Supply Chain Challenges
Well before the COVID-19 pandemic upended global commerce, consistent access to necessary tracheostomy supplies was a challenge.
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November 2022“Managing the practicalities of tracheostomy supplies has never been a simple matter for patients, or for hospitals,” said Michael Brenner, MD, president of the Global Tracheostomy Collaborative and associate professor in the department of otolaryngology–head and neck surgery at the University of Michigan in Ann Arbor.
Products from different manufacturers aren’t necessarily interchangeable. If a hospital or health system cannot obtain their preferred equipment from their regular supplier, they can usually order from another supplier. But using less familiar products complicates care and introduces safety concerns.
Patients and families in the community lack the buying power of health systems and may not be able to obtain supplies at all if the manufacturer of their equipment is unable to continue production for any reason, as their DME provider may be locked into a contract with a particular company.
“Hospitals and large healthcare systems can often be agile in terms of negotiating purchasing contracts, making bulk equipment purchases, or navigating supply chain shortages, but that versatility and agility simply doesn’t exist for patients and families,” Dr. Brenner said.
Insurance-imposed limitations are another long-standing problem. Access to trach supplies varies greatly depending on geography and insurance coverage. In some states, children on Medicaid who have tracheostomies are entitled to five tracheostomy tubes per month; in others, children covered by Medicaid get just two tubes per year, although the tubes are not intended to be used for longer than 30 days.
“These devices haven’t been tested for longer periods, and their safety and fidelity over longer periods is unknown,” Dr. Brenner said. “Manufacturers designate these devices to be used for 30 days,” he said, because “otherwise the devices would be required to meet standards for implantable devices. Yet payers will only pay for them to be replaced every 90 days. So, you have a perverse situation where people’s only option is to use the devices in a manner that’s inconsistent with manufacturers’ instructions.”
To cope, families have “historically had online peer support exchanges where people post what they need and what their kids have outgrown,” said McLelland, a former police officer turned nurse and disability advocate. “There has always been a massive transfer of supplies.”
DME companies, which charge insurance companies a global billing rate for tracheostomy supplies, don’t always deliver the supplies ordered by patients’ physicians or the correct number of inner cannulas, heat moisture exchangers (HMEs), speaking valves, or ventilator circuits.