Providers: The uncertainty surrounding maintenance and service has them worried, so they're reassessing their biz plans, including role of RTs

Tuesday, January 31, 2006

YARMOUTH, Maine - HME providers have begun wracking their brains over how they will maintain current service levels, especially respiratory therapist visits, if a proposal to cap oxygen at 36 months passes muster with Congress.
"I think all of us are taking a step back and re-looking at our business plans," said Jill Spellman, president of Waukesha, Wis.-based Oxygen One. "Personally, I've tried to close my office door and ask myself, 'How do we keep patients at the top of the triangle and provide excellent equipment and services, if this is the reality of the future?'"
Although service levels for oxygen equipment vary from provider to provider, they often include evaluations, delivery, set-up, training, maintenance, RT visits and 24/7 emergency response, said various industry sources.
Right now, Medicare reimburses providers about $200 a month to maintain and service stationary oxygen. Under the proposal, however, the agency would cap reimbursement at three years and transfer title of the equipment to the beneficiary at that time.
The proposal states that maintenance and service payments may be made after 36 months if the secretary determines they're "reasonable and necessary."
It's that uncertainty surrounding maintenance and service that worries providers the most. Many providers believe they work in a therapy-driven business, and they provide RT-related services to help them provide top-notch care: RTs review patient profiles, develop care plans and determine whether a beneficiary would benefit from a different modality.
In some cases, having one or more RT on staff also helps companies stay competitive, providers say.
But Medicare doesn't reimburse providers for RT-related services per se--or not outside its monthly $200 reimbursement.
"There's no benefit to providing some of these services besides good, community-based service," said David Law, director of operations for Raymond, N.H.-based Lifeplus, a division of Apria.
Because of that, RT-related services would likely be the first services providers would cut back under the proposal, said various industry sources.
"If the medical community agrees at all that what our therapists do for patients is positive and keeps them out of hospitals--well, the day is very near when we're not going to be able to do that anymore," said Les DeFelice, president of Wheeling, West, Va.-based DeFelice Care.
Providers also had the following reactions to the proposal:
- Commodity vs. service: The proposal is proof that the HME industry still struggles with its reputation as a commodity vs. a service industry.
"I think what Congress hopes for and has seen in the past--with the exception of the two competitive bidding demonstrations--a lack of concern from beneficiaries that their service level has been affected," said Jeff Wills, chairman of AAHomecare's HME/RT Council and owner of El Reno, Okla.-based Canadian Valley Medical Solutions. "Congress hopes providers just swallow it and go on. As providers, we need to develop some data to show them that we can no longer take (reimbursement cuts)."
- Technology: Providers who harness new technology like the Venture HomeFill, which reduces services like deliveries, will help providers adapt to reimbursement changes. However, one industry source pointed out, new technology carries significant up-front capital costs (one HomeFill unit costs more than $3,000), especially when investments in existing equipment are taken into consideration.
- Beneficiaries: At the end of the day, it's the beneficiaries who will suffer from any cutbacks in services, said various industry sources.
"Businesses can always cut costs to survive, but how does this affect the beneficiary?" asked LifePlus' Law. "I don't think anyone in Congress has thought about that.
- The Future: Providers fear that Congress won't stop at 36 months.
"Those 36 months were initially 18 months," Wills said. "Some of the concern is that those 36 months will be ratcheted down."