Clinicians: This will lead to noncompliance

YARMOUTH, Maine - Clinicians fear that a proposal to cap oxygen at 36 months and transfer title of the equipment to the beneficiary at that time will lead to reduced access to care and increased hospital visits. HME providers argue that capping oxygen would force them to cut back on services. With fewer available services--everything from visits by respiratory therapists to 24/7 emergency response--beneficiaries would be less able to manage their conditions, according to various industry sources. "HMEs and the clinical services they provide are the first line of health care," said Cynthia Gray, an RT with 30 years of experience who's vice president of clinical respiratory for El Reno, Okla.-based Canadian Valley Medical Solutions. "Without access to these services, beneficiaries will be in hospitals earlier and longer." It's still unclear how maintenance and service would be handled after Medicare caps reimbursement after three years. Will the agency still reimburse providers for maintenance and service? Will beneficiaries pay out of pocket? (The proposal states that maintenance and service payments may be made after 36 months if the secretary determines they're "reasonable and necessary.") Clinicians fear the proposal would cut them out of the picture and leave beneficiaries to perform much of the maintenance and services clinicians currently perform: refill oxygen tanks, change filters and disposables, check oxygen purity, etc. "What you'll get is noncompliance," said Vernon Pertelle, an RT and licensed practical nurse who's corporate director for respiratory and HME services at Lake Forest, Calif-based Apria Healthcare. "These people are already challenged and frail. The irony of all this is that oxygen technology isn't viewed as complex. That's unfortunate because, for someone with no frame of reference in health care, it's extremely complex." Joan Kohorst, an RT with 20 years of experience who's the homecare section chairwoman for the American Association of Respiratory Care (AARC), agreed. "These pieces of equipment that they're trying to convert to sale aren't toasters," she said. "If my grandmother were on this product and she was forced to purchase it, she wouldn't have a clue what to do with it if the light changed colors or an alarm sounded or it required preventative maintenance or, God forbid, it stopped functioning. Her health would be in danger." One industry source, however, downplayed the fear that the proposal will lead to reduced access to care and increase hospital visits. "I don't think the patients will necessarily suffer under this proposal," the source said. "Beneficiaries, by and large, don't have access to RTs, because the services they perform aren't reimbursed. It's the smaller, regional providers with three or four branches that use RT." Still, clinicians agreed that it behooves Congress and Medicare to nourish, not take away from, the HME industry, if they're planning on keeping beneficiaries healthy and saving money long term. "If a concentrator breaks down at 2 a.m., the provider is obligated to take care of the customer," said Joe Lewarski, the former homecare section chairman of AARC and vice president of government and clinical affairs for Goleta, Calif.-based Inogen. "They're going to send out a clinician, and there won't be an interruption in therapy. The patient doesn't have to call 911 or go to the E.R. This happens every night, all over the country."