Pulse oximetry suffers blow

Sunday, September 30, 2007

DENVER, Colo. - Colorado HMEs who bill Medicaid for pulse oximeters got the wind knocked out of them Aug. 1, when the state capped reimbursement at $750 a year.
Previously, Medicaid paid a monthly rental fee of $372.35 for as long as the patient needed the oximeter. Now, once the cap kicks in after month two, ownership transfers to the patient.
"We were paying too much," said Joanne Lindsay, the public information officer for the state's Department of Healthcare Policy and Financing. "It's not as if we are trying to gyp people. We're just trying to be cost efficient. It was a higher rate than it needed to be and still deliver quality care."
At least one Colorado provider feels differently. While the $372.35 monthly fee may have been too high, the provider said, "now they've cut it too much." When you add this to Medicare's 36-month cap on oxygen and its 13-month cap on other DME, "there is not enough money in the pool."
"With one cut after another, it's tough," said the provider, who also questioned the logic of requiring a patient to care for a piece of complex medical equipment.
While a decent pulse oximeter can cost as little as $125, say providers, they often cost much more and are used to treat very sick patients, often those on ventilators. These patients require a pulse oximeter 24/7 to monitor their oxygen level to ensure they do not desaturate.
In Illinois, the state caps pulse oximeters at $1,243.10, paying $124.31 per month for 10 months, said Alan Kirk, vice president and general manager of Total Home Health in Elgin, Ill.
"Pulse oximeters are very finicky," he said. "They break all the time, and you are going out there in the middle of the night, swapping them out. Those are total loses. If you are a little company and don't have business to offset that, it would be a huge drain to accept public aid for pulse oximeters."