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.”
