There’s no place like home?

Monday, January 31, 2005

Editor, HME News

No one disputes the need for home care patients to utilize the most efficacious means of delivery when it comes to home oxygen. But splitting the Medicare oxygen code into separate classifications for reimbursement, as the National Association of Medical Directors of Respiratory Care is now proposing in a draft statement (see page 4), is not the best approach.

First of all, there’s some question as to whether there is a problem with access to premium oxygen systems. The largest COPD needs assessment survey ever conducted, released last summer by the National Emphysema/COPD Association (NECA), found that clinicians did not believe access to ultra lightweight portable oxygen systems was limited. That study may be the best science on the issue to date.

Allegations that patients aren’t getting liquid oxygen are just that - hunches, not fact. By its own admission, NAMDRC states that evidence pointing toward limited access to premium systems is “anecdotal.” To wit, see NAMDRC President Steven M. Zimmet’s article in the October issue Chest Soundings, a periodical put out by the American College of Chest Physicians.

Beyond the NECA study, sales data from industry manufacturers would suggest that access to premium oxygen systems is on the rise. Sales of such systems were slow to get out of the gate, for obvious reasons. The systems costs thousands of dollars. Suppliers were heavily vested in existing technologies. But the adolescence of these new markets is maturing fast. Invacare, for one, is reporting that it’s sold tens of thousands of Venture HomeFill IIs.

Given that the best estimate of the Medicare market for home oxygen involves 820,000 individuals (see HME News’ ‘State of the Industry’ white paper, September 2004), inroads by one company that number in the tens of thousands is compelling evidence that the market is quickly on its way to providing access where necessary.

Remember, too, that Invacare is not alone. CHAD Therapeutics, Puritan Bennett, AirSep, Inogen, Penox and Caire are all marketing ultra-lightweight systems that are taking share from the old concentrator workhorse.

So why go to CMS with an issue like this now, unless of course there is more than anecdotes to support a contention that there’s limited access to the attractive new systems.

Some say the issue is a non-starter at CMS, partly because CMS doesn’t want to provide a financial incentive that could possibly balloon reimbursement for liquid oxygen.

Moreover, Medicare by law is restricted to paying for equipment that’s used in the home. NAMDRC is agitating for an exception to this rule since the kind of ambulatory systems it’s championing would be used, primarily, beyond the four walls of a beneficiary’s home.

Most would agree the homebound limitations are antiquated. That ought to be changed, and changed first. If later there’s evidence that people aren’t getting their Helios, their HomeFills, their Total O2s, their Lifestyles and Freestyles, their Inogen Ones, their Escorts, their Strollers and their Sprints, then perhaps it will make sense to revisit this issue.