Oxygen: Reform heats up, utilization drops, bill gains sponsors

Sunday, July 12, 2009

WASHINGTON - Various industry groups are jockeying for position to lead efforts to reform the oxygen benefit.

AAHomecare announced last week that it expects Rep. Mike Ross, D-Ark., to introduce its oxygen reform bill by Monday. The Committee to Save Independent HME Suppliers (CSIHME) and NAIMES announced last week that they drafted a "simplified" oxygen reform plan and presented it to the House of Representatives and the Senate.

AAHomecare's oxygen reform plan would, among other things, eliminate the 36-month cap, reclassify suppliers as providers and link reimbursement to patient needs.

On Friday morning, "AAHomecare held a strategy call which gathered a representative group of members who could speak for all sectors of the HME community to make sure we are working in a coordinated fashion both on the Ross bill and in counteracting threats of further cuts to the oxygen benefit," said Tyler Wilson, president of the association.

CSIHME's plan, Home Oxygen Therapy Services (HOTS), would, among other things, address utilization issues by preventing patients from migrating to a higher reimbursement category, eliminate the 36-month cap and recognize oxygen as a drug regulated by the FDA. Additionally, it would be modality-neutral, allowing appropriate payments for new technology such as home transfilling equipment.

Both groups seek to have their plans included in healthcare reform legislation.

Cap cliff: Oxygen concentrator utilization drops

YARMOUTH, Maine - There was a huge drop off in the number of allowed beneficiaries for oxygen concentrators (E1390) in January 2009 across all four jurisdictions, thanks to the 36-month cap on Medicare reimbursement that went into effect that month.

In Jurisdiction C, for example, the number of allowed beneficiaries dropped 32% from 407,719 in December 2008 to 277,292 in January 2009, according to data obtained by HME News through the Freedom of Information Act.

"Medicare predicted approximately 22% of patients would likely cap at 36 months (on Jan. 1)," said Joe Lewarski, vice president of the Respiratory Group, at Invacare. "But discussions with providers and the noticeable trend in the rise of stationary-only patients over the last five to 10 years suggested that the cap number was going to be higher than initially predicted."

Contributing to the drop off, industry stakeholders say, was the lack of guidance from CMS. As a result, providers held off submitting claims in the first few months after the cap went into effect. 

"What we saw in January was an industry in complete paralysis," said Kelly Riley, director of The MED Group's National Respiratory Network. "No one filed anything."

Industry stakeholders expect the number of allowed beneficiaries for oxygen concentrators to creep back up in March and April, which was when CMS issued additional guidance on the cap.

HOPP Act gains sponsors

WASHINGTON - Industry stakeholders like The VGM Group and NAIMES urged providers last week to continue pressuring their congressmen to support H.R. 2373, a bill that would repeal the 36-month cap on Medicare reimbursement for oxygen. The bill now has 61 co-sponsors. While it's unlikely that the bill will pass as a "standalone" bill, industry stakeholders say they seek to get its language included in broader healthcare reform legislation or the "doc fix" bill. To contact your members of Congress, dial the U.S. Capitol switchboard at (202) 224-3121. The switchboard operator will connect you to your legislator's office by using your ZIP Code.