Wheelchair story rankles CPAP crowd

Monday, August 31, 2009

CNN's story in July on Medicare reimbursement for wheelchairs struck a chord with CPAP providers.

The six-and-a-half minute segment featured a beneficiary whose provider, Apria, was reimbursed $1,200 by Medicare for her manual chair. The same chair, says the narrator, can be bought online for $440.

CPAP machines can also be purchased online, sometimes for much lower prices than what a traditional HME can offer.

"You read these pieces in the paper and see these CNN pieces where we are getting bashed," said Jamie Blair, vice president of New Boston, Ohio-based Genesis Respiratory Services. "People start agreeing with (what the stories say) and they don't know what they are talking about."

If you treat CPAP as a commodity instead of a service-intensive therapy, you overlook the importance of quality care, say providers.

"We take a lot of time with patient set-ups, often as long as three hours," said Glenn Steinke, owner of Bishop, Calif.-based Airway Medical. "We then call the patients on a regular basis until they are tucked in. Online providers don't do that."

When it comes to taking care of Medicare patients, such handholding is actually required, thanks to guidelines issued in 2008. For initial coverage of a CPAP, the patient must have a face-to-face evaluation by the treating physician prior to the sleep test, and he must have a follow-up visit to document compliance after the first three months. That's on top of accreditation and surety bond requirements, neither of which is required of cash-only online providers.

"It's a challenge to stay in the Medicare CPAP business," said provider Jack Hogan, owner of Waterbury, Conn.-based Health Complex Medical. "There's lots of red tape and hoops to jump through."

For patients--and payers--going straight to the Internet for a machine can prove costly in the long run, providers say.

"We've got patients that come to us that didn't buy the CPAP from us but ask us to explain it to them," said Blair. "We say we can, but there will be a fee."

When all is said and done, however, most providers don't see the online providers as competition. Provider Mike Kuller developed a user-friendly CPAP Web site and matched prices with a well-known online provider.

"I have not had one single person buy online," said Kuller, president of Concord, Calif.-based AllStar Oxygen Services.