Issued jointly with the National Home Oxygen Patients Association and the National Association for Medical Direction of Respiratory Care, a physicians' group, the statement said, "We believe the proposed change in payment methodology places an unfair, unsafe and unrealistic burden on the beneficiary." The organizations said they are "deeply concerned that Medicare policy is increasingly at odds with the clinical needs of home oxygen therapy patients, as well as physicians' and home oxygen providers' ability to deliver optimal home respiratory care."

"The president's proposed budget significantly impacts citizens least able to manage ownership of respiratory medical equipment," said Jon Tiger, president of NHOPA. "It leaves them without a network to ensure proper functioning of the equipment and to whom concerns can be raised. The proposal also removes the incentive for manufacturers to continually improve their equipment and will result in used prescription equipment ending up in the secondary market."

The statement also pointed out that the proposed 13-month cap comes on top of numerous other cuts and freezes mandated by Congress in recent years. AAHomecare President and CEO Tyler Wilson noted that "Congress has reduced Medicare reimbursement for oxygen therapy by nearly 50 percent over the past 10 years."

"Cuts of this magnitude have the potential to disrupt the quality and continuity of care for our patients," said Mark Shreve, CEO of the Coalition for Pulmonary Fibrosis, which represents more than 128,000 patients with idiopathic pulmonary fibrosis, for which oxygen is a critical component of treatment. "We urge Congress to reject this provision in the president's budget to ensure that patients are able to access the services they need to survive."

Concern over the proposed cuts is compounded by the fact that "the Medicare home oxygen benefit is still experiencing the impact of several years of cuts enacted by Congress as part of the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005," CQRC said.

According to Peter Kelly, the group's chairman, "Providers of oxygen home health services are just starting to absorb the reductions in funding enacted by Congress in recent years ... Further cuts in the benefit would be destabilizing to the system. Additionally, this proposed 13-month cap comes on the heels of the administration's recent overhaul of the reimbursement system for home oxygen."

Duane Greer, supervisor of RTA Homecare in Mesa, Ariz., said he is concerned about the effects of a 13-month cap on his customers, many of whom are winter visitors. "Now they're going to be stuck with [transporting] all their equipment. They're not going to have the freedom to go to a provider and get set up [when they visit]," he said. "And then, who is going to service them? They're not going to be able to get the service."

He is also concerned, he said, about what will happen to used oxygen concentrators if providers are no longer able to remove them. "You're going to see the market flooded with used concentrators because [people] aren't going to know what to do with them after purchase," Greer predicted. "It's still a medical device, and [people are] going to be using them without a prescription and with oxygen picked up at a garage sale."

"Currently, Medicare permits a beneficiary to choose to purchase a power wheelchair when it is prescribed by a physician," the association said, noting that with the option, Medicare payment is made on a lump sum-basis. "In October 2005, the Senate debated a provision to eliminate the first-month purchase option for power wheelchairs and decided to reject this policy change," the association said, based on the following reasons:

--Beneficiaries in need of power mobility devices suffer from long-term debilitating conditions. More than 95 percent of all PWCs are purchased in the first month because beneficiaries who meet the coverage criteria have long-term life needs.
--Many PWCs are custom-configured and individualized for the patient. These are not commodity items.
--Eliminating the first-month purchase option would severely curtail beneficiary access as the supplier will be unable to cover the significant up-front service costs that go into the provision of the most appropriate power mobility device to accommodate the beneficiary's needs.

The association urged Congress to "reject the administration's proposal and maintain the first-month purchase option for power wheelchairs to ensure beneficiary access and cost savings to the Medicare program."

Providers agreed with this, too.

"Obviously, that's unacceptable," said Wendell Matas, president of Wheelchairs Northwest in Bellevue, Wash., president of the Pacific Association of Medical Equipment Services, about the president's proposal. "I don't think people ever think in terms of renting a power wheelchair. I can understand a capped rental for people who may need it for a short while. But when you get into rehab, those chairs are custom built for each individual. You just don't turn 'em around [and give them to someone else]."

Kurtis Blunt, owner of Santa Barbara Healthcare in Santa Barbara, Calif., said he's already selective about the power wheelchairs he bills Medicare for, but if Bush's proposal goes through, it would quash that business entirely.

"If they're going to do a capped rental on a power wheelchair, I am not going to do it at all. It's not worth it to me," he said. "Unfortunately, the people who are going to be hurt by it are the patients because they are going to need equipment and they aren't going to be able to get it."

Said AAHomecare's Wilson of the budget proposals, "Home care provides a clear path to more cost-effective care in Medicare and Medicaid. Home care delivers value for every health care dollar and is clinically effective and preferred by patients and families. These proposed cuts serve only to hobble the home care infrastructure that this nation desperately needs."

Congressional hearings on the budget proposal are scheduled for later this month. To view the proposal for the Department of Health and Human Services, visit http://www.hhs.gov/budget/08budget/2008BudgetInBrief.pdf. Go to page 50 for a discussion of proposals affecting home care.