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The BASE Problem with DME's

Posted by Perry on August 18, 2001 at 08:39:55:

Folks:

Many of us have some interesting and sad stories to tell about our experiences with US DME's. Some of us have good stories to tell about their DME's.

A question that gets debated at least in the background every several forums is why the difference. What is the "reason" for the different levels of service.

Why the US DME's don't seem to care about us is perhaps one of the more common questions not directly related to diagnoses and treatment on this forum.

The BASE reason for this, is that in almost all cases the US DME's customer is the insurance company (the insurance company pays them in over 99.9% of all cases). As a part of the deal with the insurance company the US DME must provide "service" to us patients. However, the level of service is usually not defined, or a certain minimal level of service is acceptable to the insurance companies.

Compounding the problem is the fact that the insurance companies have not contracted with you to provide "good" service unless you purchased a specific "good service" policy (and these do exist, but rarely from your employer). The insurance companies have contracted to provide a certain mimimal level of health care survices, and the cheeper the policy cost, the less service they provide (please keep that in mind the next time you ask for, or choose the cheepest cost insurance - you get what you pay for (and what you pay for are certain words - or the lack of certain words in the fine print - that actaully define the level of service you are actually going to get). Are you and your co-workers willing to tell your employer that you are willing to pay serious money for good health insurance).

Thus, a DME's real customer in the US is the insurance companies. You are a secondary party to the deal, and there is rarely any added profit to the DME for providing "extra" service to you beyond what the insurance company is willing to support.

An example of what happens is that my initial DME made a big point that they provided home service. What actully happened is that they visited my house exactly once, and I signed a form indicating that they came to my house. I was then asked to come to their office for all other needs, and I believe that I made about 5 trips to their office - during working hours of course (my alternative was to get put on the schedule for an appointment several weeks out - and I found out from others that they often missed those appointments). But the insurance company was satisfied because I received "home care service."

Another example dear to my heart is where an insurance company allows the use of an AutoCPAP. The DME meets the requirement by carrying "any" AutoCPAP. Depending on the DME you they may carry the cheepest AutoCPAP (the Virtuoso), or maybe a better name-brand AutoCPAP (the AutoSet T has been well marketed in the US for this). Whatever machine they provide, by providing access to one AutoCPAP the DME has met the minimum requirements of the insurance company. Thus, their main customer is happy.


In some cases the US DME's may have employees, or even managment, who want to better serve the patient and you will get better service from these people. For those who have DME's in the US that are more responsive than that - you are blessed with some truely caring people. Treasure them, and let their managment know how good a job they have done. Managment does sometimes respond to praise, and it may make some difference when they weigh the different levels of service options that they will provide in the future. Just keep in mind that the primary DME managment focus is on how to serve the insurance companies in a way that generates the most profit because their business, and all the jobs, will not exist if they do not make a profit.

It is a sad commentary on the state of the US healthcare system that I rarely see older caring people in these and other positions. It seams that caring people cannot make a long term satisfying carrear working for the DME's (or in many other health care positions).

Unfortunately, there is no real fix for this problem under our current system of insurance practices. If only the insurance industry could be changed that the vendors (and this includes the Dr's, nurses, clinics, and hospitals) only got paid if we the patients reported that they provided good service and solved the problem. Afterall - I don't pay the auto mechanic beyond some diagnostic fees unless they fix the problem (and they know that).

What has really corrupted the health care system in the US is the concept that they vendors get paid regardless of the outcome.

The current fix for the problem is to use the independent DME equipment providers, who are largly on the internet.

In that case you are the primary customer, and you pay them direct for their services (in some cases you are able to get reimbursed by your insurance company for this). Thus they cater to your needs and in general provide you a much higher level of service (although internet providers cannot provide personal home service). Aferall - their business is directly tied to how well they serve you and their future customers (and they won't have many future customers if they provide a lot of poor service). This does not mean that there are not individual problems. Just that you are the primary focus of their attention - and they could care less about the insurance companies.

Of course, people can only take advantage of this level of service if they can break away from their dependance on the insurance companies for service.

It would also help if some "independent" suppliers could exist in our areas. Would you be willing to shun the insurance connected DME and pay a company up front for a service call, and pay them direct for the equipment, and perhaps an hourly rate for long discussions and troubleshooting help. All it would take is a few percent of people to do that and we would have the needed basis for service orintated DME's that could really help you.

What matters most to you in the long run. Arguing over who should have paid the bill for good service, or getting good service up front and improving your health sooner (I know that I have touched on a sensitive subject here, but seriously ask this question of yourself).

Hope this helps explain some things - I just felt it was something I needed to say at this time.

Perry

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