Due to recent Medicare cuts, my organization is constantly trying to find ways to cut costs. I have been tasked with finding less costly medical equipments if I want to continue to provide services to my referrals. This has been extremely difficult to do due to the fact some equipments cannot be substituted. For instance, I received an order for a ASV machine that cost my company $3000 and Medicare only reimburses us $2420. This equipment cannot be substituted due to fact that it is a vent and provides the patient with certain pressure support, which keeps them breathing. Although, we knew Medicare was going to cut down on their reimbursement, neither us or the manufacturers of the equipments anticipated the cuts to be drastic. It’s made each of us reassess our budgeting plan. We operate on a quarterly budget and I must say we don’t plan as well as we should. End of quarter is coming up the end of this month and looking at how much we’ve spent on equipment purchasing and repairs it will not be a good quarter. Personally, I am not a numbers person so budgeting seems overwhelming to me. I don’t believe a realistic budget was established from the initial stage and have expressed the need for a well-designed budget, but I don’t think it will be taken seriously as I am not part of the group that plans the