ARLINGTON, Va. — The American Association for Homecare intends to put its reworked 15-point plan for oxygen reform before Congress following a "yes" vote by its board, the association said last week. But during a nationwide call Thursday, it was clear some stakeholders are not so sure about the move.
"It's been a long year for us trying to get through [an oxygen reform plan] that everyone can endure and feel comfortable with," AAHomecare Chairman Alan Landauer told conference call listeners. While there has been a "tremendous amount of compromise," he explained, "we obviously have not been successful in getting everyone to agree on every point."
Engineered by the New Oxygen Coalition after months of work, the plan would exempt oxygen from competitive bidding, eliminate the 36-month oxygen cap and recognize 13 specific home oxygen services.
"The idea is to get us out of a reactive position with respect to proposed cuts in Congress," said Tom Ryan of Farmingdale, N.Y.-based Homecare Concepts and past AAHomecare chair. "It's important for us to rationalize the oxygen benefit to get paid for the patient-centric services we provide and not rely on the irrational cross-subsidies that the current benefit supports."
But the plan would also change status under Medicare's oxygen benefit from "supplier" to "provider," a controversial step some listeners said they are not prepared to take.
Callers posed a number of questions on the point to a panel of AAHomecare members:
- Why is it more likely that CMS and elected officials would perceive more value for the oxygen benefit if we call ourselves "providers," when so far they have refused to see the value of those services?
- Is it true that even as providers, Congress/CMS could cut the benefit and increase red tape that would have an effect similar to that seen with the oxygen cap and competitive bidding?
- Providers under Medicare are accredited by only three organizations, not 10 as for DMEPOS. If a company is a "supplier" and a "provider," would they have to be accredited by one of the three?
- Would an oxygen provider have to obtain a separate NPI for oxygen therapy?
- Could providers still remain non-participating under the plan?
All good questions, panel members responded, but because the reform plan has not yet been presented to members of Congress, there are no guarantees on any of its provisions. In a document supplied to call participants, however, the association addressed the rationale of transitioning to provider status.
"The primary threat to the home oxygen benefit is the continued belief by policymakers that the oxygen benefit is simply an equipment-based benefit, which requires little if any service to meet patient and physician expectations … We will not be able to break out of this mindset in Washington if we do not seek recognition as home oxygen providers, commit ourselves to provide a core set of services and allow for some form of cost transparency.
"Simply put, provider status will allow the federal government to recognize what it is paying for," the paper said.
Some hold a different view. The National Association of Independent Medical Equipment Suppliers issued a statement on the plan, noting, "We do not agree that a move to provider status is the only path leading to meaningful reform, nor do we believe that such a move will protect us from further cuts to reimbursement." The statement also said NAIMES believes including elimination of competitive bidding in the plan "will result in an unacceptable cut to payment if it is to remain budget-neutral."
Various callers also wondered about other points in the plan, which would classify patients in three categories and bundle payments and services in the monthly allowable.
"I get nervous when we allow the government to determine our cost structure," commented one. "They have not been friendly to us in the past."
Asked another, "What if Congress doesn't like the bundled category system? How can the industry be assured once legislation is passed into law there will not be any burdensome consequences providers will be forced to abide by that would be a great burden to small independent providers?"
Again good questions, the panelists said, but there simply are no answers at this point. Once the plan is written into legislative language and the hunt for supporters on Capitol Hill begins, many of those answers should be cleared up as work progresses with congressional staffers, association officials said.
That's another rub, according to NAIMES. "While reform of oxygen may be needed, there are too many unknowns and too many risks to move this quickly on a plan that could result in dangerous unintended consequences … There is no assurance that the bill will end up as we proposed, or that it will reach the final vote as it leaves committee," the statement said. (Read the entire NAIMES statement.)
"A lot of things are unknown," said Karyn Estrella, executive director of the New England Medical Equipment Dealers Association, on the call. "That's the fear across the states. We know reform involves risk and we want reform. Whether we want it with 14 points or provider status, we have questions."
But while he has questions of his own, commented Tim Pederson, CEO of WestMed Rehab in Rapid City, S.D., "moving ahead with any plan is preferable to having no plan."
"Right now this is just about getting a plan before Congress that we hope will fly," said AAHomeCare's Mike Reinemer, vice president, communications and policy, following the call. "The danger is that if we don't move ahead, we're not part of the solution to the perceived overpayment questions and the equipment-only perception and the Internet pricing myth. If we can't counter that with a positive reform package, then we're sitting ducks for more cuts."