HME industry prepares to battle oxygen cap

Sunday, December 25, 2005

WASHINGTON - AAHomecare has begun an all-out grassroots effort to convince members of Congress to vote against a bill that eliminates the cap rental option for DME and caps oxygen reimbursement at 36 months.

"I've never seen our grassroots folks so fired up, and beneficiaries are furious--once you explain it to them, they are livid," said Michael Reinemer, AAHomecare's director of communications.

On Dec. 19, House and Senate negotiators approved a Medicare/Medicaid spending plan that included the drastic reimbursement changes. Rep. Bill Thomas, R. Calif., blindsided the HME industry by inserting at the last minute language capping oxygen at 36 months. That language also transfers equipment ownership at that time to the beneficiary, who then becomes responsible for the equipment's maintenance and service.

The full House voted to approve the bill on Monday. On Wednesday, the Senate approved the bill--but with some minor changes. As a result, the House must vote on the bill once more.

Some industry watchers suspect the House won't vote again on the bill until members return from their holiday break in late January. AAHomecare, however, is not taking it for granted. There's a chance members could return to Washington sooner, Reinemer said.

The association has begun distributing "talking points" that providers can use to lobby against the bill. The goal: to convince congressmen who voted for the bill to vote against it the second time around.

By eliminating the cap on DME and capping oxygen, the bill saves Medicare $750 million over five years. While the change to oxygen reimbursement will hurt providers, it's the patients that will really suffer, say industry watchers.

"This is a very shortsighted and misunderstood response by a small group of people who don't support the HME industry," said Joe Lewarski, vice president of government and clinical affairs for Inogen, which manufacturers a portable oxygen concentrator. "The opposition made it sound like these are commodity items that are not expensive, that require no servicing whatsoever, that a lay person can manage them.

"They can't fully appreciate another Katrina or a snow storm in the Midwest, when the power's out for three days in a row. For the patients on oxygen concentrators, who's going to go out and service them? They're all going to end up in the E.R. or worst case scenario, die."

Based on his past experience as a provider, Lewarski estimated that
13% to 15% of his patients used a concentrator longer than 36 months. On average, he said, depending on the individual provider, between 10% and 20% of patients stay on a concentrator longer than 36 months.

AAHomecare Chairman Tom Ryan said last week that about 12% of the patients his company cares for stay on a concentrator longer than 36 months.

But with earlier COPD diagnoses and improving care, patients will most likely live longer, and the number of those on concentrators longer than 36 months will increase, say industry watchers.

According to AAHomecare, capping oxygen reimbursement raises the following questions and concerns:
- Turning ownership of oxygen-generating equipment to patients runs the risk of putting the ability to get oxygen in the hands of the general public. Oxygen is a drug and requires a physician's management. The families of people who were on oxygen and then passed away will have oxygen available for use without appropriate medical supervision.
- Who is going to pay for backup systems that are in place to support concentrator failures?
- Is Medicare going to pay for the rental of loaner concentrators while owned concentrators are being repaired?
- Is Medicare going to pay for portable oxygen tank refills; delivery of refills; and consumables, tubing, canulas, etc?
- Is Medicare going to pay for phone consultants to help patients with their oxygen problems?
- Is Medicare prepared to pay for the ambulance trips to the acute care facilities when concentrators fail, and patients can't wait until the next business day for oxygen service?
- Is Medicare prepared to pay for the hospital stays caused by hypoxic episodes because a patient's owned concentrator has not been properly maintained and, unknown to the patient, has been delivered sub par concentrations of oxygen?