Washington
In a move both expected and dreaded by home medical equipment providers, early last month President Bush revealed his 2008 proposed budget, which includes a 13-month cap on home oxygen rental and elimination of the first-month purchase option for power wheelchairs.
In addition, the budget calls for a five-year freeze to the Medicare market basket update for home health agencies and a reduction of almost two-thirds of a percent for each year thereafter.
The proposed $2.9 trillion budget provides nearly $700 billion for the Department of Health and Human Services, but seeks to carve out $66 billion in savings from Medicare and $12 billion in savings from Medicaid over five years.
While the president's budget must be approved by Congress, its provisions generally set the tone for debate. Just hours after the budget was released, Bush's proposals triggered protests from a number of home care groups, who warned such moves would curb accessibility for oxygen and mobility patients and would threaten home care itself.
A statement from the American Association for Homecare blasted the proposed 13-month cap on oxygen rental, calling it “particularly severe.”
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.”
According to Jon Tiger, president of NHOPA, “the president's proposed budget significantly impacts citizens least able to manage ownership of respiratory medical equipment. 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.”
The Council for Quality Respiratory Care, an alliance of 11 of the country's largest companies that provide home oxygen care to approximately 650,000 Medicare beneficiaries, joined with patients and physicians in opposing the 13-month rental cap.
According to Peter Kelly, CQRC 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.”
But manufacturing giant Invacare pointed to a bit of good news regarding the oxygen proposal. While the budget would shorten the rental period from its current 36 months to 13, it would also exempt “new oxygen technologies,” such as home transfilling equipment, from the cap, said Cara Bachenheimer, vice president of government relations.
Invacare and others have spent months trying to educate the administration about the effects of capping oxygen equipment, Bachenheimer said, one of them being that if new technology were capped, “no one would buy it” and no one would develop it.
The exemption puts the oxygen market in a “much better position,” she said.
AAHomecare and others also vehemently opposed Bush's proposal to establish a 13-month rental period for power wheelchairs — which would eliminate the first-month purchase option for the equipment — saying the change would reduce beneficiary access and increase costs to Medicare.
The association pointed out that 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.
Kurtis Blunt, owner of Santa Barbara Healthcare in Santa Barbara, Calif., said he's already selective about the power chairs he bills Medicare for, but if Bush's proposal goes through, it would quash that business.
“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,” Blunt 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.”
