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At capacity: Pandemic exacerbates problems created by bid program

At capacity: Pandemic exacerbates problems created by bid program

WASHINGTON – CMS’s competitive bidding program set the stage for a number of the difficulties that the HME industry is seeing as it tries to meet increased demand for oxygen therapy for COVID-19 patients, say the leaders of Apria Healthcare and Lincare and the Council of Quality Respiratory Care. 

The agency may have dropped oxygen from Round 2021, its latest round of bidding, but 10 years since the program’s kickoff and the damage has already been done, they say.  

“If people think it’s bad now, I can’t imagine how bad it would be had we further reduced capacity in the industry (through Round 2021),” said Dan Starck, Apria CEO and former CQRC chairman. “It’s not just the smaller providers. We’re moving equipment around the country every day.” 

Throughout the pandemic, which is fast approaching the one-year mark, HME providers have reported lengthy delays in obtaining both oxygen equipment and parts. Post-holiday surges in December and January have stretched them, and the health care system at large, to the limit. 

The bid program, which drastically reduced reimbursement and forced providers and manufacturers to run much leaner operations, has in some ways handicapped the industry’s ability to respond to increased demand in the way that it would like to, Starck says. 

“Manufacturers only manufacture enough to keep up with normal demand,” he said. “The last 60 days have been anything but ordinary. Manufacturers can’t just flip a switch and make more widgets. Supply has been impacted and it’s downstream effect (has hit) at all levels in the industry.” 

As the “second line of defense” in fighting COVID-19, HME providers have a broad view of the resulting impact, says Crispin Teufel, Lincare CEO and CQRC chairman.  

“It’s difficult for hospital systems to get the oxygen to the bedsides, given the significant liter flows required,” he said. “It’s difficult for the industry to get enough concentrators and make them available to deal with the discharges from the hospital.” 

Stakeholders would like CMS to make permanent some of the changes it has made during the pandemic to increase access, like allowing coverage of home oxygen for acute conditions (including COVID-19) and waiving medical record review requirements for respiratory therapy.  The CQRC will advocate for this streamlined approach, continuing to gather data and work with policymakers, says a representative of the CQRC. 

“We do not know how long some COVID-19 patients will require home oxygen,” she said. “There may be some whose lives have changed forever and will never return to the respiratory capacity they had. Medicare will be grappling with that problem in a real way. We need to make sure the current flexibilities can be continued beyond the PHE.” 


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