It's time to play it straight

Saturday, January 31, 2009

Shortly after we blasted out our February HME NewsPoll about the industry’s plan to overhaul the oxygen benefit, I got a call from a stakeholder who said it was “leading.” The questions we chose and the way we worded them, he said, left readers no choice but to support overhauling the benefit. “It’s as if AAHomecare wrote the poll,” he said.

Mostly, I think the stakeholder was miffed (some feel they have been kept in the dark about the plan).  He was right about one thing, though: An overwhelming majority of respondents believe, in general, that the oxygen benefit needs to be overhauled (95%).

That puts them right in line with AAHomecare, the Council of Quality Respiratory Care (CQRC) and others who have had a hand in developing the plan.

But changing the current payment methodology for oxygen, as we suspected, was a tougher sell. Only 56% of poll respondents like the idea of being paid based on patient ambulation and needs; 33% don’t like it; and 11% aren’t sure.

For most respondents, there are probably too few details about the proposed payment methodology - called the case mixed adjusted system - to get behind the idea completely. The biggest question: How much will providers get paid?

The devil, as they say, is in the details.

Their concern is understandable, but it shouldn’t take much for them to rally behind the idea of getting paid for the equipment and services they actually provide. That may mean lower reimbursement for patients who are nocturnal-only, but it may also mean higher reimbursement for patients who are highly ambulatory.

The proposed payment methodology would go a long way toward ending this decades-long charade of providers making up what they lose on reimbursement for one product with reimbursement from another product. Wouldn’t that be a relief?

Additionally, beneficiaries would be better off (they’d have a better shot at getting the most appropriate equipment and services) and so would taxpayers (they’d get the biggest bang for their buck).

It’s time for providers - and the stakeholder who called to complain about the NewsPoll - to face the cold, hard truth: They can leave the oxygen benefit as is and risk another reduction in reimbursement this year and every year after that; or they can support overhauling the benefit, including how they get paid, and cut themselves some slack this year and, hopefully, well into the future.

I know change is disconcerting. So is putting the fate of your companies in the hands of AAHomecare and the CQRC (One respondent said the idea of the two organizations working together was “scary.”)

But get over it - and get involved. When it comes to reimbursement, it’s time to play it straight.