Industry fast tracks oxygen reform

Tuesday, March 31, 2009

WASHINGTON - AAHomecare and a wide array of industry stakeholders last week detailed a revised plan to revamp Medicare oxygen reimbursement--and not a moment too soon, if it's to be included in upcoming healthcare reform legislation, they say.

There's now talk in Washington of reducing the oxygen cap from 36 to 18 months, cutting reimbursement or both, according to Tyler Wilson, AAHomecare's president and CEO.

"The oxygen benefit is under siege, and it's time for the industry to come together," he said. "We need to have a united voice and a loud voice on Capitol Hill."

The reform plan has been in the works for about 45 days and calls for eliminating home oxygen therapy from national competitive bidding and eliminating the oxygen cap. It also calls for revolutionizing the way Medicare pays for oxygen.

Over the next week or so, AAHomecare's New Oxygen Coalition (NOC) will collect industry comments on the plan. Those comments will be considered by NOC as it crafts a final plan, which it will them translate into legislative language.

Once a final plan is approved, the industry must build support among lawmakers and have the plan incorporated into healthcare reform legislation. That legislation could be crafted by June and voted on by August, industry stakeholders say.

"We are not in control of the process, but we have to make every effort to meet with members of Congress and meet their deadline," said Walt Gorski, AAHomecare's vice president of government affairs.

Among other things, the plan would:

- Reclassify patients into three groups: Category 1 (patients who lack mobility or who need oxygen for nocturnal use only); Category 2 (patients with standard portability needs--less than or equal to 40 liter hours per week); Category 3 (patients with high portability needs--more than 40 liter hours per week). Liter hours is defined as the prescribed LPM multiplied by estimated number of hours of use per week.

- Bundle payments for services and supplies into a monthly allowable.

- Make annual allowable updates based on the Consumer Price Index for Urban Consumers (CPI-U).

- Create an advisory committee to advise CMS on issues related to the Medicare oxygen benefit. The committee will include oxygen providers, patients, nurses, respiratory therapists, pulmonary and primary care physicians, public health organizations, patient advocates and manufacturers.