To date, a number of unanswered questions about exactly how the equipment transfer will work remain.

For example, asks Kelly Riley, director of the National Respiratory Network for Lubbock, Texas-based The MED Group, “If you transfer the piece of equipment to the patient and the patient has ownership, who is the accreditation body going to look at if there is failure of the equipment? Are they going to hold the provider accountable for the safety issues related to the patient management?”

She says some providers want to retain ownership of the equipment while others, citing potential liability and cost, do not, making this “a horribly difficult issue.”

Landauer's Devlin points out “there still are no defined guidelines that outline what will happen to the patient-owned equipment, maintenance, service, cylinder replacements and so forth.”

Another question that bears an answer is what providers will get paid for servicing the beneficiary-owned equipment.

”There's a lot of debate about if providers can even afford to do something, or anything, for a patient after title transfers,” says Richard.

“When we [as a manufacturer] build a product, we have the mindset that it's going to be maintained by a home care provider who has biomedical people on staff. In other words, it's built so the patient can easily use it and that it meets their clinical needs, but most manufacturers build devices with the thought that providers are going to take care of it.”

It gets even more complicated.

“Patients are sick, and who are they going to call? There's not a Geek Squad for the medical industry. It will be a cost that is out of their own pocket, and on top of that, if the devices are not maintained properly, they can produce less than desirable outcome,” Richard continues.

“They will stop working correctly and they will start malfunctioning, and then when patients do pass away, what's the family member going to do with that equipment? CMS and the insurance companies need to get rid of the notion that title transfer is a good idea for oxygen equipment for the future until there are more policies and procedures in place for providers to get paid to do intermittent, interval service-type routine maintenance on devices like that.”

But, as with competitive bidding, the only way to change the DRA is through the legislative process, so providers need to start making preparations now.

“Providers need to continue to have discussions with their beneficiaries and explain the benefit and the legislation that will impact their therapy. They will need to ensure the beneficiaries are well-educated in the matter and the impact on them, and then they will need to ensure the beneficiary contacts their elected officials to voice their concerns,” advises Pontzius.

“Providers will also need to educate elected officials on the benefit, especially the in-the-home rule, and will need to show how they were providing services beyond the benefit they were getting reimbursed for and show the impact the law will have if allowed to continue.”

Clevidence agrees. “We must all get active in writing to our congressional representatives. Competitive bidding has helped to place us in front of our lawmakers to help them understand what we are experiencing and what it means to the sick in our country.

“We are getting support from a growing number of congressional representatives. I think that they are beginning to take note and actually see how it is impacting our industry and their constituents,” he says.

LOOKING TO TECHNOLOGY

Today's respiratory products, however, continue to raise the bar in terms of patient care and providers' bottom lines.

“New technology is allowing providers to rationalize care,” says McBride, adding as an example that a provider using a portable oxygen concentrator can deliver the unit to the hospital and not have to visit the patient for a home delivery. “Also, these patients can bring the unit to the provider for the unit check and preventative maintenance,” he says.