Medicare maintains status quo on retesting respiratory patients

Friday, October 31, 2003

WASHINGTON - Respiratory providers can breathe a sigh of relief that CMS’s new Oxygen Retesting Policy, released in September, doesn’t mess with existing requirements for recertifying Group I oxygen patients.
In a draft plan released in July 2001, Medicare proposed retesting Group I patients and recertifying them between the 61st and 90th day after initial certification. Currently, Group I patients with a lifetime CMN - 90+% of all Medicare oxygen patients - must be recertified but not retested by the 12th month following the initial prescription.

In lobbying against the proposed recertification change, the industry noted, among other things, the shortage of independent testing facilities, which would make retesting Group I patients extremely difficult.

“Logically who is going to test these patients?” ask Joe Lewarski, president of Hytech Homecare & Medical Supply in Mentor, Ohio. “The HMEs can’t test their own patients. The physicians aren’t going to test them and hospital outpatient settings aren’t prepared to test them. You can’t enforce a policy when the infrastructure isn’t there to support it.”

Added Asela Cuervo, AAHomecare’s senior vice president of government relations. “The industry worked hard on that issue and the outcome reflects that. But it’s like everything else in this industry: that issue won’t go away forever.”

Indeed, in a September bulletin, Region A DMERC stated it was still considering how to implement the proposed recertification. The DMERC added that it “will be included in a future revision of the policy.”

In part, Medicare’s desire to require the retesting stems from an April 2000 article in Respiratory Care magazine. The article stated that potentially 60% of all COPD patients initially evaluated in an unstable state could be discharged from long term oxygen therapy. By retesting LOT patients and removing those who don’t qualify, Medicare officials estimate they could save $150 million a year. Industry officials say that claim is based on limited and questionable clinical data.

Providers agree that some Group I patients probably should be retested. But rather than retesting all Group I patients, industry officials have suggested testing only those whose condition may permanently improve - people with pneumonia, for example.