Last month, when my father was in a rehab facility and was preparing to be discharged, I found myself with a new responsibility as his primary caregiver. Although in my professional role, I manage the CareCentrix Durable Medical Equipment (DME) program, navigating care coordination became personal as I had to make sure he had everything he needed for a smooth transition home. There were a lot of phone calls, a lot to manage, and plenty of stress.

Unfortunately, stories like ours aren’t uncommon.

There are 73 million baby boomers1 in the U.S., and many of them have chronic diseases, have been hospitalized, and require DME in their homes for ongoing care. Providing the right equipment at the right time is critical to optimal outcomes, yet the DME industry has many challenges, such as inefficient processes that have impacted care, outcomes, and costs.

The Challenges of DME

The DME market continues to grow and is expected to reach $93B by 2030. For many, DME is a critical part of their care, yet gaps that have persisted for years have been hard to overcome.

For example, the system-wide lack of transparency and integration has led to fragmentation, poor communication, and collaboration between providers, payors, and members, and care delays that drive costs. In fact, between $129 billion to $244 billion annually is wasted on failures of care delivery and coordination.3

For members returning home after a hospital stay, our goal should be to make the transition easier and ensure they have the right equipment at the right time to manage their conditions, heal and recover, perform activities of daily living (ADLs), and avoid hospitalizations.

20% of adults aged 85 or older need help with ADLs, especially after a hospitalization.4

The DME process isn’t always straightforward, and it can take a lot of time and resources to identify and order the right equipment and supplies for each member. Some of these challenges include:

  • Identify the right supplier
    DME can be sourced from different suppliers for different needs and additional time may be needed to figure out which supplier and supplies to select for a particular patient need. For example, a DME supplier may provide ambulatory aids and home oxygen but may not provide enteral pumps and the nutrition supplies that a member may need. Additionally, not all DME suppliers are contracted with the member’s insurance, or they may not have the equipment available, which can cause further delays.
  • Ensure timely delivery
    Ensuring the DME equipment and supplies ordered are in the home when the patient needs them is paramount to avoid delays in therapy, their ability to ambulate, carry out activities of daily living, and avoid any unnecessary hospital readmissions. Since many DME requests are still submitted through phone or fax, it’s no surprise that errors and delays can occur, which can lead to unnecessary costs. DME suppliers that do not receive accurate and complete information to process the request in a timely manner, can create a lot of unnecessary back-and-forth between the supplier and the ordering provider.
  • Streamline authorization and claims processes
    Some equipment may require prior authorization, which can be time-consuming for the ordering provider. Additionally, there are more than 1,000 HCPCS codes for DME that can be ordered. Understanding how to accurately code claims can be a challenge. Items such as lack of documentation or coding errors can all lead to denials.

As more healthcare services move into the home, providers, payors, and other stakeholders must find new ways to support members and enable better, more seamless care coordination. Fortunately, new solutions have emerged that are elevating support in the home.

Up to $265B annually can be saved due to administrative simplicity5

Innovative Point-of-Care Platform to Streamline DME

Recently, I witnessed how one supplier is making efforts to improve DME management and the member experience. When my mother’s nebulizer stopped working, she called her pulmonologist to let him know. Within just two hours, she received a text confirming the order for a new nebulizer, the name of the DME provider and their contact information, as well as the status and tracking information.

It was great to see the improvement in communication, and while two hours is impressive, and not necessarily the norm, there are innovative and modern point-of-care platforms such as DME Navigator that are making DME management even more efficient.

DME Navigator can offer providers an easier, more transparent way to select the right equipment for their members, ensuring it is for the right medical need, at the right time, from a reliable supplier, at an affordable cost, driving consistent cost savings. It also provides status updates which ensures a seamless experience.

This point-of-care platform can display the equipment from a list of suppliers, with descriptions, photos, HCPCS codes, and information about whether or not a prior authorization is required. A member’s insurance information is pre-populated and with EHR integration, providers have access to the member’s records.

This more advanced platform integrates evidence-based criteria that streamlines prior authorization processes and enables faster decision-making, provides access to credentialed, in-network providers that are vetted for product and service quality, accessibility, and cost-effectiveness, and offers claims oversight to quickly identify incorrect or fraudulent billing practices. Once an order is placed, members receive notifications with status updates and tracking information.

With more care moving into the home every day, the industry will need to work together to implement innovative solutions that improve care, outcomes, and the experience for the ever-growing population of members and caregivers like my father and me. While the journey hasn’t been easy, I’m happy that my father received the equipment and care he needed, right on time and in his home. He also has a team of home health providers by his side to help him recover and adjust back to life at home.

To learn more about simplifying DME management for your members, visit our DME Navigator Page.

 

Sources:

  1. United States Census Bureau, 2019.
  2. Grand View Research, 2023.
  3. Peter G. Peterson Foundation, 2023
  4. National Library of Medicine, 2023.
  5. McKinsey & Company, 2021.

 

EDRC 2210 102024

Tags
  • DME
  • Durable Medical Equipment
  • technology