Oxygen cap: Repercussions sink in

Sunday, November 9, 2008

YARMOUTH, Maine - Shell-shocked providers spent the first days of November picking through the rubble of what is left of Medicare oxygen reimbursement.

Providers had been waiting for guidance on the 36-month oxygen cap for most of the year, but even those who said they were prepared for the worst were stunned.

"We are expected to take care of these patients whenever they want us to for free," said Joan Cross, co-owner of Bradenton, Fla.-based C&C Medical Services, who estimates about 50% of her patients will cap out Jan. 1. "I can't afford to do that."

Providers must stop billing Medicare for oxygen patients who cap out Jan. 1, but they must continue providing supplies, accessories and repairs, as well as emergency services. Medicare will continue paying for oxygen contents (liquid or gas) and for routine, in-home service and maintenance once every six months. It will not pay for supplies, such as tubing, cannulas and water bottles.

Provider Julie Weidemann says she typically changes tubing every month and cannulas every week, which costs her $5 to $7 per month, not including labor or travel. After the cap, Wiedemann says she may have to cut back--a bad thing for patients.

"You'll see increased infections and ER visits," said Weidemann, director of Palmer Home Medical Equipment in West Union, Iowa, who estimates about 20% of her oxygen patients will cap out Jan. 1.

Repairs to oxygen equipment are infrequent, but when they're necessary, they're usually expensive, says provider Gary Sheehan.

"It never breaks at noon on Wednesday," said Sheehan, owner of Cape Medical Supply in Sandwich, Mass. "It breaks at 3 a.m. on Sunday. Forget my cost to repair it. It's about paying (the technician) time-and-a-half and the cost of gas."

Many providers say they do more than 30 minutes of routine service and maintenance every six months. That raises the question: How should providers handle beneficiaries who request more frequent service and maintenance?

"Can we legally bill for that?" Weidemann asked.

One of the biggest concerns providers have is CMS's position that providers must arrange for service when patients move out of their areas. In the months leading up to the cap, providers reported having a hard time finding other providers who were willing to accept patients with less than a year left on their benefit.

This policy discriminates against local providers and their patients, says provider Scott Lloyd.

"If a beneficiary is the patient of a national and moves from Atlanta to Albuquerque, N.M, there's a good chance the national can still service them," said Lloyd, president of Norcross, Ga.-based Extracare. "It's challenging for smaller providers to arrange that. It's the patient who is the loser."

Overall, the new guidance highlights the continuing disconnect between the industry's and CMS's view of the value providers offer patients, says provider Anthony Ellis.

"I think they think it's like walking outside and breathing the air," said Ellis, president of Ellis Home Oxygen in Pulaski, W.Va. "They don't understand it's a machine along with our services."