WASHINGTON — With a deadline looming at close of business today, home oxygen providers and other stakeholders pressed legislators last week to sign on to a bipartisan "Dear Colleague" letter calling for appropriate payments for home oxygen therapy (see Price Asks House Colleagues to Act on Oxygen Payments, Feb. 10).
"We are pressing every button we can press to get everyone to call their congressman," said Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers. "The drop-dead deadline is Monday."
As of Friday, 59 legislators had signed on to the letter, authored by Reps. Tom Price, R-Ga.; Mike Ross, D-Ark.; Jo Ann Emerson, R-Mo.; and Heath Shuler, D-N.C. Crafted with the aid of the American Association for Homecare, the letter asks members of the powerful Ways and Means and Energy and Commerce committees, as well the top leaders in the House of Representatives, to urge CMS to provide appropriate payments for home oxygen throughout the period of the patient's medical need. A Senate letter is also being drafted.
"There's still time to call those offices," said Cara Bachenheimer, senior vice president of government relations for Invacare, Elyria, Ohio. While there is no "magic number" of signatures, Bachenheimer said, "the more the better."
Providers are looking for relief from the 36-month cap that went into effect Jan. 1, saying it is unworkable. Post-cap payment rules require providers to continue service to beneficiaries for an additional 24 months, including patients who move outside the provider's service area.
The cap and payment rules have worked a major hardship on Neal Hansen, owner of Hansen Homecare Specialty Services in Ketchikan, Alaska.
"We are in a situation where we have to travel so far," said Hansen, whose business is 600 miles away from Seattle and 600 miles from Anchorage. "We have to go to the outer islands. You can take a ferry over, but you have to wait a day to come back. It costs close to $900 a [round] trip. We try to do everything by mail and float plane."
But not everything can be handled that way. Hansen often travels to Prince of Wales Island or Annette Island to service oxygen patients there. With reimbursement being what it is, however, he's not sure how much longer he can continue to do that.
Reimbursement must go up, he said, "or we are out of business on the outer islands. To take that service away would be pathetic. It would be catastrophic for some people." No other oxygen provider serves the islands, Hansen said. "They all refer [patients] to me because I am the only one crazy enough to do it."
He and other oxygen providers are hopeful that Congress will provide some relief.
"My opinion is that Congress is looking for reform," said Joan Cross, co-owner of C&C Homecare in Bradenton, Fla. "They don't like what they are hearing. They are looking to reform oxygen."
Cross said she is encouraging her legislators to sign on to the letter, and she believes they will.
John Reed, COO of Pro2 Respiratory Services in Cincinnati, spoke to his representatives during an AAHomecare fly-in Feb. 11. He said he was encouraged by the reception the Ohio delegation got.
"We were there on the Hill the day of the stimulus package," he said, "so we saw that the timing was not going to benefit us. But we were amazed how much time they sat with us. I think we do have a group of people who are trying to balance the cost of care and do it in a way that is responsible."
Reed said his group spent a lot of time educating legislators. "They could all recite the prices of an Internet oxygen concentrator," he noted. "We tried to communicate very clearly [the realities of the business]" and detailed the current reimbursement model that doesn't pay for services.
"I think the message is working," he said. Two Ohio legislators signed on right away, and he is hopeful others will also support the Price-Ross letter.
In addition, stakeholders are working to reach consensus on long-term oxygen reform. Toward that end, earlier this month AAHomecare formed the New Oxygen Coalition, or NOC, after many state HME associations said they could not support an overhaul plan backed by AAHomecare and the Council for Quality Respiratory Care. After a meeting Feb. 11, the coalition is attempting to reach a clear consensus on a plan to present to Congress, but as of Friday, stakeholders remained divided.
"There is still a considerable movement of providers that feel some immediate relief must be obtained from whatever source we can [get it]," said NAIMES' Stanfield. "The vast majority feel that a repeal of the cap is the only solution to get things back to a level point where you can talk long-term reform."
Stanfield is among nine members of a NOC workgoup charged with ironing out the reform plan. Other members include AAHomecare Chairman Alan Landauer; Lisa Getson, executive vice president of Apria Healthcare; Chris Kane of Pacific Pulmonary; Joe Lewarski, vice president of Invacare's respiratory group; John Gallagher of VGM; Don Clayback of The MED Group; Montana provider Mike Calcaterra of the Big Sky Association of Medical Equipment Services; and provider Jason Rogers, president of the Georgia Association for Medical Equipment Services.
The AAHomecare/CQRC plan calls for the cap to be repealed and for oxygen to be removed from any competitive bidding project, but it also includes a case-mix adjusted payment system some independent providers don't like. Both Calcaterra and Rogers have presented alternative plans (see Oxygen Stakeholders Work toward Common Ground, HomeCare Monday, Feb. 9).
Bachenheimer noted the AAHomecare/CQRC plan and the other plans that have been floated have an "extraordinarily similar" framework.
"The devil's in the details," she said. "We just need to get everybody on the same page."
Read the Price-Ross sign-on letter in full.
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