WASHINGTON--Getting members of Congress to sign on to the Home Oxygen Patient Protection Act was one of the main "asks" HME stakeholders took to Capitol Hill at a legislative fly-in sponsored by the American Association for Homecare last week.

"Don't make it harder for Americans to breathe," association Chairman Tom Ryan, president and CEO of Homecare Concepts, Farmingdale, N.Y., urged 150 providers and others participating in Tuesday's lobbying day to tell their congressmen. "We've got to get more people behind H.R. 5513. Patients should not be forced into [equipment] ownership."

The bill, introduced by Reps. Joe Schwarz, R-Mich., and Tom Price, R-Ga.--both physicians--would repeal the 36-month cap on Medicare oxygen reimbursement enacted under the Deficit Reduction Act, which passed in late 2005 (see HomeCare Monday, June 5). Inserted in the DRA as a money-saving effort by California Rep. Bill Thomas--considered an industry nemesis by many for his role in pushing through the DME competitive bidding mandate in the Medicare Modernization Act--the DRA provision also transfers equipment title to the beneficiary when the cap kicks in.

In addition, President Bush's proposed 2007 budget includes a provision that would shorten the rental period to 13 months, for an estimated $6.6 billion savings over five years.

Approximately a million Medicare beneficiaries now receive oxygen therapy, and 15 million more Americans have been diagnosed with chronic obstructive pulmonary disease (COPD), a progressive, fatal illness requiring long-term oxygen therapy. It's the fourth-leading cause of death in the U.S.

But according to a survey of oxygen providers commissioned by AAHomecare and set for release Tuesday, only 28 percent of the cost of serving oxygen patients can be attributed to the actual equipment, while 72 percent is related to the cost of services and operations such as delivery, maintenance, patient assessment and education, 24-hour on-call support, regulatory compliance and other expenses.

While the change in oxygen policy makes "rent-to-purchase" sound like a good thing for beneficiaries, Ryan said, "it's forced ownership." What's more, the policy change could result in a number of patient safety issues and increased hospitalizations for oxygen patients who don't--or can't--maintain their equipment. According to association figures, the average annual cost for home oxygen therapy is $2,784, or $7.62 a day, versus an average $4,600 cost for a one-day stay in the hospital.

"I can't imagine where the concept came from that older people--people who have difficult times with just taking care of themselves--would be required to take care of oxygen equipment, would be required to own it and would be required to somehow find a way to pay for maintaining it," said Schwarz. "I can't believe that someone would put that in federal legislation."

An ear, nose and throat surgeon, Schwarz said that oxygen is a highly regulated drug and that Congress never "considered the clinical dimensions of this issue." Because the DRA provision "bothered me a great deal," he said, he and eight other physicians in the House decided "the only thing we could do would be to introduce legislation that deletes the language.

"We're going to get this bill through. It makes imminent good sense," Schwarz continued. If the bill doesn't move in this session of Congress, he said, "then I'm going to introduce it on Day One of the 110th [Congress]. This is just one of those little pieces of good government that has to happen."

The bill has 18 co-sponsors so far.

Other issues home care advocates took to federal legislators in 250 Hill meetings included:
--softening effects of the MMA's competitive bidding mandate through support of H.R. 3559, known as the Hobson-Tanner bill. With 119 cosponsors in the House, AAHomecare, VGM, The Med Group, state associations and others are now working to get a companion bill introduced in the Senate.
--preserving the Medicare home health inflation update.
--urging CMS to consider alternatives to gap-filling, the method currently used to set prices for new HCPCS codes. If the method is used to develop fee schedules for CMS' 64 new power mobility codes, AAHomecare warned that Medicare payments for power wheelchairs could decrease by as much as 25 to 30 percent.

All of these issues are about "older Americans getting the home care they need," Ryan concluded. "This is about quality of care to help people live with dignity and a quality of life."

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