Rural Americans on Medicare Will Continue to Receive Inadequate Care Unless Congress Acts

Medicare beneficiaries deserve to receive quality health care no matter where they live. Unfortunately, that is not the case today for hundreds of thousands of seniors in rural America. While Congress talks a big game about helping seniors on Medicare, they have failed to listen to the voices of countless beneficiaries who are at risk of losing access to quality in-home medical equipment and the valuable services that support these lifesaving products.

CMS recently expanded its regional reimbursement rates without a comprehensive evaluation of its impact on all parties involved, such as patients, medical equipment suppliers, hospitals, and the diverse communities served. Regions such as Atlanta and Los Angeles set prices for small town rural communities hundreds of miles away.

CMS implemented an initial six-month rollout of this program to rural communities to gauge its proficiency before expanding it to all of rural America. Despite the results showing it failed to achieve tax savings and negatively affected quality of care for patients, the program was fully phased in July 1.

The reimbursement rate on average for rural America was slashed by 50 percent. Large-scale medical equipment providers in urban areas can capitalize on economies of scale and leverage efficiencies from their operations. But this is not possible for home medical equipment companies servicing smaller communities, slowing the delivery of medical equipment and supplies.

As a result, local medical equipment suppliers are facing layoffs or – worse – going out of business, even though they provide a unique service designed specifically for these rural communities. Andy Fish, the owner of Minden HomeCare Equipment in Louisiana, sees first-hand how this affects the seniors he previously served with manual and power wheelchairs. “We could get equipment out the same day, but now the patients have to wait,” said Fish. The lower reimbursement rates do not allow for the level of service Medicare seniors want and need.

Medical equipment suppliers in rural America operate in conditions unlike any urban environment. In addition to the increased fuel costs and staff time needed to serve patients in less-densely populated communities, rural America includes dirt roads that may require specific all-terrain vehicles, tractors, and/or snowmobiles. A collapsed bridge can cause a supplier to drive 20 miles out of his/her way to make deliveries, adding to the operational costs of a rural business.

If Congress waits to fix this problem it will be too late and the local suppliers will have closed their shops. Rural America has specific needs that require specific solutions, and Congress needs to demonstrate its support for small businesses. Both the Senate and House of Representatives easily passed separate versions of legislation to fix it, but only a few short weeks remain before the end of the session for both chambers to agree on a solution. Time is running out and Congress needs to act.


Keith Pemrick spent more than a decade working for a House Democrat, is an adjunct professor at American University and is managing partner of the bipartisan public policy firm Commonwealth Strategic Partners.

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