Letters to the editor

Wednesday, May 31, 2006

There seems to be a distinct element of cognitive dissonance in the recent actions by CMS to decreases reimbursement for oxygen and other respiratory care equipment. In continuing to reduce reimbursement, CMS acknowledges that it doesn't value the services that HME providers bring to the table. The premise that devices such as suction machines, oxygen equipment and CPAP can be appropriately provided to sick patients by people with no clinical expertise is flawed. First, it compromises compliance and the patient's well-being. Secondly, most state respiratory care licensure laws are quite specific regarding limitations on unlicensed personnel to render advice regarding respiratory medications or respiratory care. Thirdly, all nationally recognized accreditation agencies require that patients (including Medicare beneficiaries) who receive respiratory equipment be given appropriate instruction on the operation and maintenance of the equipment. Meanwhile, the patient suffers as HME providers take Medicare's most recent assertions to heart and move to provide respiratory equipment by unlicensed personnel without the input of clinicians. Sounds like a very funny way to improve quality.
- Tim Good, president, Good Care by CPCI, Logan, Ohio

Thanks to Congress' recent vote to cap oxygen reimbursement at 36 months and eliminate the cap rental option for DME, we all better realize that we are retailers now--not providers. Adding insult to injury, President Bush now wants to cap oxygen at 13 months! The long and short of all this is that as Medicare cuts reimbursement, providers must become advocates of cash and carry. That means beneficiaries will end up paying more out of pocket for HME benefits promised to them previously by politicians hungry for votes. Now that the pols realize they've overpromised, they've got to cut. But in doing so, they're being crafty. They whack our reimbursement, which in turn forces us to reduce services. The result: Beneficiaries get mad at us, not the politicians. We become the bad guys. You can't blame Congress. Beneficiaries vote and they are more powerful than the providers who just complain a lot. That said, we are a stupid group of people if we allow Congress to run our companies. Bill non-assigned, do all rentals on an advanced beneficiary notice. Better to be a "bad guy" than a good guy who finishes last.
-Vince Destigter, CEO, Western Healthcare, Jackson, Calif.


As the sales representative and purchasing coordinator of a small DME provider in Trenton, N.J., I try to keep abreast of what is going on in the "corridors of power." I also know my superiors have noted the recent warning signs that capped rentals for home oxygen and competitive bidding could signal the end of "mom-and-pop" DME businesses within a few years. I find it ironic that Medicare (via its representative organizations) cannot handle a simple claim review properly without messing it up so badly, yet it can find the time and resources to encourage legislation that will make the lives of providers and patients more difficult as the days go by. I personally understand the desire for companies to join the H.R. 3559 bandwagon, even if it may not be possible for small outfits like us to do so. What I do fear, though, is whether anyone in Congress will ever understand that competitive bidding may end up being the root cause of "cheap and inferior" quality equipment being provided to patients by "unscrupulous" people who will bid low simply to win. Capped rentals for home oxygen are likely to lead to the same thing except I doubt savvy patients (or their caretakers) will settle for anything less than the very best equipment out there being provided. All this, while Medicare continues to lower reimbursements for home oxygen.
- Imran Ahmed, sales rep, Oxy-Med Homecare Equipment, Trenton, N.J.