WASHINGTON, D.C. (August 19, 2021)—Stakeholders representing health care providers and end users with medical needs developed a white paper to educate payers and state Medicaid programs on the types of products and services needed to successfully manage an individual’s bowel and bladder needs in a home-based setting to achieve the Triple Aim of improving patient experience and health outcomes while reducing overall cost.
An estimated 725,000 to 1,000,000 individuals in the United States are currently living with an ostomy. Each body and ostomy type is unique, and a customized approach is required in order to determine the combination of products and brands that best meet a person’s clinical and personal needs. Home medical equipment (HME) providers work closely with the clinical community and end users to deliver appropriate supplies and provide education and services to people living with an ostomy in a cost-effective, homecare setting. However, continued reductions to reimbursements for ostomy supplies jeopardize access to ostomy supplies and services and increase the risk of adverse health outcomes, which increase costs to the payer and/or health system.
"When a person living with a permanent or temporary ostomy does not have access to their prescribed ostomy supplies, the consequences can be severe. Inflamed skin, pouch leaks, and emotional stress are just a few of the outcomes that can have devastating effects on a person's quality of life," explains James Murray, president of United Ostomy Associations of America, Inc. (UOAA).
“Although it is understandable that state Medicaid, as well as federal Medicare spending programs, are under extreme pressure to control costs while still providing quality outcomes, investments in quality ostomy products are crucial and will ultimately assist in controlling these costs and improving patient outcomes. It is imperative that we continue to educate and advocate on behalf of patients requiring necessary life-saving products and services,” explains Kate Lawrence, MSN, RN, CWOCN, public policy and advocacy coordinator for the Wound, Ostomy, and Continence Nurses Society
The white paper, developed by the American Association for Homecare, United Ostomy Associations of America, Inc., United Spinal Association, Wound Ostomy and Continence Nurses Society, and the Wound Ostomy and Continence Nursing Certification Board, addresses the variables going into managing each person’s ostomy needs, the role of the HME provider, the risks of improper management, and the value of managing ostomy with sustainable reimbursement.
“It is critical that payers understand the distinct needs of this population and what is required to safely and effectively manage their medical conditions,” affirmed Laura Williard, Vice President of Payer Relations at the American Association for Homecare. “By providing sustainable reimbursement, the HME community will have the resources to maximize outcomes while ensuring cost-effective payer management.”
The paper requests that payers ensure rates for ostomy products and services are no less than the current corresponding 2021 Medicare fee for service rates for these products. Partnering organizations will use this resource in outreach and education to payers, state programs, and legislators to preserve access to ostomy supplies and services.
See the white paper here.
