Oxygen reform: 'The timing is good'

Sunday, July 19, 2009

WASHINGTON - Rep. Mike Ross, D-Ark., a prominent figure in the healthcare reform debate, introduced a bill last week that would restructure the Medicare oxygen benefit.

Ross, a member of the Energy and Commerce Committee and the Blue Dog Coalition, a group of fiscally conservative Democrats, opposes the current draft healthcare reform bill that's making the rounds in the House of Representatives. That may give him leverage, industry stakeholders say, to add amendments to the bill, including an amendment to reform the oxygen benefit.

"The timing is good," said Walt Gorski, vice president of government affairs for AAHomecare, which worked with Ross to craft the bill. "Clearly, there will be various versions of the healthcare reform bill and various opportunities to include oxygen reform. But our first opportunity is with the Energy and Commerce Committee."

The budget-neutral Medicare Home Oxygen Therapy Act of 2009, H.R. 3220, would repeal the 36-month cap on Medicare reimbursement for oxygen. It would also require CMS to recognize the services that make up home oxygen therapy; reclassify suppliers as providers, effectively pulling the product category out of national competitive bidding; and link reimbursement to patient needs.

AAHomecare urges providers to contact lawmakers and ask them to co-sign the bill. A "dear colleague" letter circulated by Ross and Rep. Kendrick Meek, D-Fla., which was sent to the Ways and Means Committee on June 16, had 70 signatures.

But the association's efforts may be set back by two other industry groups, CSIHME and NAIMES, which recently presented lawmakers with an alternative oxygen reform plan, also budget-neutral, that they believe better serves independent providers. Mainly, the plan stops short of reclassifying suppliers. It's based on an initial 13-point plan crafted by AAHomecare's New Oxygen Coalition (NOC).

After Ross introduced H.R. 3220 last week, CSIHME and NAIMES sent him a letter signed by 21 independent providers listing their concerns with the bill. At the top of the list: The unfounded belief, they believe, that reclassifying suppliers will pull oxygen out of competitive bidding and protect the product category from further cuts. CSIHME and NAIMES believe competitive bidding should be dealt with separately.

"In its current form, we don't support the Ross bill," said Wayne Stanfield, NAIMES's executive director. "If it's amended in a way that takes it back to the point where the industry agreed on it initially, we'd reconsider."

AAHomecare maintains there's consensus built into the Ross bill.

"The bill represents a broad consensus within HME," said A.J. Filippis, chairman of the association's board of directors and president and CEO of Wright & Filippis. "Consensus extends to some other important stakeholders beyond HME."

Provider Michael Calcaterra says too much is being made of the two plans. They both, for example, propose linking reimbursement to patient need to achieve savings, albeit in different ways. (AAHomecare's plan would classify patients into three categories: nocturnal only, standard portability, high portability; CSIHME and NAIMES would classify patients into two categories: stationary and stationary/portable.)

"Everyone keeps talking about competing plans, but they're 95% the same," said Calcaterra, a member of the NOC who signed CSIHME and NAIMES's letter to Ross.