ATLANTA--It's an issue that can be sharply divisive in the HME industry: equipment reuse.
On the one hand, reuse can be viewed as a way to get much-needed equipment to people who would otherwise go without. On the other are warnings about the dangers of faulty equipment and undermining innovation from manufacturers who could be pushed out of the marketplace from payers who are not buying new.
Jeremy Buzzell, a program specialist for the Washington-based Rehabilitation Services Administration, works with grants and programs designed to help more people with disabilities get assistive technology through statewide programs. The RSA is a division of the Office of Special Education and Rehabilitative Services under the U.S. Department of Education.
Buzzell notes equipment reuse has been going on for a long time in many parts of the country, in some cases for up to 25 years. "It's something that vendors and manufacturers of durable medical equipment should be aware of," he said.
According to a study by the Rehabilitation Engineering and Assistive Technology Society of North America, there are 154 assistive technology reuse programs across the country this year. Of those, 60 refurbish assistive technology, 45 reassign it and 26 run an exchange program. Of the remaining programs, 11 refurbish, reassign and exchange devices; for the other 12, information is incomplete.
From October 2005 through September 2006, according to the RSA, 24 states reported the reuse of 5,602 devices. Of those, 678 were exchanged, 4,482 were reassigned and 442 were on long-term loan.
Buzzell said while reuse has been around for decades, what's new is RSA's focus on it, beginning in 2004 with the reauthorization of the Assistive Technology Act. The department also works in conjunction with President Bush's 2001 New Freedom Initiative, which, among other things, is intended to help people with disabilities get access to assistive technologies and promote increased access to community life.
Buzzell, who participated as a panelist in a Medtrade 2007 seminar on equipment reuse, said one of the concerns he hears from DME suppliers and manufacturers is that reuse will hurt their bottom line, not only by impacting new sales but from the fear of liability issues.
As far as DME reuse hurting provider sales, Buzzell said, "A majority of folks who go to a reuse program are uninsured, aren't qualified for Medicare or Medicaid or have no other option for DME, so [they] wouldn't be able to purchase DME anyway."
Regarding liability, Buzzell said his department shares that concern, which is why it has focused on ways to facilitate reuse correctly and build partnerships with DMEs.
According to Buzzell, there are many advantages to DMEs getting involved in equipment reuse. One is that they can collaborate with reuse programs to ensure outgoing equipment is in good condition. Another is that the programs offer a way for providers to get rid of excess stock.
They're also a donation venue: Providers can refer people who need equipment but can't pay for it to the programs, or donate equipment that was given to the provider because someone no longer needed it.
"Some of these programs benefit from vendors and manufacturers who just volunteer their time and their expertise," Buzzell says. "The most successful ones that we have seen are ones where there is some collaboration with the vendor community."
A national collaborative for reuse is the Pass It On Center, based in Atlanta. The center is also home to a national task force on the matter that includes members from universities and industry associations with a goal of "finding solutions to issues in AT reuse."
Rita Hostak, vice president of government relations, Sunrise Medical, Longmont, Colo., and president of the National Coalition for Assistive and Rehab Technology, was also a panelist at the Medtrade session. She said initiatives like the Pass It On Center will ensure that "issues are thoroughly investigated, data is gathered to support informed decisions and guidance is published that will go a long way in ensuring that reuse of DME is performed in a responsible way, a way that is sustainable, and that strives for a positive clinical outcome of each individual."
In addition, Hostak said, "The Department of Education, Office of Special Education and Rehabilitative Services is dedicated to making sure steps are taken to identify good service/delivery models."
It's not that simple, however. While noting the positive aspects of reuse--that, for example, valuable and useful equipment that might otherwise be abandoned somewhere can be given to people who are uninsured or under-insured--Hostak also identified "a number of logistical and financial issues" with the concept.
"If medical devices are not reassigned through a model that ensures positive clinical outcomes for the individuals it serves, then the good intentions are completely lost," she said. "In addition, there are FDA regulations that apply to medical devices which cannot be overlooked. Moreover, if re-issuing is used as a way to reduce health care budgets related to the provision of DME, then there is a whole new set of negative consequences for consumers, suppliers and manufacturers."
According to Hostak, the HME industry must be proactively involved in shaping the future of reuse.
"Reuse has the potential for doing harm to consumers as well as suppliers and manufacturers," Hostak says. "While there are dedicated and thoughtful people like those involved in the Pass It On Center and the national task force who are dedicated to investigating all of the important issues and gathering the type of data that will be necessary in controlling how reuse is applied, the industry must be engaged and equally as dedicated to ensuring the right outcome."
Hostak said "now is the time" to work to ensure that, if equipment is reused, it is "done appropriately and only in the right circumstances."
"We cannot just say no to reuse," she said. "It is already happening today to a much greater extent than most people are aware."
To visit the Pass It On Center Web site, go to www.passitoncenter.org".