ATLANTA — Members of a newly formed oxygen coalition sifted through provisions of several plans last week looking for common ground on reform of Medicare's oxygen benefit and repeal of the 36-month rental cap.

"The big push now is to get a unified voice," said Mike Calcaterra, Montana state chairman and legislative/DAC chair for the Big Sky Association for Medical Equipment Services, which covers Idaho, Montana and Wyoming. With industry advocates headed to Washington this week for the American Association for Homecare's lobby day, "we need to make sure we are on message there with something that is giving us immediate relief. We are already seeing providers closing their doors," Calcaterra said.

AAHomecare convened the New Oxygen Coalition, or NOC, after a number of state HME associations said they could not support the long-term plan unveiled in January by AAHomecare and the Council for Quality Respiratory Care. Some state leaders said the plan lacks specifics and does not immediately address the 36-month cap and the post-cap payment rules, which took effect Jan. 1.

AAHomecare leaders fear, however, that Congress won't budge on the cap before a reform plan is in place.

"While everyone would like to eliminate the 36-month cap or get a better set of payment rules, both are difficult targets to achieve in the current political environment," said Tyler Wilson, president of AAHomecare. "Many within the oxygen community view the likelihood of more cuts to oxygen as an imminent threat. The big challenge right now is to develop a consensus plan that will address both the immediate issues and the longer-term goal of reform.

"All of us face real peril at the hands of Congress and CMS if the oxygen provider community does not present at least a core of common principles to address the issues."

Members of the new coalition — which includes some state associations, VGM, The MED Group, the CQRC and AAHomecare — all agree long-term reform is needed and the cap must be repealed, but they are at odds over how those things can be accomplished. State association representatives held a conference call last week to make sure they were "all on the same page," said one state exec, and participated in calls with AAHomecare to try to hammer out their differences before lobbying in Capitol Hill offices Wednesday.

"There are different versions of what reform might look like," said Teresa Tatum, executive director of the Georgia Association of Medical Equipment Services. "There is some agreement, but the major disagreement is on the payment methodology."

In addition to the AAHomecare/CQRC plan, two other reform plans have been proposed by Big Sky AMES and Jason Rogers, president of GAMES.

"We think we have a vehicle that can give us an immediate fix [to the rental cap]," said Calcaterra about the Big Sky plan. "AAHomecare brought their proposal they worked on with CQRC — and a lot of work, a lot of time went into that — but we didn't see any immediate fixes in it," Calcaterra said. "It's big-scale reform, and that's going to take a while. We are worried about providers being there when the reform takes place. We feel we have the plan for realignment on how they pay for the service that would eliminate both the cap and competitive bidding."