CMS proposes 'aggressive stance' on oxygen

Thursday, July 1, 2010

WASHINGTON - If CMS has its way, providers who service oxygen patients on or after month 18 of their 36-month rental payment period will be on the hook to service them through month 60.

Industry stakeholders were taken aback by CMS's proposal, which is tucked into a physician payment rule that's scheduled to be published in the Federal Register July 13. Earlier this year, when Congress was working on a healthcare reform bill, legislators had floated around the idea of locking providers in at month 27.

"We're stunned at the aggressive stance CMS appears to be taking," said Walt Gorski, vice president of government affairs for AAHomecare. "It doesn't reflect how HME is practiced."

Currently, providers who service oxygen patients in month 36 are on the hook to service them through month 60, with payments, of course, capped at month 36.

CMS wants to change that to address concerns that oxygen patients who relocate with just a few months left in their 36-month rental payment period are being stranded. These patients, the agency says, are experiencing "great difficulties" finding new providers to take them when payments have nearly run dry.

In CMS's eyes, the proposal would make it easier for the original provider to arrange for service and the new provider to take the patient.

But industry stakeholders say the proposal won't solve anything.

"Providers have made a commitment to caring for patients, but there's just not enough there to cover their costs, not with accreditation and everything they have to do," said Kelly Riley, director of The MED Group's National Rehab Network. "It's like saying the cost of eating an egg in a restaurant is the cost of the egg itself."

The real problem, industry stakeholders say, is the 36-month cap itself.

"It's another illustration of how, when you have this arbitrary cap, it just causes more problems than it resolves," said Cara Bachenheimer, senior vice president of government relations for Invacare.

Provider Lou Kaufman says amen to that.

"Instead of CMS going back and saying, oops, let's do this the right way, they're sticking Band-Aids on it," said Kauffman, vice president of patient/clinical services for Roberts Home Medical in Rockville, Md.

CMS played down the impact of the proposal, stating that only 38% of patients are still on oxygen by month 18.

"Relocation between the 18th to the 36th month is not a common occurrence," the agency stated. "Such relocation happens with less than 0.5% of beneficiaries using oxygen equipment."

To read a summary of the rule, go here,

To read the rule in full, go here