A conversation with Mr. X

I received an interesting phone call in early July that made me feel a bit like Bob Woodward or Carl Bernstein, the Washington Post reporters who cracked the Watergate scandal thanks to the insider knowledge fed to them by Deep Throat. Like their's, my Deep Throat demanded that I not use his name. I agreed, and from this point on we'll refer to this Washington insider--a man who sounds at home with good scotch and fancy cigars--as Mr. X. Mr. X told me the following: When it comes to Medicare and the future of the home respiratory market, the writing's on the wall. CMS bureaucrats, Republicans and Democrats all favor new non-delivery technology (transfilling and portable oxygen concentrators) over traditional stationary concentrators and cylinders. As proof, he said, just look at recent proposals to reduce oxygen reimbursement from 36 to 13 or 18 months. It's true, as he said, that these proposals have exempted this new high-tech equipment. Mr. X gave a few reasons for this. The new technology will save Medicare billions by shrinking the need to pay for oxygen contents; it will eliminate a ton of overhead for providers by reducing deliveries; patients, no longer having to wait for tank deliveries, enjoy unprecedented freedom; and physicians like this technology because it enhances a patient's ability to ambulate and exercise, which improves overall health. "The policy is established," Mr. X said. "It is to protect and enhance new technology. What they will do now is address some kind of reasonable transition period to the new technology. Providers have huge embedded investments in concentrators, trucks, drivers and warehouses. You can't expect them to write that off, and go in one day from stationary concentrators and tanks to state-of-the-art technology." Mr. X admitted that the new technology is not for everyone. But for the majority of oxygen patients, it fills the bill, he said. Mr. X encouraged me to take a position. His position, of course. Advise providers to embrace this new technology, he said. I hemmed and hawed. He persisted in the way a good salesman does. I got off the hook by saying I'd think about it. Of course, while I'm swayed by Mr. X and know plenty of providers who espouse his view, I can't endorse any respiratory technology. I'm not a clinician or a provider. What's more, I know enough to take people like Mr. X, people with a vested interest, with a grain of salt. Still, three weeks after our conversation, I'm still thinking about what he said.