Providers fear HMOs will follow gov't lead

Wednesday, January 31, 2007

WASHINGTON - Even though the first year of Medicare's plan to transfer ownership of home oxygen equipment to beneficiaries after 36 months has come and gone, providers still aren't sure whether private payers will follow in the government's footsteps.
Some providers believe it's only a matter of time--"Private payers always follow Medicare," says Dan DeSimone, CEO of Continued Care of Long Island in Farmingdale, N.Y.--while other providers believe private payers know better.
"They've gone to ownership in the past, and they've turned around because they don't like dealing with unhappy subscribers," said Tom Inman, president of Virginia Home Medical in Newport News, Va.
Inman pointed out that patients insured by private payers often have more leverage than those insured by Medicare because, typically, they're still employed.
"It's not like a Medicare beneficiary can complain to their company or shop around for insurance," Inman said. "They're stuck."
Still, providers like Michael Clark, president of Anthem Health Services in Albany, N.Y, are concerned. There's a lot at stake: Because patients who are insured by private-payers are usually younger, they're on oxygen longer, he said.
While she sees the Blue Cross Blue Shields of the private-pay world following Medicare eventually, Carlia Cichon doesn't see other private payers making the leap.
"We deal a lot with auto insurances and workers' compensation, and they're truly into service," said Cichon, president of Advent Home Medical in Madison Heights, Mich. "We talk directly with a case manager who knows the patient."