To Enrich Lives

Courtesy of AA Homecare

INTRODUCTION

Incontinence, also known as the loss of bladder or bowel control, is a common problem among older adults as well as people with disabilities. Urinary incontinence can lead to unwarranted physical, psychosocial, and economic burdens on both the patient and their caregivers. This is the first of a two‐part white paper series to address the types of products and services needed to successfully manage an individual’s incontinence needs; the next paper will address the use of ostomy and urology products.

Annual costs of managing and treating incontinence in the United States is estimated to cost $65.9 billion, with $51.4 billion directly related to medical care, such as medical treatments/procedures, supplies, medication, hospitalization, long‐term care stays, physician visits, and laboratory tests (Coyne KS, 2014). Failure to properly manage incontinence results in medical complications including incontinence‐associated dermatitis (a known precursor to ulcers and pressure injuries), urinary tract infections, falls, and psycho‐social issues.

Home Medical Equipment (HME) providers who provide incontinence products and services are critical to patient (end user) care and cost management. They work with the prescribing health care provider and end user to properly manage the individual’s incontinence needs by matching the person with the appropriate product(s) to ensure proper fit and size and providing essential services and ongoing monthly support in a costeffective homecare setting. To optimize end user experience and outcomes while decreasing utilization and the overall cost of care, HME providers use high quality products that meet or exceed the National Association for Continence (NAFC) premium standards.

However, recent payer trends in the Medicaid and MCO market have challenged the HME provider community. Unsustainable rate reductions prevent HME providers from being able to provide premium products, as well as products that meet the patient need and optimize self care, and provide services such as monthly consultations with the end user/caregiver to manage incontinence. Without these premium products and services, the total cost of care increases significantly while patient outcomes and satisfaction deteriorates.

By ensuring adequate reimbursement for quality products by reputable HME providers, payers can achieve the triple aim of improving the end user’s experience and quality of life, creating better health outcomes, and reducing the overall cost of care.

OVERVIEW OF INCONTINENCE

People with Incontinence

51% of females and 21% of males deal with incontinence at some point after 65 years of age. Females are 1.7 times more likely than males to become incontinent during their life span (Gorina, 2014).

Studies estimate that bladder incontinence alone costs $20 billion dollars annually (American College of Chest Physicians, 2014). In addition to the cost associated with products and services needed to manage an incontinent condition, many complications and added costs can be attributed to daily management. Adults who suffer from incontinence also have a high risk of falls, UTIs, and complications with skin breakdown due to being in contact with the high acidity of urine and or stool (Health Economics Resource Center, Department of Veterans Affairs, Sanford University School of Medicine, 2002). Incontinence also affects sleep quality, which can lead to increased daytime sleepiness, increased fall risk, and cognitive impairment among other problems (DeMarinis M, 2017). Incontinence can contribute to social isolation which can lead to depression; according to the Boston Area Community Health Survey as published by the National Institutes of Health, symptoms are also linked to “anxiety… fear of incontinence, and hopelessness” (Kupelian V, 2009) (Elstad E, 2010) (Tang D, 2014). Read more