Jun 24th 2020

Durable Medical Equipment: Much like mobile communications, what determines cost is more than the device

Patient healthcare costs are a top concern for both patients and healthcare organizations. A 2017 survey by the Kaiser Family Foundation showed that almost a third of the U.S. population has forgone needed medical care due to cost concerns, and more than a quarter of patients find it difficult to pay their medical bills.

Consumers have been given the message that shopping around when seeking healthcare is a good way to save money, and that's generally true. But when it comes to durable medical equipment (DME) such as wheelchairs, walkers, oxygen tanks, and infusion pumps, there is more to the picture.

Patients may think that some DME providers have better prices than others, but the truth is that DME pricing is often relatively consistent across providers. The greatest savings opportunities related to DME often derive from utilization management and care coordination, in addition to unit cost comparisons.

A bit like buying a phone


In some respects, buying DME is not unlike a cell phone purchase. Consumers pay similar amounts for the latest smartphone no matter which phone service provider they choose. The true cost hinges upon how the phone is utilized: what data plan the consumer selects, what's included in that data plan, whether the consumer pays for using extra additional data, and what perks are included in the plan.

Assessing DME can seem pretty basic in that many products cost about the same. The true cost is associated with how those products are used.

If managed by a vendor like eviCore, utilization management and care coordination can result in substantial savings of between 20-30%.

The role of utilization management


High-quality utilization management will include:

  Processing medical equipment referrals

  Reviewing clinical appropriateness of DME

  Expert guidance on coverage and claims submissions

  Important information on regional availability and a list of available providers.

Utilization management for DME at eviCore, for example, helps patients evaluate the medical necessity and efficiency of applicable DME. In addition, our utilization management services can review risk and quality assurance to help reduce costs.

The benefits of care coordination

Care coordination helps all those involved in the delivery of equipment, including the ordering provider, patient, and equipment supplier. Coordination should be occurring within the various departments of healthcare organizations, as well as with outside vendors, insurance providers, referral sources, and others involved in a patient's care. 

Appropriate and timely care coordination will provide patients all the services they need while keeping costs manageable across the board.

The bottom line on DME

The greatest value of a DME program for patients and health plans is measured in how utilization management and care coordination are implemented—more than just the unit cost.