Durable Medical Equipment: A Streamlined Approach
Durable medical equipment helps patients live healthier, more independent lives. Here's how to minimize the hassles of getting it to them.
Fam Pract Manag. 2021 Mar-Apr;28(2):15-20.
Author disclosures: no relevant financial affiliations disclosed.
Patients depend on durable medical equipment (DME) to function independently in their homes and communities. But fulfilling DME requests for patients can be time-consuming and burdensome for physicians. Getting the equipment often requires collaboration between multiple parties: the primary care physician and staff, the patient and family, the insurance company, and the equipment supplier. Common hurdles in the DME process include the complexity of the equipment, lack of standardized workflows, and variable insurance coverage requirements. In many practices, there may also be a lack of clarity surrounding the workflow. This can cause delays in patients receiving their DME and may even prevent some patients from ever receiving it. That increases risks to patient health, decreases patient satisfaction, and spurs staff frustrations.
But there are ways for practices to streamline the process, once they better understand it. This article includes a brief overview of DME regulations, tips for navigating them more efficiently, and several templates we have found useful in our practice.
Patients often depend on durable medical equipment (DME) to function in their homes and communities.
Getting DME ordered, authorized, and delivered can be challenging for physicians and staff, leading to delays in patients receiving their DME.
DME delays can cause safety risks, decreased patient satisfaction, and increased staff frustrations.
Designating a staff DME expert and developing templates for DME documentation and orders streamlines the process so patients can obtain their equipment quickly.
RULES AND REGULATIONS
As with most aspects of medicine, the Centers for Medicare & Medicaid Services (CMS) has created rules and regulations for DME. First, the agency has guidelines for what qualifies as DME under Medicare. The equipment must be durable (can withstand repeated use and generally lasts at least three years), used for a medical reason, not typically useful to someone who is not sick or injured, and used in the home.1
DME that meets this definition and is medically necessary is covered under Medicare Part B. Medicare sets an approved price for each type of equipment. Patients have to pay 20% of that amount, and their Part B deductible applies as well. Coverage varies somewhat based on the type of DME (for example, patients may be eligible to have some items replaced sooner than others). Although private insurers tend to use Medicare as a guide, they may have their own rules about what is covered and what isn't. All of this has implications for patients' upfront and ongoing costs.
1. Medicare coverage of durable medical equipment and other devices. Centers for Medicare & Medicaid Services. Accessed Feb. 12, 2021. https://www.medicare.gov/Pubs/pdf/11045-Medicare-Coverage-of-DME.pdf
2. Fields E, Neogi S, Schoettker PJ, Lail J. Using Lean methodologies to streamline processing of requests for durable medical equipment and supplies for children with complex conditions. Healthc. 2018;6(4):245–252.
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