is now facing competitive pressures from many sides. Patients have opportunities to step out of traditionally funded health solutions to find more cost-effective solutions on the Internet, within community support groups or from alternative health care providers. Is this good health care? In many instances, yes, it can be. But just as the US Military famously bought hammers for $300, we don’t need to be approving Medicare payments 7-8 times the market price.
So what is the real value of DME? We like to think that Medically Guided Shopping™ helps to determine DME value. Myfootshop.com uses Medically Guided Shopping™ to help our customers understand their health problems and find affordable solutions with products specifically intended to treat their conditions. No guessing, no upsell. We simply combine consumer-focused health information and cost-effective products.
My personal interest in this story is two-fold. I dispense night splints from my office and bill at accepted Medicare rates. I also sell night splints here on Myfootshop.com - $49.95. Can we compete with Amazon? No, but depending on your preference and your interpretation of value, I think we fit right into that sweet spot of true DME value.
Jeff
Medical Advisor
Myfootshop.com
Updated 3-11-2021
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