Oxygen reform: State associations withhold support

Sunday, January 25, 2009

 WASHINGTON - State HME associations have refused to back the plan to reform Medicare oxygen reimbursement. The reason: a lack of details and concern that the oxygen cap should be tackled first.

"Both of my boards came together for an emergency conference call, and I asked them, 'Can we continue with this plan, not knowing what it's all about and leaving all other important issues, like the cap, to come second?'" said Beth Bowen, executive director of the North Carolina and Virginia state associations. "We agreed we couldn't."

The associations and other industry stakeholders learned about the plan, crafted by AAHomecare and the Council for Quality Respiratory Care (CQRC), for the first time at a meeting earlier this month.

The most controversial part of the plan: a new payment methodology called the case mixed adjusted system. Under the system, providers would be paid based on patient ambulation and needs.

"What are providers going to get paid?" asked Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services (MAMES) and chairwoman of AAHomecare's State Leaders Council. "Who determines what they get paid? We're not sure."

Proponents of the plan, however, point to its budget neutrality, saying that, collectively, providers would get the same reimbursement, it would just be carved up differently.

"Obviously, everyone would like to know the payment details," said Walt Gorski, AAHomecare's vice president of government affairs. "But they haven't been calculated."

AAHomecare may not have the information, but the CQRC does, according to industry sources.

"Details are available," said John Shirvinsky, executive director of the Pennsylvania Association of Medical Equipment Suppliers (PAMS). "They're just not being made available to us."

The state associations believe the industry should work toward repealing the 36-month cap before reforming the oxygen benefit.

"They're saying reform will take 18 months to years to put in place," Bowen said. "Providers and patients can't last that long. They're already having huge problems."

That's why, at the AAHomecare fly-in on Feb. 11, state associations plan to emphasize the cap, not reform.

While AAHomecare originally envisioned the fly-in as a lobbying event for reform and alternatives to competitive bidding, industry sources say the association changed its mind after "very strong feedback from the industry."

For AAHomecare, the next steps in reforming oxygen include taking into consideration comments and concerns from the industry, and drafting legislative language, Gorski said.

State associations say they need to be more a part of the process moving forward.

"If they want to put something together that doesn't result in active opposition, they need to think about being a little more open and forthcoming with information," Shirvinsky said. "Right now, they're holding everything close to the vest."