O2 providers weigh in on modality neutral debate

Monday, February 28, 2005

YARMOUTH, Maine - We have seen them advertised on television, which may have contributed to why portable, lightweight oxygen systems seem to be grabbing market share from the industry’s perennial work horse, the oxygen concentrator. But, providers who use the systems attribute their success to a host of external pressures completely removed from Medicare reimbursement.

Eighty percent of 188 providers who responded to February’s poll said that they currently make a lightweight system, like Puritan Bennett’s Helios and Invacare’ s HomeFill, available to their patients.

Growth of these products continue despite tight reimbursement for the systems due to Medicare’s modality neutral payments. Some providers say the reimbursement hampers their ability to provide the high-tech products, while some say other pressures make ignoring the systems an impossibility.

“I believe patients are being deprived of some higher end systems because of Medicare’s policies,” said Darren Barnhill, ConvaCare Services’s regional health care manager. “Without additional reimbursement, it is simply prohibitive to provide all the choices available.”

“Like all HME companies, we provide concentrators if the patient or doctor does not request access to lightweight equipment,” said another provider. “It’s really a shame though because I would like to be able to put all mobile patients on lightweight equipment even if they didn’t request it. But, in today’s marketplace it is costly to put all patients on a liquid or a Home Fill system.”

Others argued that Medicare reimbursement challenges should be overlooked when deciding whether or not to provide premium systems and that aspects like competition, referrals and patient well being should come to the forefront.

“Patients are not the blind followers they were in years past. This is a consumer driven market, and the patient is very aware of different modalities that are available. They not only require the best modality for their lifestyle but demand it,” said Cynthia Gray, vice president of respiratory services for Oklahoma City-based CV Medical Solutions.

“If we refuse to provide liquid, or one of the new concentrator technologies, we would likely be taken off that physician’s list and never get another referral from there again,” said Tim Pontius, president and CEO of Young Medical Equipment in Toledo, Ohio.

Despite the reimbursement pressures that exist in Medicare’s modality neutral environment, providers overwhelmingly said they did not want to be left behind by the technology boom.

“Medicare oxygen cuts continually force the HME supplier to provide the most cost effective oxygen modality with no regard whatsoever for the end user,” said Michael Mayfield, vice president of operations at Signature Healthcare in Lutherville, Md. “Just when you think you’ve streamlined your equipment and operations to net a profit on home oxygen, watch out, Medicare is right behind you reducing your return once again. It has become the challenge of the HME industry to provide quality equipment that benefits the end user and at the same time providing your organization with something resembling a profit margin.”