Oxygen cap: Providers paint bleak picture of future

Sunday, November 16, 2008

YARMOUTH, Maine - When the 36-month oxygen cap goes into effect Jan. 1, CMS will pay for routine, in-home service and maintenance once every six months. That's of little comfort to the 57% of HME NewsPoll respondents who service and maintain equipment three to five times per beneficiary in any given year.

"There is no way not to cut service to the bone," wrote Joe Lybrook, vice president of operations for Bluegrass Oxygen in Lexington, Ky. "The new ruling from CMS is a straight kick in the side to patient care and servicing."

Other results from the NewsPoll, which was completed by 204 respondents: 60% say they repair oxygen equipment up to two times per beneficiary in any given year; 33% say three to five times per year; and 7% say more than five times per year. CMS will not pay for repairs for capped patients.

Additionally, 38% percent of respondents say that 16% to 30% of their patients will cap out on Jan. 1.

In dozens of written comments, respondents said the cap will force them to make changes in their business models. Here is a sample of what they had to say:

Reduced services
"We plan to change our face-to-face patient evaluations from every two months to every six months." - Greg Winn

"We will furnish supplies through the mail and will train the patients to check their own filters and change them as needed. The routine visits to check the equipment will stop." - Anonymous

"We are billing non-assigned $15 per cylinder, $5 per cannula per beneficiary to pick up supplies if mobile, otherwise there will be a delivery charge." - Anonymous

Staffing shakeups
"We had a part-time employee who checked concentrators only. We are laying him off." - Anonymous

"As a small company, we are going to be letting go some administrative customer service positions that we will not be able to pay." - Anonymous

"We will be changing to non-medical professionals whenever possible." - Bill Kellenberger

On the future
"The difficulty I foresee is providing the newer technologies like portable concentrators, which do not have either the warranty or the useful life of a traditional oxygen concentrator or liquid oxygen system and for which no contents can be billed subsequent to the 36-month rental period." - Scott Dinning

"Unfortunately, it's going to take numerous patient 'adverse events' to occur before CMS realizes the extent of these actions. This will lead to bad service, infections, hospital visits and increased MD visits." - Joe Mitas