ATLANTA — The rift within the industry over how to reform the oxygen benefit is confusing congressional supporters, and stakeholders must somehow unite in their message before it is too late, HME leaders warned Friday.
"The stakes couldn't be any higher, and the state of disunity in the industry couldn't be any worse," said John Shirvinsky, executive director of the Pennsylvania Association of Medical Equipment Suppliers. "Unless we can pull our act together and find a way to stop dividing up the limited resources we have as a very small industry, we are going to be in trouble."
"It is quite unfortunate that our industry is so seemingly fractured on the issue of how to reform the way Medicare pays for home oxygen therapy," said Cara Bachenheimer, senior vice president of government relations for Elyria, Ohio-based Invacare. "In actuality, when you examine the details, the various groups are not that far apart. We are hopeful that the oxygen community can continue to dialogue and work together to achieve 100-percent consensus.
"In the meantime," she added, "there is no question that promoting different messages on Capitol Hill hurts us — it makes those who are inclined to be helpful to be less so."
At issue is the Medicare Home Oxygen Therapy Act of 2009 (H.R. 3220), introduced last month by Rep. Mike Ross, D-Ark., with cosponsor Kendrick Meek, D-Fla. The bill, crafted with the aid of the American Association for Homecare, calls for sweeping changes in Medicare's oxygen benefit: eliminating the 36-month oxygen cap, removing oxygen from competitive bidding, taking oxygen out of the DMEPOS benefit, moving from "supplier" to "provider" status and recognizing the services that go with providing home oxygen. The bill would also require cost-reporting.
As of Friday, the bill had gained no additional cosponsors, although more than 60 legislators had signed a "Dear Colleague" letter that preceded its introduction.
An earlier measure, the Home Oxygen Patient Protection (HOPP) Act (H.R. 2373), introduced in May by Reps. Tom Price, R-Ga., and Heath Shuler, D-N.C., has generated 76 cosponsors. That bill would simply repeal the oxygen rental cap.
The goal is to attach either bill to the health care reform package. The House and the Senate are hammering out their versions of a plan, and votes are expected after legislators return following Congress' August recess.
In recent weeks, however, legislators have heard from members of some state associations calling on them to withhold support of the Ross bill. The National Association of Independent Medical Equipment Suppliers and the Committee to Save Independent HME Suppliers also oppose the bill and told Ross so in a July 13 letter, detailing objections to the provider status change and cost-reporting measures.
On July 22, five clinical and patient groups — the American College of Chest Physicians, the American Lung Association, the American Thoracic Society, the National Association for Medical Direction of Respiratory Care and the National Home Oxygen Patients Association — also sent a letter to Ross and other legislators saying they could not support H.R. 3220.
"The opponents are unanimous in their opposition for the provider status, as well as opposing the related cost-reporting issues and the removal of oxygen from competitive bidding through this bill," according to NAIMES President Wayne Stanfield, who said competitive bidding should be addressed in a separate bill or providers will not be able to bear the "pay-for" cost demanded in a budget-neutral environment.
NAIMES and CSI:HME have presented their own oxygen reform proposal to some congressional committees, including the Senate Finance Committee, which is still working on its health reform draft. Called the Home Oxygen Therapy Service, or HOTS plan, Stanfield has described the proposal as a "simplified" version of oxygen reform that includes some elements of the Ross bill but leaves out the provider status and cost-reporting.
Providers, still reeling from effects of the Jan. 1 oxygen cap and the 9.5 percent reimbursement cut, are also fearful of even more cuts, others said.
Karyn Estrella, executive director of the New England Medical Equipment Dealers, said providers want to know what the price tag would be for oxygen reform.
"Bottom line, what would reimbursement look like? Now we are at a point where a bill has been introduced and it has been challenging for those associations — and NEMED is one of them — that have questions that haven't been answered yet," she said.
Providers recognize that any final reimbursement figure would likely be established by CMS, she said, but they would still like a ball park figure.
"It's tough to take a leap of faith, especially with CMS," said Estrella. "CMS has not indicated that they are our friend and are willing to work with us. If we had that kind of relationship, I think we would take that leap of faith and say, 'We can work out those details later.'"
Cap Is 'Devastating'
According to Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services, "The major concern about this whole process is that we are biting off more than we can chew at this time.
"Everybody agrees oxygen reform has to happen, but the No. 1 priority is to eliminate the cap. We're hearing from everybody that the cap has been devastating, not only for providers but for their patients. They have example after example of people they can't serve."
Michael McDonald, president of Clinical 1 Home Medical in Weymouth, Mass., and immediate past president of NEMED, is one of those providers. One of his patients, a woman who had been with his company for five years, was admitted to Massachusetts General and learned she had only a few months to live. The hospital called Clinical 1 and said she wanted to go to another state to live out the rest of her life. Could Clinical 1 arrange for her oxygen there?
McDonald explained to the caseworker that it might be difficult. The woman had capped out, she needed a lot care and she was moving to a very rural area.
He called seven providers. "The nearest company I was able to contact was about a two-hour drive away," McDonald said.
"I couldn't find anyone to service her," McDonald said. He called the caseworker back with the news. The patient stayed in the hospital an extra day and McDonald hit on a solution, sort of. He arranged to overnight her concentrator — at an expense of $118 — to her new address, called to verify it had been received, and that was the best he could do.
"I haven't heard any more," he said.
McDonald is frustrated and angry about the oxygen situation and what it is doing to patients, he said. "It's a nightmare. I don't understand it. I can't believe it has happened. I can't believe that Congress isn't hearing the outcry from the public."
Something has to be done, he acknowledged, but he is wary of the Ross bill. "The only problem about that is that I hear there will be an extra cut to oxygen down to $120 a month. That's unsustainable. We can't do it," he said.
Shirvinsky, whose association supports H.R. 3220, said there was no basis for that or any other figure. "You could calculate it any way you want, between zero dollars and the moon," he said.
What is really critical, he emphasized, is getting to common ground on oxygen reform. "Our organization has already thrown the provider status on the funeral pyre," he said. "We have always liked the idea of being a provider, but that's not nearly as important as getting the cap lifted and the benefit reformed."
Schafhauser also champions moving toward consensus, but with so many different options floating around, she is asking the members of her seven-state association to chime in with their opinions.
"We don't have a lot of time, and everybody knows that," she said. "We have to figure out a way to basically come up with a consensus. There is so much splintering, and that damages all of us going forward."
Rob Brant, president of the Accredited Medical Equipment Providers of America, agreed.
"It's shortsighted and simply wrong to encourage providers to waste energy speaking to legislators in any negative form about our industry," he said. "It's so difficult to get any legislation introduced at all having to do with our industry."
While the Ross bill might not be perfect in some stakeholders' eyes, Shirvinsky said, it would give the oxygen sector something it has never had: stability. And that, he said, is something worth supporting.
If the industry does not unite now, he believes, it could be disastrous. "If the Ross-Meek proposal isn't included in heath reform, I think it is highly unlikely that anything will happen [on oxygen reform]," he said.
"Time is definitely running out," he added. "There are a lot of people in Congress who are disgusted that our industry is cannibalizing itself."
