Portable O2 technology: Does an access problem exist?

Thursday, March 31, 2005

VIENA, Va. — A move by physicians to convince Medicare to pay more for lightweight ambulatory equipment than for oxygen concentrators has its heart in the right place. It isn’t, however, based on evidence that a lack of patient access to this high-end equipment currently exists, say HME industry leaders.
In March, the National Association of Medical Directors of Respiratory Care (NAMDRC) began applying the finishing touches to a position paper that lobbies for the end for Medicare’s modality neutral reimbursement methodology for home oxygen. Also in March, AAHomecare’s Respiratory Access Alliance met with NAMDRC to express its belief that now is not the time for a reimbursement change of that magnitude.
“As with any evidence-based approach, we need to define the problem, and currently it's unclear if one exists that would warrant such a recommendation in a time when there are many more definite issues that need to be resolved,” said Vernon Pertelle, Apria’s corporate director of respiratory & HME services, who attended the March meeting. “If there is a problem, then we need to collaborate and agree on what steps need to be taken to develop appropriate solutions.”
NAMDRC initiated the position paper for two reasons: 1. Members believe that HMEs are maximizing their profits by giving patients concentrators and cylinders rather than more more appropriate and expensive portable systems like Puritan Bennetts’ Helios; 2. HMEs often ignore a doctor’s prescription for such high-end equipment and provide something less expensive.
NAMDRC Executive Director Phil Porte declined to discuss his group’s position in depth, saying he didn’t want to “fight this battle in the media.”
He did say that “there are a series of issues affecting physician thinking and access is only one of them.”
“If one were to step back and reimburse one widget at X dollars and another at Y dollars, there’s a natural incentive, totally legitimate and understandable, for people to make more rather than less money,” he added.
AAHomecare member Tom Ryan attended the March meeting with NAMDRC. The association, he said, will work with NAMDRC to discover if there is an access problem to light-weight portable systems and if so what should be done to improve the situation. Ryan and other industry supporters believe competitive forces in the market require providers to supply these lightweight units when requested or lose business.
“We want to make sure that the physician gets what he prescribes and that the patient gets access,” Ryan said. “I think we are almost there, but if we can work together on their concerns, let’s work together.”
Invacare belongs to NAMDRC’s Industry Advisory Committee, and John Ledek is the manufacturer’ vice president/category manager for respiratory products. The company sells its lightweight Venture HomeFill unit nationwide and hasn’t noticed an access problem, he said.
The best way to improve access, he said, is not by eliminating modality neutral reimbursement but by educating patients and doctors that such lightweight systems exist.
“Anything we can do to encourage greater access and the ability for providers to provide lightweight portable systems, we ought to do,” Ledek said. “But we need to do that without risking the shift to payment that may reduce overall reimbursement sent to respiratory providers. That is the goal.”