As a nurse, you might not always think about how medical equipment is affecting your organization’s bottom line. In fact, it is probably the last thing on your mind when you’re busy taking care of patients. Well, you might change your mind after your read this. Let’s talk frankly about hospice durable medical equipment (DME) and ways you can lower costs and save your agency’s budget.
(This might even help you get a raise!)
Some of the top expenses that hospices accrue are related to staffing, medications, and DME. Thankfully, most of these expenses are covered by the Medicare Hospice benefit that was established in 1986.
To start, you might wonder how your agency decides what equipment it will cover and what it won’t. Well, this is pretty simple to explain. To begin with, Medicare reimburses hospice companies in what is know is cost per patient day (PPD). This is the daily rate Medicare reimburses for each day of care.
One of the features of the hospice benefit is that it covers durable medical equipment also known as DME. When a patient enrolls in hospice, they have access to items to help keep them comfortable and to make providing care to them more efficient.
What is durable medical equipment (DME)?
Durable medical equipment is equipment that can be used over and over again and serves a medical purpose. DME is typically ordered by the hospice agency from a contracted vendor who houses the equipment in a warehouse.
The hospice company typically has a contract with a DME company that will supply requested equipment once hospice care begins.
It is your responsibility to know what equipment is covered by your agency.
Though both are covered by hospice, DME is not the same thing as medical supplies. Supplies are disposable and include gloves, incontinence products , and wound care dressings.
Examples of DME include:
- Wheelchairs or walkers
- Hospital beds and overbed tables
- Oxygen equipment (including nebulizers and ventilators)
- Bi-Pap and C-Pap machines (these may be expensive and not all hospices have contracts for these machines)
- Shower chairs
- Geri Chairs
- Bedside Commode
What supplies are covered by hospice?
The hospice Medicare benefit covers supplies that the patient may need during their time on hospice. Medical supplies, unlike DME, are disposable and are not used repeatedly.
As a nurse, it is important to understand this benefit because it can help ease the burden and cost of care. Think of it this way. If a family has been caring for a loved one with dementia who is incontinent, they have been spending their own money on supplies such as adult diapers.
These costs can add up pretty quickly and can put strain on the family.
For instance, adult diapers are expensive and can cost as much as $35 per bag. If you can get these supplies for you patients, you should.
Examples of Supplies
- Incontinence products (diapers)
- Wipes
- Catheter supplies
- Wound care supplies
- Dressings (i.e. DuoDERM)
- Under pads
- Bed pans and urinals
- Syringes
Although supplies are covered by the hospice benefit, they are not completely free to your organization. Remember, hospice agencies are reimbursed at a set cost per day.
Ways To Lower DME Costs
Start Doing this NOW!
1. Remove equipment that is not being used.
My recommendation is to utilize time in IDG to discuss what equipment patients have and if they are actually using it. For instance, patients who are bedbound and unresponsive do not need a chair. Removing the chair can not only make more space for the family, but it can demonstrate that the team is adjusting care based on the patient’s individual needs.
Remember, every day that the equipment is in the house, your organization is paying for it. Make sure you recognize the signs of decline and make adjustments as needed.
Note: Some items are charged at a per-diem rate and the costs stays the same no matter what.
2. Order Supplies on a Schedule.
Nothing is more frustrating than following a nurse who has not ordered supplies for their patient. The best practice is to check your patient’s supplies at each visit. And then try to anticipate what your patients need and when they might run out. I can’t tell you how many times I’ve had to deliver diapers on the weekend when I was on-call. This is why I swear by my Trunk Checklist.
Some managers might say that the family would have to go get them until the nurse returned but I say that it is not the family’s fault when the nurse didn’t order supplies so why should they be penalized.
I get it though.
As a manager, it was frustrating and costly to pay an RN’s on call salary to deliver diapers. I would rather use my budget to ensure that we could get the best products and fair pay for my staff.
But I digress!
My point is: Don’t just take their word for it, do a physical count with your own eyes.
Best Practice Tip: Have your DME vendor provide equipment training annually.
3. Get DME Training
For instance, does your staff know when to order oxygen or special mattresses? An example of costly DME is a low air loss mattress. Work with your DME provider to set guidelines for pressure reduction surfaces use.
You can set manager alerts for non-formulary items and specialty mattresses. Another example is to consider use an overlay or eggcrate before going to an expensive mattress.
Also, dressing supplies can be expensive. So make sure that you know what the patient needs and don’t order what they don’t need. For those patients in the nursing home make sure that the nursing home understands their responsibilities with dressing care.
It is also a good ideal to set up annual training with your DME provider and medical supply vendor.
4. Assess the patient’s physical and mental status before ordering any equipment.
Confused patients who are unable to sit safely should use the BRODA chair. DO NOT order it. BRODA chairs should never be used as a restraint. You should understand how to properly use equipment before ordering it for your patient.
Alert: If you patient is in a skilled nursing facility, then you should make sure that they are actually using the equipment.
It has been my experience that sometimes the facility may utilize hospice patient equipment as a way to supplement for their own lack of equipment. Let’s be real… At the end of the day this equipment is expensive so pay attention and choose wisely.
Tips for Managers and Supervisors
Managers and supervisors play an important role in hospice DME budget management. One way they can lower costs is by utilizing a vendor that can help them identify patterns in usage.
Take for instance the clinician that consistently orders oxygen for every patient despite the patient not having a low oxygen level. Sometimes, experienced hospice nurses have tendencies that have been their practice for many years.
8 Essential Tips to Lower Costs
- Know your expenses and costs per patient day (disease-specific, care setting, and by service area)
- Utilize DME vendor reports to track patterns of usage among clinicians
- Don’t be afraid to shop around for competitive prices
- Always have a back up vendor
- Focus on clinical best practices when making formulary decisions
- Ask your staff about products and vendors (sometimes they have the best solutions, after all, they are interacting daily with products)
- Require supervisor authorization for items that are non-formulary or at a certain price point.
- Use a great DME vendor (they are a reflection of your agency)
Conclusion
Lastly, the line between being cost effective and just plain cheap is fine. Providing quality patient care goes beyond the bedside staff and DME should not be overlooked. Try to think of the DME company as an extension of the services that you provide. Now that you understand the difference between DME and supplies, you can better manage your patient’s care.
DME technician interacting with your patients, care givers, and staff are a direct reflection of your hospice.