Urgent! MediCal patients to lose reimbursement for ostomy, wound and incontinence supplies
From Marilyn Magoffin G/A chair
We are trying to mobilize as many people as possible to circumvent cuts to MediCal patients for DME (Durable Medical Equipment) and other supplies which are essential to our practice. There are meetings in Sacramento with key legislators being scheduled by AvaMed (an association of manufacturers), Feb 16 and 17. Your attendance, if possible would be essential to help educate these legislators as to how elimination of reimbursement for these items would impact your patients.
Linda Aukett from UOAA is heading up the ostomy piece and will have information about these meetings. Please contact her Tel: 856-854-3737, advocacy@uoaa.org
Additionally, contacting your own California Senate and assembly person would be crucial. Details of the cuts and contact info for your legislators are provided below.
(The following is a compilation of information provided by UOAA, ConvaTec and AvaMed (an association of manufacturers).
What’s happening
Due to the budget shortfall, the State is looking to eliminate coverage of DME and medical supplies, including ostomy, incontinence and urological treatment supplies and surgical dressings. Other DME products and supplies that could be included are diabetes monitoring supplies, supplies to manage hemodialysis, speech-generating devices, nutritional infusion devices, and apnea monitors. The California Legislature is scheduled to vote on the issue in March, and if passed, may become effective as early as May. MediCal has always covered DME and
supplies that the national Medicaid program classifies as "optional". So have nearly all the other states. If this proposal is approved as part of the overall budget package, all of the people who rely on MediCal would have to pay for their own DME incontinence and dressing supplies beginning July 1st or even sooner.
This is a devastating possibility for Californians. Medicaid programs in other states will follow California in eliminating reimbursement for these items
Who does it affect?
18% of those covered by MediCal are elderly or disabled, many of them in nursing homes and long-term care facilities. 66.9% of all MediCal spending is on that group of elderly and disabled Californians. These are the people who are more likely to have wound, ostomy and continence issues, but who have the least resources to be able to buy their own supplies. If they are paying for their own residential care now, and have to begin paying for these additional items, they will use up their resources even faster. This means California taxpayers will be paying for full care of these patients at an earlier time.
There are approximately 8100 MediCal only ostomy patients. The cost to provide supplies is approximately $6 Million per year. Figures for dressing and incontinence supplies are not available but are probably significant.
According to the California Diabetes Program, nearly three million state residents have diabetes that would also be severely impacted
What can we do about it?
Attend the event in Sacramento on February 16th to talk with the people behind this proposal and state legislators to arguments that these DME and supplies are SO ESSENTIAL that the state should not stop providing them.
Contact your own California State legislators and begin to educate them about the hardship this proposal will cause.
To find your State Assemblyperson go to www.assembly.ca.gov/acs/acsframeset7text.htm - from that page there is a "find my district" map you can use as well. Click on a name to go to their personal website and contact information.
To find your State Senator go to www.senate.ca.gov/~newsen/senators/senators.htp. Upper left is a link to a map if you need it, or click on a name to go to their page and contact details.
Send an email, make a call, begin a dialog with the staff - let them know that is an important issue to you and many other people in your district. Ask for a meeting to educate your elected officials about the wide range of people who have ostomies, utilize wound care and incontinence supplies. Talk about how your practice would be dramatically altered if your patients did not have these vital supplies.
Correspondence can also be sent to Mark Leno who is on the finance committee:
The Honorable Mark Leno
Senate Budget and Fiscal Review Committee
State House
Sacramento, CA 94249
This is a critical issue that needs to be addressed NOW.
Talking points (general)
The cost of DME and medical supplies to the MediCal program is modest compared to the benefit provided to those who rely on them, as well as the long-term savings to the program.
Access to supplies and DME provide significant contributions to the recipients’ well-being, independence, and productivity.
For many who rely on durable medical equipment it is a necessity, not an item of convenience. DME provides people the ability to manage their activities of daily living
These supplies allow patients to manage their conditions on their own, avoiding complications that would require more expensive in-patient care.
Forcing people who are currently paying out of pocket for their residential care to then purchase the DME and medical supplies will mean they run out of their own money earlier. California taxpayers will then be paying for the full care of these people as they are forced to go into nursing homes.
Add your personal stories to put a face on the impact of these cuts.
Wound care talking points
Early hospital discharge, sicker patients mean complex wounds in community need advanced wound care management
• In the United States, chronic wounds affect 5.7 million patients and cost health care systems an estimated $20 billion annually (1)
• The estimated cost of managing a single full-thickness pressure ulcer is as high as $70,000 (2)
• In 2006, the cost of hospitalizations including a diagnosis of pressure ulcers in the US totaled $11 billion (3)
• Surgical site infections have been estimated to generate $1.6 billion in excess costs to US hospitals per year (4)
• A lower extremity amputation as a result of a diabetic foot ulcer can cost as much as $70,000 (5)
• Modern wound care cannot be considered an "optional benefit": need to avoid complications and hospitalization by ensuring patients and clinicians have access to quality, clinically proven modern wound care treatments.
• Poor care results in infection, hospitalization and even amputations
1. Branski LK, Gauglitz GG, Herndon DN, Jeschke MG. A review of gene and stem cell therapy in cutaneous wound healing. Burns.
2009;35(2):171-180, citedin Fogg E. Best treatment of nonhealing and problematic wounds. JAAPA. 2009;22(8): 46-48.
2. Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296:974-984.
3. Russo CA, Steiner C, Spector W. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #64: Hospitalizations Related to Pressure Ulcers Among Adults 18 Years and Older, 2006. www.hcupus.ahrq.gov/reports/statbriefs/sb64.pdf. Accessed July 8, 2009.
4. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37(5):387-397.
5. Rogers LC, Lavery LA, Armstrong DG. The right to bear legs – an amendment to healthcare: how preventing amputations can save billionsto the US healthcare system. J Am Podiatr Med Assoc 2008;98(2);166-68.
Ostomy care talking points:
Ostomy Care is not an "OPTIONAL BENEFIT"
Patient access to well adapted quality prosthetic systems are needed to live normal life and avoid medical complications
• 45% of ostomy patients suffer from peristomal lesions
• Irritant dermatitis represents 68.6%of peristomal complications2
• The Cleveland Clinic Stoma Registry shows 26% of ostomy visits are due to irritant dermatitis resulting from chemical destruction of the skin from effluent.3
Ostomy: Surgical procedure resulting in patient need for prosthetic that is custom-fit to return to a "normal life".
• Ostomy Products are prosthetic devices prescribed by health care providers and meet the definition of prosthetics under Medicare (Title XVIII of the Social Security Act (42 U.S.C. § 1395x(s)(8))
• 8,100 Med-Cal recipients under age 65 have an ostomy
• California spends about $6MM or $750 per patient a year
• Poor quality or poorly fitted prosthetics cause complications that result in ER / medical visits: treatment & products that are more costly vs. supporting a well adapted system on an on-going basis
1. Herlufsen P. et als. Are Peristomal Skin Disorders Inevitable? Poster presented at : The 16th Biennial Congress of the World Council of Entereostomal Therapists; July 2-6, 2006, Hong Kong.
2. Ratliff C et al. Descriptive Study of Peristomal Complications. J Wound Ostomy Continence Nurse. 2005;32(1) :33-7
3. Tooth P. Erwin, Stricker L, van Rijswijk L. Peristomal Skin complications. AJN Feb. 2010.Vol 110, No2
4. Citation from: Tooth P Erwin, Stricker L, van Rijswijk L.. Peristomal Skin Complications. AJN Feb. 2010.Vol 110, No2
