I’ve gotten lots of e-mail over HHS Secretary Mike Leavitt’s op-ed about wasteful Medicare spending on medical equipment. This one was from someone in the biz:

Medicare sets the price paid for the concentrator. So, if a supplier wants to charge more, he certainly can, but Medicare isn’t paying more than its set fee. That said, Medicare doesn’t pay for anything else to go along with it either. For instance, those “tubes” you mentioned? Free to the patient. And trips to the house to service this equipment, which is required fairly frequently and often unexpectedly, like in the middle of the night.
So let’s recap: for your $7000 and change, you get 24/7 tech support, 24/7 pickup and exchange, free supplies, free inhome maintenance. In addition, many HME’s offer such value-added services as the consultation with a respiratory therapist, who also does inhome visits and a variety of disease management programs for COPD, asthma and congestive heart failure, to name a few. Leavitt does a disservice to the many HME’s out there who provide a good service on a piece of complex medical equipment. Want to buy one on the internet for $600? Go ahead. Then deal with it on your own, when Granny’s concentrator stops working because no one is standing behind it to do routine service checks and maintenance. Leavitt doesn’t mention that, does he?

But here’s another e-mail from someone else in the business:

I work for a DME [Durable Medical Equipment] company and these rates also are used as a reference point for HMO contracting. Almost always below medicare allowable. My job is to get the highest reimbursement but it drives me crazy as a conservative to see a private organization paying substantially less than the government does with my money.