WASHINGTON — In comments that sparked a televised rebuttal, a former HCFA administrator asserted last week on C-SPAN that Congress has thwarted every attempt to cut HME reimbursement and that home oxygen is "nothing but air."
"My former colleagues can tell you it used to drive me crazy that Medicare pays about three times as much as the Veteran's Administration or some private insurance [companies] for machines that provide people with home oxygen," said Bruce Vladeck, who headed the Health Care Financing Administration (CMS' predecessor) from 1993-97.
On the Aug. 27 edition of C-SPAN's "Washington Journal," Vladeck said, "I used to run around the office muttering, 'We are paying $3 billion a year for air,' because that's all it really is."
Added Vladeck, "And yet every effort for the last 20-some years to reduce Medicare payments for oxygen has run into a large lobbying campaign from the supplier industry generally organized to frighten beneficiaries to say, 'If you let this go ahead, Congress is literally going to cut off your air supply,' and Congress has stepped in to prevent reductions to oxygen payments every single time."
The former HCFA chief's remarks drew a swift rebuttal from the American Association for Homecare's Michael Reinemer, vice president, communications and policy, who responded in a blog and an email that was read by the C-SPAN host on Friday's edition of the show.
Reinemer, who called the oxygen comments "outrageous," pointed out that "Medicare pays for medical oxygen and oxygen devices, both of which require prescriptions, as well as certain accompanying services, which Mr. Vladeck chooses to ignore completely.
"The Food and Drug Administration, Department of Transportation, Department of Homeland Security, local fire authorities and state licensing boards are just a few of the groups that regulate or provide oversight to the home oxygen sector," he said.
Vladeck's statement that oxygen rates have not been reduced "is also, of course, patently false, since oxygen rates were cut in 1997, 2003, 2005 and 2008," Reinemer told C-SPAN. "And the comment that it's only 'air' is an extremely cavalier and irresponsible description of the medical oxygen and delivery devices required by more than a million Medicare beneficiaries."
Vladeck, now senior adviser to Nexera Consulting, a wholly owned subsidiary of the Greater New York Hospital Association, also charged that Congress, under both Republican and Democratic presidents, has consistently prevented any attempt to "change the system to eliminate those ridiculous overpayments."
"This is patently false," Reinemer said, noting that "Congress has cut DME payments and changed the payment system in Medicare numerous times since Vladeck left his job: in the Balanced Budget Act of 1997, in the Medicare Modernization Act of 2003, in the Deficit Reduction Act of 2005, and in the Medicare Improvements for Patients and Providers Act of 2008."
In separate on-air phone comments, Reinemer also told C-SPAN viewers about the 9.5 percent reimbursement cut the industry took to pay for the delay of competitive bidding and the less-than-1 percent growth rate in Medicare spending for HME.
Confronted with Reinemer's rebuttal, Vladeck said Aug. 28 on the C-SPAN program he guessed he "misspoke" about cuts to DME and oxygen. He maintained, however, that "DME is still overpaid" and that "even with all the 'cuts,' Medicare is still significantly overpaying for in-home oxygen."
At one point, Vladeck said that cuts made to HME had been largely "cosmetic," a charge that Reinemer found offensive.
"He kept talking about the cuts as if these weren't real or substantial," Reinemer told HomeCare Monday. "These were very substantial cuts and modifications to the whole program."
Click here to see the entire Aug. 27 "Washington Journal" segment (1 hr. 4 min.) including Vladeck's comments. For AAHomecare's rebuttal (beginning at the 1:48 mark) on the Aug. 28 show, click here.
As frustrating and upsetting as Vladeck's comments were, Reinemer said, they are even more disturbing because they are symptomatic of what the HME sector is up against with CMS.
"There is this deep-seated misunderstanding and mistrust about DME, and I think the roots go back many, many years, because the farther back some of these people go, the more prejudiced they are and the less familiar they seem with all of the laws that have been enacted since," said Reinemer. "For instance, since Vladeck left office, you have more standards, accreditation, numerous cuts and, moreover, we have really taken the lead in terms of finally getting CMS to take control of fraud and abuse."
Oxygen stakeholders are currently working on new language for H.R. 3220, a bill introduced by Rep. Mike Ross, D-Ark., that would overhaul Medicare's oxygen benefit. The industry had divided over various aspects of the bill, but came to a compromise agreement on its provisions earlier this month. (See Oxygen Stakeholders on Road to Unity, Aug. 24.)
Ross, a former HME owner, has told H.R. 3220 supporters he would work to get an oxygen reform plan amended to the House Energy and Commerce Committee's health care reform bill. The committee passed its bill before Congress' summer recess but still has more than 50 amendments to consider when lawmakers return to Washington Sept. 8.
According to published reports, Energy and Commerce Chair Henry Waxman, D-Calif., has agreed to consider Ross' amendment but does not support it.
