Providers debate oxygen overhaul

Sunday, January 18, 2009

YARMOUTH, Maine - A plan to overhaul the Medicare oxygen benefit falls short on details, say respondents to a NewsPoll that will appear in an upcoming issue of HME News.

The most controversial part of the plan: A new payment methodology, called the case mixed adjusted system, that involves paying providers a basic rate based on patient ambulation. That rate would then be adjusted based on patient needs.

While 95% of 235 poll respondents agreed that the oxygen benefit, in general, needs to be overhauled, they're not quite ready to put their full weight behind the plan.

"The proposed changes have more questions than answers," said one respondent. "There is a difference between oxygen modalities in terms of client care and in terms of the cost to providers."

AAHomecare, the Council for Quality Respiratory Care and other industry stakeholders unveiled the plan earlier this month.

Slightly more than half of respondents (56%) like the idea of a case mixed adjusted system. It's about time, they say, that different modalities are reimbursed accordingly.

"The dirty little secret in home oxygen has always been that stationary systems are what's cheap--portability is not," wrote one respondent. "Reimbursement has been backward for years."

But, again, the devil's in the details.

"I think it is a good concept, and I am excited by the change in philosophy," wrote provider Rick Wilson of Apguard Medical in Woodland Hills, Calif. "(But) I would like to see some numbers."

Numerous poll respondents wondered how Medicare would define coverage criteria under the plan and how providers would document patient needs.

"Some (nocturnal) patients use the unit during the day," wrote on respondent. "It is sometimes difficult to judge ambulation and activity, and that may vary from month to month."

Other parts of the plan received strong support. Eighty-seven percent of poll respondents agreed that oxygen companies should be reclassified as "providers."

"Recognition of the service aspect of the home oxygen benefit is way past due," wrote Ben Galbraith, director of St. John's Medical Supply in Springfield, Mo. "Service is the only thing that differentiates suppliers from providers."