Patients: Providers driven by profit margins
DENVER - One point became crystal clear during the Sixth Oxygen Consensus Conference here Aug. 25-28: When it comes to supplying home respiratory equipment, there's still little consensus in how providers see themselves and how some respiratory patients see them.
Despite the best efforts of HME industry leaders to demonstrate otherwise, patient attendees who spoke at the conference painted a picture of providers who are driven by profit margins first and patient care second. Rather than supply a patient with an expensive lightweight portable unit - or even tell them about the available options - many providers choose to pad their margins and supply less expensive and less portable equipment, patients said.
In most cases, the driving force behind this behavior is not greed, the patients said.
"It's economics," said respiratory patient John Tiger, president of the National Home Oxygen Patients Association. "I'm not blaming the provider. They need to make a living."
That said, Tiger added, a recent survey showed that while many patients like their providers, those same providers never explained to them the different portable oxygen systems available.
Perhaps, he said, those patients are satisfied because "they don't know what they don't know."
Tiger and other patients pointed to Medicare and its modality neutral payment methodology as the chief culprit in what they see as a major access issue for oxygen users. Because Medicare pays the same for all oxygen systems and since 1997 has continued to ratchet back reimbursement, providers have a natural tendency to maintain their margins by supplying less expensive modalities, patients say.
"The industry isn't just looking for the buck - there is economic viability to consider," said Vlady Rozenbaum, founder of COPD Alert, a Web site that provides education and support for COPD patients.
(Patients and other attendees also blamed prescribing physicians for what they see as a lack of patient access to lightweight portable systems. Most doctors, they said, don't prescribe or recommend such systems because the know little or nothing about them.)
While patients seem to appreciate the reimbursement challenges providers face, their solution is something the industry wants no part of: a switch to a modality specific reimbursement that would pay more for an expensive portable unit and less for a basic concentrator. While patients say this would result in a redistribution of existing funds, the industry fears CMS would use the opportunity to further cut reimbursement by, say, capping payment for an oxygen concentrator. Ultimately, it could also result in higher Medicare expenditures as prescriptions for these units skyrocket - even for patients who don't need them.
Vernon Pertelle, Apria's corporate director of respiratory & HME Services, spoke at the conference as a representative of AAHomecare. He disputed the view that there is a lack of patient access to lightweight ambulatory technology. There is no evidence to suggest that's the case, he said.
In fact, preliminary results from an AAHomecare survey showed that 97% of 316 provider respondents made portable systems available to their patients; 42% provided liquid portable systems and 26% provided portable concentrators, Pertelle said.
A number of factors beyond a provider's bottom line influences what equipment a patient receives, Pertelle said. Sometimes a provider bases the decision on whether it reduce labor and delivery costs.Providers in many markets need to provide specific technology to meet a geographic demand and to remain competitive. Finally, HMEs provide technology based on what will best benefit the patient.
"There is value in matching the best system to the patient, and it may not be the lightest weight system," added Bob Fary, vice president of sales at Inogen, which manufacturers a lightweight portable concentrator.