Patients coming home from the hospital after surgery or treatment for an illness often require extra help. They may have difficulty getting around the house, bathing or even using the bathroom. Mothers coming home with new babies may need breast pumps. The concept of durable medical equipment (DME) was developed to describe equipment that a patient might need on a temporary or long-term basis to accomplish activities of daily living or to tend to a short-term medical need.
What Does DME Stand For?
DME is essentially medical equipment paid for by an insurance company. The category includes those items that would be covered by Medicare or other third-party payers. Accordingly, DME requires a physician to write a prescription for the equipment, and a certified supplier must accept the patient’s insurance.
The name ‘durable medical equipment’ can be confusing. According to Blue Cross/Blue Shield, DME is ‘primarily and customarily used to serve a medical purpose’; is not useful in the absence of illness or injury; is reusable; and is appropriate for use in the home.
Nevertheless, some DME are items that most people would not consider ‘equipment’ as such; some DME have questionable medical purposes; and as we will see shortly, some DME are not particularly durable.
What Qualifies as Durable Medical Equipment?
According to the Centers for Medicare and Medicaid (CMS), a walking cane is DME, and is therefore covered by Medicare. The same goes for walkers and other assistive ambulatory devices. However, the ‘white canes’ used by blind people are not considered DME according to CMS. This is despite the fact that white canes primarily serve a medical purpose (helping a blind person navigate the world) and they are useful in the home. Motorized scooters are also not covered, perhaps because they are primarily (though not exclusively) used outside of the home. Portable oxygen units are covered by DME, despite the fact that they are designed to be used outside the home.
Breastfeeding is not ordinarily thought of as a medical procedure, and yet breast pumps are covered by many insurers as DME. The same goes for the accessories that accompany the breast pump, including bags and tubing.
Air conditioners can prevent hospitalizations for people with chronic diseases who are at high-risk for falling ill on hot days. Nevertheless, air conditioners are not covered as DME. CMS will cover commodes for those who have difficulty using a standard toilet, but they will not cover toilet seats.
[Learn more about “home first when possible”]
Is DME Single-Use Only?
The ‘D’ in DME stands for durable; according to some definitions, DME should last for at least three years. Nevertheless, CMS covers some items that are used only once and are then thrown away, such as blood sugar test strips for patients with diabetes. Bladder catheters, also thrown away after use, are not typically considered DME, however if the physician fills out the correct paperwork, catheters may be covered as prosthetic devices.
Who else pays for DME? The Role of Payers and Suppliers
Commercial third-party payers generally follow the lead of CMS and will cover most DME. Prior to discharge from an acute care facility, if a patient will require DME, typically a hospital care coordinator will identify local suppliers that accept the patient’s insurance. Care coordination of this type is standard practice whether the patient is hospitalized for an illness or following surgery.
Care coordinators and other discharge planners relieve the patient of the stress of having to shop for medical necessities when leaving the hospital. This is especially important if the hospitalization was not anticipated, as in the case of an accident or acute illness. Nevertheless, it is a good idea periodically to review your health coverage to identify whether your plan covers DME. New mothers ought to check their coverage before they run out and purchase their own breast pumps. Finally, don’t be confused by the expression ‘durable medical equipment’: the item you need might not be equipment, it might not serve a medical purpose, and it might not be very durable.