Q&A: John Walsh

Sunday, December 30, 2007

MIAMI – As president of the COPD Foundation, John Walsh knows a thing or two about this growing and crippling disease. At 57, he’s lived with Alpha-1, a hereditary condition that causes COPD, for 17 years. In November, the foundation partnered with Dey Laboratories to help the National Heart, Lung and Blood Institute raise public awareness of COPD. “Most COPD is caused by smoking, and we’re trying to shift from the shame and blame that people with COPD feel about themselves to preventable and treatable,” Walsh told HME News recently. Here’s some of what else he had to say about COPD.

HME News: Unfortunately, it’s not just COPD patients who blame themselves for the disease. Many family members, healthcare professionals and caregivers do, too.
John Walsh: The image of emphysema is that these are smokers and they did it themselves. When people look at heart disease and diabetes, they don't say that. COPD is the most stigmatized. Even obesity doesn’t have the stigma COPD does. With obesity, it’s more lifestyle. The reality is that all of these diseases will probably end up being a genetic pre-disposition until an environmental trigger causes it. It’s irrelevant how someone got COPD. We have to deal with the reality that they have it and that there are medicines that will decrease symptoms, decrease exacerbations and hospitalizations, and improve quality of life.

HME: What’s your opinion of the HME industry?
Walsh: I think they are providing a critical service to individuals with COPD, but I’d like to see more of them hire respiratory therapists as opposed to people who just drop equipment off. I also think they can do a better job of presenting themselves and their case by involving patients in their messages more. When we were dealing with the FAA and the Department of Transportation on the airline oxygen issue, they gave us a very direct signal: ‘We don't want people coming in representing manufacturers of DME equipment; we don't want DME providers coming in. We want to hear from patients. We want examples of how patients’ travel has been interrupted or impeded.”

HME: What’s your opinion on the current state of COPD treatment in the United States?
Walsh: Our constant fight is making certain that you get appropriate access to new therapies as they are developed. With reimbursement challenges, the climate with Medicare and CMS nowadays, it’s a battle, but it is a battle we all have to fight together. There is no excuse why there hasn’t been more of a focus on drug development for the fourth leading cause of death, the second leading cause of disability and a disease the causes our public health system $40 billion a year.

HME: Why does it seem that a lot of people in Washington are hostile to the HME industry?
Walsh: Washington is all about money. It doesn't have to make sense. In fairness to some of the people on the Hill and in CMS, they feel like they’ve been taken advantage of for years, but they have to take some responsibility for that. Why didn't they evaluate how much they were paying? If a concentrator costs $600 and they are reimbursing ($200 a month) for 10, 12, 15 years, maybe they should have thought about having a dialogue with the HME companies sooner than this. You can’t just turn around and punish the patient because they are embarrassed that they may have been taken advantage of.

HME: What are your thoughts about Medicare’s current reimbursement for home oxygen?
Walsh: I don’t think there is anything anyone can do about the 36-month cap. I think the realty is that someone has to start to position this differently, and the core of that is what’s best for the patient. Go in there and say, ‘Don’t reduce the cap any more; freeze it.’ CMS has done a good job of requiring outcome measurements in every healthcare setting. Why not refocus on this discussion? The government will pay additional money or create incentives if you meet the following standards. From CMS’s perspective, there is no commitment by the DME industry to have that dialogue. It is all about the price and caps and competitive bidding. I think (the industry) needs to turn that around. The COPD foundation would be glad to work with the HME industry to have that dialogue with CMS.