Ryan: ‘Don’t Make It Harder for Americans to Breathe’

WASHINGTON–Getting members of Congress to sign on to the Home
Oxygen Patient Protection Act was one of the main “asks” HME
stakeholders took to Capitol Hill at a legislative fly-in sponsored
by the American Association for Homecare last week.

“Don’t make it harder for Americans to breathe,” association
Chairman Tom Ryan, president and CEO of Homecare Concepts,
Farmingdale, N.Y., urged 150 providers and others participating in
Tuesday’s lobbying day to tell their congressmen. “We’ve got to get
more people behind H.R. 5513. Patients should not be forced into
[equipment] ownership.”

The bill, introduced by Reps. Joe Schwarz, R-Mich., and Tom
Price, R-Ga.–both physicians–would repeal the 36-month cap on
Medicare oxygen reimbursement enacted under the Deficit Reduction
Act, which passed in late 2005 (see HomeCare
Monday, June 5). Inserted in the DRA as a money-saving
effort by California Rep. Bill Thomas–considered an industry
nemesis by many for his role in pushing through the DME competitive
bidding mandate in the Medicare Modernization Act–the DRA
provision also transfers equipment title to the beneficiary when
the cap kicks in.

In addition, President Bush’s proposed 2007 budget includes a
provision that would shorten the rental period to 13 months, for an
estimated $6.6 billion savings over five years.

Approximately a million Medicare beneficiaries now receive
oxygen therapy, and 15 million more Americans have been diagnosed
with chronic obstructive pulmonary disease (COPD), a progressive,
fatal illness requiring long-term oxygen therapy. It’s the
fourth-leading cause of death in the U.S.

But according to a survey of oxygen providers commissioned by
AAHomecare and set for release Tuesday, only 28 percent of the cost
of serving oxygen patients can be attributed to the actual
equipment, while 72 percent is related to the cost of services and
operations such as delivery, maintenance, patient assessment and
education, 24-hour on-call support, regulatory compliance and other
expenses.

While the change in oxygen policy makes “rent-to-purchase” sound
like a good thing for beneficiaries, Ryan said, “it’s forced
ownership.” What’s more, the policy change could result in a number
of patient safety issues and increased hospitalizations for oxygen
patients who don’t–or can’t–maintain their equipment. According
to association figures, the average annual cost for home oxygen
therapy is $2,784, or $7.62 a day, versus an average $4,600 cost
for a one-day stay in the hospital.

“I can’t imagine where the concept came from that older
people–people who have difficult times with just taking care of
themselves–would be required to take care of oxygen equipment,
would be required to own it and would be required to somehow find a
way to pay for maintaining it,” said Schwarz. “I can’t believe that
someone would put that in federal legislation.”

An ear, nose and throat surgeon, Schwarz said that oxygen is a
highly regulated drug and that Congress never “considered the
clinical dimensions of this issue.” Because the DRA provision
“bothered me a great deal,” he said, he and eight other physicians
in the House decided “the only thing we could do would be to
introduce legislation that deletes the language.

“We’re going to get this bill through. It makes imminent good
sense,” Schwarz continued. If the bill doesn’t move in this session
of Congress, he said, “then I’m going to introduce it on Day One of
the 110th [Congress]. This is just one of those little pieces of
good government that has to happen.”

The bill has 18 co-sponsors so far.

Other issues home care advocates took to federal legislators in
250 Hill meetings included:
–softening effects of the MMA’s competitive bidding mandate
through support of H.R. 3559, known as the Hobson-Tanner bill. With
119 cosponsors in the House, AAHomecare, VGM, The Med Group, state
associations and others are now working to get a companion bill
introduced in the Senate.
–preserving the Medicare home health inflation update.
–urging CMS to consider alternatives to gap-filling, the method
currently used to set prices for new HCPCS codes. If the method is
used to develop fee schedules for CMS’ 64 new power mobility codes,
AAHomecare warned that Medicare payments for power wheelchairs
could decrease by as much as 25 to 30 percent.

All of these issues are about “older Americans getting the home
care they need,” Ryan concluded. “This is about quality of care to
help people live with dignity and a quality of life.”

Friday is the last day to submit comments on CMS’ Notice of
Proposed Rulemaking on DME competitive bidding. CMS said it
will read and consider all comments. To get the agency’s attention,
industry advocates recommend making sure your criticism is
specific, and providing constructive recommendations to CMS to
improve the program. To view the proposed rule,
click here. Summaries of the rule are available at www.vgm.com and www.aahomecare.org. To submit
comments, visit www.cms.hhs.gov/eRulemaking.