Bush's plan to cap oxygen encounters stiff opposition

WASHINGTON - President Bush's FY2007 budget proposal to cap oxygen reimbursement at 13 months would reduce Medicare payments to home medical equipment providers by a whopping $6.5 billion over five years. With elections coming up in November, however, there appears to be little stomach among Washington lawmakers to further cut Medicare or Medicaid benefits this year. In early March, for example, the Senate unveiled a budget proposal that included no cuts to Medicare or Medicaid. Republicans in the U.S. House of Representatives also voiced concern over cutting Medicare funding. Despite that apparent lack of support, providers cannot consider the cap dead on arrival. They must continue to rally against it and encourage beneficiaries to do the same, said John Gallagher, vice president of government affairs for The VGM Group. "This isn't about a concentrator," he said. "It is about the service that goes with it. This needs to be talked about." In lobbying against the 36-month cap on oxygen, which passed in February, the industry's argument that respiratory therapy involves a significant service component fell short. In their fight against a further cap on oxygen, however--and even in their efforts to mitigate or eliminate the 36-month cap--providers have a willing ally in Medicare oxygen patients. For example, by capping oxygen at 13 months, patients worry that Medicare would eliminate the financial incentive for manufacturers to produce expensive lightweight portable units and for providers to supply that equipment. An additional fear--one that applies to the 36- and 13-month cap--is that patients will have to monitor and maintain their own equipment once the title transfers to them, said John Tiger, a COPD patient and president of the National Home Oxygen Patients Association. "Eighty percent of the people on oxygen are on Medicare and 65 or older," said Tiger, 57. "Not that they are intellectually incapable, but they haven't had training to teach them how to use it and don't necessarily adapt as well." Tiger acknowledges that Congress must control entitlement spending, but it shouldn't do so at the expense of compromising patient care. "Thirteen months is unfathomable," said AAHomecare Chairman Tom Ryan. "It would drive a lot of providers out of business and a lot of patients back into the hospital. We've put in an invitation to the president's budget people to discuss it but haven't gotten a response back. I'm hoping we can get this change before it has an effect on us." Another patient concern: Once title passes to the beneficiary, how will service and maintenance be handled? Lawmakers have said Medicare will provide for that, but they haven't said how. "At this point, if I need a new cannula, I can call up a provider and they will bring it," said COPD patient Vlady Rozenbaum, 65. "They are obliged to supply supplies. How will this work when the patient acquires ownership? These are little things but they are not little things (to patients)."