Medicare cuts hit home for medical-equipment users, suppliers

Randy Grunau needs expensive, home-medical equipment to breathe. Cuts to Medicare reimbursements for such equipment would be disastrous, his wife, Stephanie, said.

Her 56-year-old husband suffers from amyotrophic lateral sclerosis, commonly known as Lou Gehrig’s Disease, which causes muscle weakness, paralysis and, ultimately, respiratory failure.

Diagnosed in July 2014, the Puxico, Missouri, man almost is totally reliant on a ventilator.

“He can’t walk at all. His speech is all but gone. Right now, it is affecting his arms and his hands,” Stephanie Grunau said.

It costs more than $1,500 a month to rent the equipment that keeps her husband alive. Medicare Part B pays the bill, but she fears federal spending cuts will hit them in their pocketbook.

She said she is frustrated and angry.

“You expect to have benefits,” she said Wednesday.

Medicare began phasing in the first of two cuts to medical equipment, supplies and services in January. The second phase of cuts is slated to occur July 1. Combined, the cuts will total about 40 percent, according to The Centers for Medicare and Medicaid Services (CMS).

In terms of the cuts, CMS has determined new reimbursement prices on everything from wheelchairs to hospital beds based on an analysis of prices submitted by various suppliers in areas across the country.

Stephanie Grunau said she and her husband don’t have a lot of money and can’t afford to pay several hundred dollars a month for rental of a ventilator.

Her husband’s condition makes it impossible for her to work.

“I stay home and take care of him all the time,” she said.

As she sees it, the federal government is ignoring the home-medical-equipment needs of seriously ill Americans.

“They are just more or less writing people’s death sentences,” she said.

Patrick Naeger, who operates a health-care equipment company in Perryville, Missouri, said CMS in January enacted a 35 percent cut in reimbursements for home-use ventilators. That cut was in addition to the first phase of cuts for other home-medical equipment.

Naeger’s company serves residents in 22 counties between St. Louis and Dexter, Missouri.

“These cuts will affect many items Medicare beneficiaries need such as oxygen equipment, CPAPS (positive-air-pressure machines), hospital beds, walkers and wheelchairs,” he said. “This equipment is vital for many to maintain independence and live a better quality of life.”

Naeger said the massive cuts in federal reimbursements will force some home-medical-equipment businesses to close. In rural areas such as Southeast Missouri where there are few such businesses, access to such services will be “a huge problem,” he said.

As president of the Midwest Association for Medical Equipment Service, Naeger speaks for more than 200 businesses covering a seven-state region.

“Not only does this put seniors at risk of not having access to the equipment, supplies and services they need to be cared for in their homes, it puts them in jeopardy of sizable, out-of-pocket expenses like they have never seen before,” he said.

Naeger said the Medicare cuts will be “brutally harmful to some of our most vulnerable citizens.”

Allowing people to continue living at home is more cost-effective than placing them in hospitals or nursing homes, he said. Naeger predicted hospitalizations and nursing-home admissions will increase as a result of the cuts.

For now, Naeger’s company has not raised costs for its customers such as the Grunaus. He said he doesn’t want to see his clients suffer. But he said he can’t afford to take a financial hit forever. Naeger said he will be forced to charge new clients higher charges to make up for lower reimbursements. As a result, a client may end up paying about $500 a month in rental charges for a ventilator, with the Medicare reimbursement covering the other $1,000 of the expense.

The Perryville businessman and former Republican state lawmaker said Medicare reimbursements for home-health equipment total $11 billion to $14 billion annually, which is less than 1 percent of the Medicare budget.

Naeger said the cuts will leave people like the Grunaus “without any options.” Ventilators, he said, are not luxuries.

“This is not an iPhone. This is lifesaving equipment,” he said.

The Medicare cuts are taking away the option for Americans with health issues to stay in their homes, he said. Naeger wants Congress to act to restore Medicare reimbursements to their previous level.

U.S. Rep. Jason Smith, R-Mo., said in a statement Congress has had some success in reforming the health-care system, including blocking cuts in Medicare payments to physicians. In addition, Congress has prevented reductions in Medicare reimbursements for rehabilitation products and services, he said.

The 8th District congressman blamed the latest Medicare reimbursement problem on implementation of the Affordable Care Act, adding the rates for home-health equipment and services don’t cover the cost of care.

But Naeger said he is frustrated lawmakers have yet to address the issue.

“I have no faith in Congress,” he said.

mbliss@semissourian.com

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