On one of the few flights I took the last quarter of 2020 (thanks, Covid!), a seatmate struck up a conversation with me. Yes, it’s still possible to do these simple and rather “human” things we took for granted before the pandemic—even while wearing facemasks. The conversation started with the usual “So, what do you do for a living?” question. A couple exchanges with my new friend later, I found myself drilling down into what DMEPOS is and some of the myriad types of equipment and supplies that fall into the Medicare definition.
For even the most seasoned DME industry veterans, it can be surprising how many different types of suppliers require accreditation and fall into what we now call DMEPOS. DMEPOS, of course, is Durable Medical Equipment, Prosthetics, Orthotics, & Supplies. The Centers for Medicare & Medicaid Services (CMS) laid out regulations for certain categories of equipment and supplies, which it began calling “DMEPOS” about the time mandatory accreditation became an industry reality. For purposes of our conversation, DMEPOS is typically billed through Medicare Part B, and accreditation by an approved accreditation agency such as HQAA is required in order to participate as a provider in this program. Some of the equipment and supplies is competitively bid—and we could write a book about that subject alone. And some is billed from a traditional fee schedule and any accredited provider can supply customers and bill for it.
DMEPOS had a broad and –some would argue—vague and arbitrary definition. The definition initially stated that DMEPOS was equipment that was used primarily for a medical purpose; was not useful to people without injuries, disabilities, and illnesses; and was appropriate for use outside the hospital setting in the home. The list of equipment and supplies considered DMEPOS read like a “who’s who” of the old-fashioned sickroom supply store’s product offerings and included:
- Hospital beds
- Oxygen equipment
- Traction equipment
- Suction devices
- Diabetic testing supplies and equipment
- Infusion pumps
- Negative pressure would therapy (NPWT) devices
- Intermittent positive pressure breathing (IPPB) devices
All the equipment categories that require accreditation can be found on your organization’s Equipment List. The list includes three pages of medical equipment and supplies on a checklist form. The equipment list is something that HQAA (and all accreditors) maintain and present to CMS to validate an organization’s accreditation.
Sometimes, our work can seem mundane. As a surveyor and industry consultant, I’ve been to literally thousands of DME organizations. It would be easy to think “there’s nothing new under the sun” once you walk through the door of your 1500th company for a visit. The truth is, not only that there are remarkably unique ways that these DME organizations operate, but there are also countless new product offerings and delivery methodologies that make my job and our industry interesting. Talking to my seatmate on the plane was instructive. He was truly fascinated by what I do for a living and I was invigorated as I realized just how broad, varied, and diverse our industry can be.
“Unusual” is in the eye of the beholder, but here are some of what I’ve found to be the most unique product offerings:
- Bone Growth Stimulators: These compact devices, some as small as cell phones, use a technology that sends energy in the form of either electromagnetic or ultrasonic waves to promote healing and speed up bone growth. Energy is concentrated and sent to areas on the body where electrodes are placed. Use of these devices have been shown to speed up healing at bone fracture sites in some cases. Coverage by Medicare and insurances is available for only a few types of fractures and only certain bones.
- Cranial Helmet Orthotics: These orthotic devices resemble a football helmet and are used to treat plagiocephaly, which is a condition where an infant develops a flat spot on the back or side of the head. While the skull bones are fusing in the first year or so of life, this device can be custom made to help the skull mature into an appropriate shape. Obviously, because they are used for treatment of infants, Medicare is not who requires these organizations to maintain accreditation. But many other insurance payers require accreditation. The providers of these devices are typically also the manufacturers and undergo rigorous inspection from FDA. The patient’s condition almost always improves, often with dramatic and poignant positive results, making these organizations some of the “happiest” DME providers in the industry.
- IPPB Machines: The seasoned respiratory therapists among us will remember Intermittent Positive Pressure Breathing machines as an aerosol therapy that delivered bronchodilators (medications to make breathing easier) with a component of pressure. Much like CPAP machines today, they send positive pressure into the airways as a patient inhales, helping the medication get delivered deeper into the lungs. This therapy was widespread in the 1960’s into the early 1980’s, but is much rarer today. The machines were relatively expensive and complicated compared to an inhaler or a vaporizer. A common therapy to treat most forms of COPD, it was especially popular in the treatment of black lung disease, an occupational hazard of coal miners. In some geographical pockets, it is still utilized. Seasoned, veteran (I’m trying to avoid the use of the word “old”) respiratory therapists delight in seeing IPPB being used because of the memories it evokes. During an accreditation survey, I had the honor of watching a semi-retired 72-year-old RT set up a machine on a patient. The RT had a pleasant and reassuring demeanor and told the patient --no exaggeration--he had been working with IPPB machines for over 50 years!
- Ultraviolet Light Devices: Sometimes referred to as phototherapy units, these small electrically powered units produce ultraviolet (UV) light. Certain wavelengths of UV light are therapeutic in the treatment of skin diseases and mental disorders, such as seasonal affective disorder.
- Speech Generating Devices: These are broadly defined by CMS as “DME that provides an individual who has a severe speech impairment with the ability to meet his or her functional speaking needs”. There are several different types of devices in this category including neurostimulation devices. Recent technological advancements have been made and, in some cases, these devices can be computer software and hardware that generates “text to speech”. Medicare and insurance coverage for these devices are tricky to say the least.
These equipment categories and types are usually (but not always) provided by niche DME organizations who only work in their own specialty area.
Take a moment to review your equipment list, which can be viewed by logging in to your account at www.HQAA.org. You can also update the form anytime by logging into your account, revising the form, and submitting the changes to HQAA.