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Newsletters: Medicare Decides Price More Important than Quality
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Medicare Decides Price More Important than Quality

Rick Davis, HEN Consumer

If you receive good service and quality care from your home care company, how would you feel if the government said you had to change? It happened to me and it may happen to you.

Medicare pays for 80 percent of my home enteral nutrition (HEN) formula and supplies. Under a program called “competitive bidding,” Medicare will no longer reimburse my home care company. I must use a different service, which may have unacceptable patient care or customer service. The objective of competitive bidding is to reduce government spending, but patient care and quality of service are NOT considered. “Cheap” is no guarantee of quality.

 

My Experiences

I use a feeding tube for 100 percent of my nutrition and hydration. Over eighteen months of stroke rehabilitation, I relearned how to walk and talk, but my esophagus is permanently paralyzed. I cannot swallow, and I could not work at my former job. At age 57, I began to receive Medicare benefits under a Social Security Disability qualification. Medicare and my secondary insurance have paid all the costs of my HEN.

I have had twelve years of experience with home care companies. The first experience was not good. The second was excellent. I have just started with the third company and the jury is still out.

Some examples of bad experiences: (1) upon delivery, plastic containers of formula were sometimes broken and leaking; (2) a home parenteral nutrition (HPN) order was mistakenly delivered to me, which may have been a serious problem for the HPN patient who received my HEN; (3) a home care nurse who couldn’t fix a non-working feeding pump said to me, “Can’t you just try really hard to swallow?” Sometimes I received more than I needed, sometimes less; sometimes I received supplies I did not need. I had no contact with anyone except the nurse who could not fix the pump and someone who called each month to confirm shipment of my order.

When I moved to Florida, my home care company said they could not ship out-of-state. Because of the Oley Foundation, I knew more about my care then and I researched before choosing another company. My experience was excellent. Formula and supplies were never damaged. Every shipment was as ordered. They found special equipment for me that the first company said was “not available.” A dietitian followed my progress. My questions were always answered—if not immediately, within twenty-four hours. I heard from pharmacists, nurses, and dietitians as needed. When I traveled, my formula and supplies were awaiting me when I arrived. Everyone I dealt with was pleasant and professional.

 

The Unknown

When I learned I had to switch companies because of competitive bidding, I was not happy. I did not complain when competitive bidding was introduced, but I will definitely complain now. I am writing to Medicare and my Congressman, and I hope you will also. If all HEN consumers complain, it may make a difference. Members of Congress pay more attention to their constituents than they do to industry representatives, who may only want to protect their business.

Reducing government spending is a worthy goal. The media regularly report exorbitant costs charged to Medicare and fraudulent claims. But healthcare savings should not be at the expense of patient needs or quality of service.

LifelineLetter, July/August 2013

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Malnutrition Awareness Week

5/6/2017
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This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.

 

Updated in 2015 with a generous grant from Shire, Inc. 

 

This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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