Oxygen cap update: 'It's not snowbirding as usual'

YARMOUTH, Maine - It's that time of year when so-called snowbirds leave the cold of the North for the warmth of the South. But this winter, thanks to the 36-month cap on Medicare reimbursement for oxygen, providers will have a harder time making their stay a relaxing one.

For capped patients, providers in the North can no longer bill Medicare each month for equipment, so how do they pay providers in the South to take care of their patients?

“It's not snowbirding as usual,” said Kelly Riley, director of The MED Group's National Respiratory Network. “We've heard stories of providers in the South wanting to charge providers in the North as much as $300 to $500 per month.”

Medicare regulations require providers to continue serving capped patients, even if they move to Florida for three months, essentially tying their hands, industry sources say.

Some providers in the North screen for snowbirds and refuse to serve them, saying they're too risky.

“What am I going to do if a patient calls me from Florida and says, 'I can't breathe'?” said one provider. “I have to take care of that right away and usually that means at whatever cost. I don't want to be held hostage to a provider in the South.”

Provider Jim Travis can see both sides. He's president of Home Respiratory Care in West Seneca, N.Y., and Naples Oxygen in Naples, Fla. As a provider in the North, he tries to get his oxygen patients to take their equipment with them for longer trips and loans them portable oxygen concentrators for shorter trips to minimize the need for service by other providers.

As a provider in the South, Travis charges a premium for his services—he has no choice.

“You're doing it on an emergency basis, or you're serving patients that are getting off planes and need their oxygen right away,” he said. “A provider in the North may say, 'You're charging $30 for a portable?' but it's expensive to provide these services.”

Providers like Butch Vanderpool say member organizations like The MED Group have helped them keep issues at bay. MED has a program for National Respiratory Network members that outlines how providers should deal with snowbirds. One component of the program: The original and new providers share the expense of purchasing agreed-upon equipment.

“We all know each other, too, so we have that hanging over our heads,” said Vanderpool, owner of Mobility Specialists in Auburndale, Fla.

Other providers, like Jose Linares, say not much has changed since the cap went into effect.

“We're just covering our costs and charging a small administrative fee,” said Linares, vice president of sales and marketing for All-Med Services of Florida in Miami Lakes.

Fortunately, snowbirds represent a small percentage of any provider's patient mix, maybe 5%, industry sources say. Still, one snowbird “can turn into an instant migraine,” said one provider in the North.

“It's like having a car accident,” Riley said. “The majority of your life, it doesn't happen, but when it does, it's a wreck.”