Oxygen reform: Coalition seeks one voice

Sunday, February 8, 2009

WASHINGTON - Sensing a need for urgency, AAHomecare has formed a coalition to build consensus in the industry to reform the Medicare oxygen benefit.

The New Oxygen Coalition (NOC) had its first teleconference Feb. 3, amid a growing number of horror stories from providers and beneficiaries about post-cap life.

"Whatever plan is put together, the industry has to be moving in a coordinated fashion," said Tyler Wilson, AAHomecare's president. "The most counterproductive thing we could do right now is go off to Capitol Hill with half a dozen different messages."

The NOC comprises AAHomecare, which hosts a Washington, D.C., fly-in this week; the Council for Quality Respiratory Care (CQRC); several state associations; The MED Group; The VGM Group; and other stakeholders.

Since AAHomecare and the CQRC shared their plan for reform in January, two state associations have put forward alternative plans. The plans have this in common: They categorize patients into different reimbursement buckets based on ambulation. But while the alternative plans stop there, AAHomecare and the CQRC's plan further adjusts reimbursement based on factors like liter flow.

Proponents of the alternative plans worry that the complexity of this case mixed adjusted system will put independent providers at a disadvantage, if not out of business.

"It's administratively burdensome," said Jason Rogers, president of the Georgia Association of Medical Equipment Services (GAMES), who developed one of the alternative plans. "The nationals, with their teams of accountants and lawyers, can comply with that, but not us. We don't have the wherewithal, when it comes to the reporting mechanisms and the financial projections needed."

Proponents of the alternative plans also worry that there's no time to win widespread support for such a complex payment system, never mind implement it.

"To be honest, we have people in our industry who don't understand the current system; what would they do with a case mixed adjusted system," said Mike Calcaterra, Montana chairman for the Big Sky Association of Medical Equipment Suppliers, who developed one of the alternative plans. "Reform is an elephant; you have to eat it in bite-sized pieces."

While stakeholders may disagree on how reform should be done, they agree it should be done. The NOC, they say, brings them one step closer to that goal.

"The bottom line is getting key industry organizations at the same table and giving them all a chance to present their thoughts," said Don Clayback, vice president of government relations for The MED Group. "Then it's incorporating comments and suggestions, and coming up with a proposal everyone can get behind."

Through NOC, stakeholders hope they'll find they have more in common than they thought.

"The common thing everyone shares is that the Medicare payment system has to be rationally related to the costs of providing services and equipment," said Cara Bachenheimer, senior vice president of government relations for Invacare. "If they think about that, people will realize there's already a fair amount of consensus."