Letter to Delay Oxygen Cap Gains Scores of Signatures

WASHINGTON — In an eerie echo of the summer’s frantic bid
to derail competitive bidding, HME providers implored federal
lawmakers late last week to sign onto a letter to CMS calling for a
delay of the 36-month oxygen rental cap.

As of noon Friday, some 70 members of the House of
Representatives had agreed to sign the letter, authored by Rep.
Heath Shuler, D-N.C, and supported by Rep. Tom Price, R-Ga. In
explaining the request to their colleagues, the congressmen said
they feared the cap would “hurt the quality of care Medicare
patients receive,” and they urged CMS to delay the new oxygen payment rules
“until Congress is able to legislatively reform the Medicare policy
as it is necessary to the survival of the home medical equipment
industry and the quality of care they provide to our nation’s
seniors.”

In the letter sent to CMS, addressed to Acting Administrator
Kerry Weems, the House members point out that under provisions of
the cap, which takes effect Jan. 1, providers will be reimbursed
for only one 30-minute routine maintenance visit every six months
after the oxygen equipment has capped out. They will also be
required to maintain and service the equipment for its “reasonable
life” (generally five years under Medicare guidelines) even if the
patient moves. As well, they will not be reimbursed for emergency
calls or replacement items such as masks.

In their “Dear Colleague” letter, which they titled “Help
Protect Home Oxygen Suppliers,” Shuler and Price also noted the
looming cap coincides with the 9.5 percent reimbursement cut for
product categories in Round 1 of bidding, including oxygen. That
cut is also set to go into effect Jan. 1.

“Home oxygen suppliers do more than just drop off equipment to a
patient. Many suppliers, particularly smaller ones, have staff on
call 24 hours a day to make home visits to repair equipment, drop
off replacement supplies and ensure that patients are receiving the
proper amount of oxygen,” the letter reads. “Without adequate
recognition of the services that home oxygen providers furnish, the
quality of care that patients have come to expect will deteriorate,
leading to an increase in the number of emergency room visits.”

Cara Bachenheimer, senior vice president of government relations
for Invacare, Elyria, Ohio, said the Shuler-Price letter
raises the visibility of the industry’s concerns about the oxygen
cap.

“Members of Congress need to be educated about the incredible
shortcomings of the new oxygen rule,” she said. “That’s really our
top priority as an industry. People in Congress are already hearing
that. And this does further the message.”

The question, she said, is how to fix the problem permanently.
“That’s not an easy answer. In the short term — the next
month or two or three — political pressure is the only way to
make it happen,” Bachenheimer said. However, she added, “There’s
not a piece of legislation that’s going to be happening in the next
three months [to tack the bill to].”

Bachenheimer said there are two possible fixes: an oxygen
payment policy reform, which would be “patient-centric, related to
patient needs” and is a long-term fix; and a legislative mandate,
which would be a short-term fix.

Wayne Stanfield, president and CEO of the National Association of
Independent Medical Equipment Suppliers, said the industry must
try everything it can to get the cap delayed.

“It’s NAIMES’ belief that every path should be followed,” he
said. “I think this is an important attempt to try and delay it. I
certainly hope that [the letter] strikes a chord with someone in
CMS who realizes that it is a problem.”