Dr. Petty: Change O2 reimbursement

Thursday, March 31, 2005

DENVER, Colo. — In his role as the acknowledged father of long term oxygen therapy (LTOT), Dr. Tom Petty has regularly lambasted providers for placing their economic goals ahead of a patient’s clinical and equipment needs.
He’s mellowed a little bit on this point, but not much.
“The good providers are moving from the thing they can do to the thing they should do,” Petty said last month, adding that the movement is hardly universal. “I’ve had some friendly fights in public with suppliers, and they say, ‘You don’t understand that we have to make a buck.’ I say, ‘I know you have to make a buck and so do I, but you can make a buck with a variety modalities.’”
Not surprisingly, in the industry’s latest battle to scuttle attempts to change Medicare’s modality neutral reimbursement formula for home respiratory services, Petty, while respected for his work and dedication to the patient, is considered a foe.
For years, Petty has contended that respiratory providers cut corners and boosted profits by supplying concentrators and compressed-gas cylinders when what the patient really required was more expensive liquid oxygen equipment and services.
Today, he makes the same charge when discussing high-end, lightweight portable units. Rather than investing in and providing this high-end lightweight equipment, providers prefer to supply lower-end systems and maximize their reimbursement profits. He blames this on Medicare’s modality neutral formula, which reimburses providers the same no matter what respiratory equipment they supply beneficiaries.
Industry leaders argue that this perception is anecdotal and not based on fact. Patients have adequate access to lightweight portable equipment, they say.
Anecdotal or not, Petty said, he’s seen it with his own eyes.
“I’ll see someone in a grocery story schleping around an 18-pound E cylinder, and I’ll show them my 4-pounder and say, ‘You can do better that this,’” Petty said. “But the guy says, ‘I’m doing just fine.’ And you see the guy struggling with his shopping cart, struggling to get it into his car.”
Ultimately, he predicted, the government will do away with modality neutral. That will happen when it documents and fully understands the health benefits associated with a respiratory patient being able to ambulate. When that happens, modality neutral will be replaced with a reimbursement formula based on a product’s weight and how long it allows a patient to ambulate. At the bottom of the reimbursement scale will sit concentrators and other equipment for homebound patients. Ambulatory yet still relatively clumsy or “schlepable” units will be reimbursed at a higher rate. Portable lightweight units will be reimbursed at the highest rate. For providers who buck this movement, Petty has harsh words.
“The argument against changing modality neutral is that it cuts down on the paperwork,” he said. “Their real argument is that they want to push the cheapest stuff. There is something about the human spirit — or lack of spirit — that doesn’t always adhere to the truth, and it troubles me.”