The Lesser Known COVID-19 Supply Chain Issue: DME Shortages for At-Risk Patients


How health plans and providers can work together for better outcomes via a data-driven approach that streamlines the prescribing and procurement process.

It’s well known that COVID-19 is still disrupting the healthcare industry supply chain, most noticeably around repeated shortages of personal protective equipment (PPE) to protect frontline clinicians. The supply chain challenges, however, also extend to durable medical equipment (DME) and supplies required by often at-risk patients in their homes to manage chronic conditions and other medical issues.

As highlighted in a report issued by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG), these DME items include essentials such as oxygen equipment, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP) machines, nebulizers and other respiratory assistive devices (RAD).

The OIG report’s findings were echoed in a recent survey of more than 500 DME companies that found, in addition to PPE and ventilator shortages, supply chain interruptions also have occurred for items such as oxygen equipment (81%), CPAPs and RADs (53%), and nebulizers (49%). Nearly three-quarters (74%) of suppliers have reported delays of two months or more during the pandemic for such equipment, and 67% reported increased costs.

Immediate and Long-term Risks

The immediate consequences of shortages and delays of DME could logically mean poorer population health, including increases in emergency department (ED) visits and hospitalizations due to chronic condition exacerbations. If patients do not have access to critical DME such as nebulizers or oxygen equipment, they could face a costly medical crisis. Meanwhile, if patients are receiving home care, their care teams also need access to PPE, which remains in short supply in many areas of the country.

The shortage of DME is further complicated by the fact that many high-risk patients with chronic respiratory, cardiometabolic or other conditions have avoided visiting medical facilities for routine or acute care, due to concerns about becoming infected with COVID-19. Risks could continue over the long-term if chronic conditions are poorly controlled due to the combined issues of lack of access to necessary DME and less preventive care—which could lead to worse outcomes and increased healthcare spending.

Often, physicians write a DME prescription for a patient, and may not even be aware that a supply chain shortage exists. Given the current environment fraught with unanticipated DME shortages, it’s important for payers and providers to work together to ensure patients have ready access to much-needed home medical equipment. One of the best ways to do that is to access commercially available data sources organized with objective and reliable DME information. These databases compile and vet information from multiple other sources so healthcare providers and DME fulfillment companies can safely broaden their supply chain networks without facing the price gouging or months-long fulfillment delays mentioned in the previously referenced survey results and OIG report.

Some of these no-cost COVID-19 resources are listed on the AHRMM website, along with other helpful COVID-19-related supply chain information. AHRMM, or the Association for Health Care Resource & Materials Management, part of the American Hospital Association, is the leading membership group for healthcare supply chain professionals.

Utilizing these types of resources, especially those that include identifiers and other information needed to accurately track medical devices and supplies, can help supply chain managers and other leaders at health plans and provider organizations identify new or untraditional sources for needed medical equipment while helping control spending for the organization and for payers.

Lost in the Gaps

Key problems for hospitals, as well as patients filling their prescriptions, are the data gaps and lack of standardization in the healthcare supply chain. The FDA took initial steps aimed at correcting these problems five years ago by introducing the Unique Device Identifier (UDI), but massive inconsistencies remain. Supplemental information and context are needed for safer and more efficient supply chain management.

DME prescribing is impeded by this lack of standardized data, which can lead to patients receiving unnecessary or incorrect devices that contribute to reduced quality of care. Physicians report that they find the process for prescribing DME “an administrative hassle and time drain,” according to an American Academy of Family Physicians (AAFP) blog post. They also find DME prescribing “very tedious and confusing” which could further contribute to COVID-19-related delays in patients receiving necessary DME, according to a position paper in the Annals of Internal Medicine.

During the COVID-19 pandemic, providers are likely inundated with advertisements or unsolicited requests by DME companies and sales representatives to prescribe equipment, which likely causes skepticism and raises their concerns about potential fraud. This uncertain environment presents an opportunity for health plans to work with providers to ensure they have resources for reliable, unbiased data at the point of care as well as automated documentation tools to help comply with regulations and demonstrate medical necessity.

Data Accuracy Benefits All

When it comes to prior authorizations (PAs) for DME, some providers struggle with the necessary level of device detail that is required to ensure PA approval. Providers must have access to part numbers to include, such as the UDI/GTIN, descriptions, vendor information, UNSPSC and HCPCS category codes, to find and prescribe the appropriate—and authentic—product for their patients. Once the product has been received and provided to the patient, the DME fulfiller must submit a claim to the relevant health plan—and once again, accurate product information is imperative for correct billing and reimbursement to occur.

The DME data delivered to prescribers and fulfillment companies must be dependable, which is exceedingly difficult when shortages plague the market—an issue that is magnified now more than ever. For a comprehensive and reliable perspective, the database accessed by clinicians should aggregate, consolidate and normalize data from a variety of high-quality sources, including medical device manufacturers, industry data pools, providers and government agencies. The data should include identifying information as well as clinical, operational and financial attributes and codes to ensure authenticity.

These attributes will help avoid the challenges the OIG described in its report where ordered items often did not show up, were expired, or were different than what was ordered. A reliable supply chain data source is needed to vet sources to prevent lost, damaged or erroneous items, and to validate data so that the insight delivered is accurate, reliable and actionable. The data source gives hospitals the “ability to evaluate the quality of the equipment in a meaningful way,” as recommended in the OIG report.

Strengthening the Supply Chain

DME is an essential tool to care for patients with COVID-19, and to support patient care in the home so their chronic conditions can be well-managed to prevent exacerbations. Healthcare organizations and supply chain professionals need a broad, integrated, data-driven approach to streamline the prescribing and procurement process and to ultimately achieve better patient outcomes.

The COVID-19 crisis has shone a light on existing supply chain issues that have downstream quality and economic effects far broader than PPE and ventilators alone. When health plans partner with provider organizations to implement successful supply chain quality improvement initiatives, all stakeholders are rewarded with improved clinical, operational and financial outcomes.

Marsha Flores-Harris is Product Manager for FDB PrizmTM, a medical device knowledge base platform from First Databank.

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