Firing from All Cannons

In the December 2005 issue of HomeCare, AAHomecare reiterated its call to rally around the home oxygen patient community, which is made up of nearly one million Medicare beneficiaries.

Later in December, the very controversial budget reconciliation bill, known as the Deficit Reduction Act of 2005 (S. 1932), narrowly passed in the Senate after a tie-breaking vote by Vice President Dick Cheney. At this writing, the bill is scheduled to be returned to the House for a final vote in early February.

An alarming and completely unexpected provision in the bill is a new rent-to-purchase payment policy for home oxygen. After a maximum 36-month rental period, all stationary and portable home oxygen equipment would be considered “purchased,” and the title of the equipment and responsibilities for its maintenance, service and repair would be transferred to the beneficiary.

This would be a drastic, unprecedented and inappropriate shift of oxygen equipment from the Medicare “frequent and substantial service” category to a “rent-to-own” payment model.

The potentially harmful oxygen capped-rental provisions in the bill have given home care a new battle to fight, with an added focus on vulnerable oxygen patients. The bill has been publicly opposed by industry stakeholders, as well as numerous professional clinical and patient advocacy organizations, because it is simply bad health care policy.

In November 2005, AAHomecare commissioned Morrison Informatics to gather significant data on long-term oxygen therapy patients. With a series of studies, Morrison aims to reach an estimate of the financial burden facing Medicare beneficiaries as a result of the capped rental of oxygen equipment.

This includes quantifying individual Medicare beneficiary repair cost estimates, the overall Medicare beneficiary financial burden, equipment replacement and purchase option proportions, and the services and overhead costs involved in home oxygen provision. Medicare does not reimburse home oxygen providers for equipment alone — there is tremendous patient value in the delivery of oxygen therapy. It is important for regulatory and legislative bodies to remember that medical oxygen is a therapy ordered by a physician.

In January 2006, to further advance the understanding of this policy, AAHomecare’s Medical Gases Committee presented concerns to the U.S. Food and Drug Administration that the transfer of ownership of oxygen equipment to patients after 36 months could endanger patient and public safety and present the FDA with many compliance oversight challenges.

Medical oxygen is a drug that is currently regulated by the FDA and prescribed by a physician specifically for individual patient use. With transfer of ownership of the medical device to the patient, the control over the dosage levels becomes the patient’s responsibility, and the opportunity for self-medication to his or her own detriment is increased significantly.

The oxygen capped-rental provisions in the budget bill, as they stand at press time, raise a number of questions:

• What is the home care provider’s role to the beneficiary when the title of oxygen equipment is transferred to him or her?
• Who will take care of these patients, many of whom are frail and elderly?
• Who will service their equipment in the middle of the night?
• What will become of the equipment when it is no longer needed by the beneficiary? What if there is no scheduled maintenance? While oxygen has many therapeutic benefits, it can be dangerous if not properly administered, used or discarded.

According to the language of the bill, many of these questions would be left to be determined by Department of Health and Human Services Secretary Mike Leavitt. But when will these questions be addressed, and what will home oxygen patients and providers do in the interim?

AAHomecare emphasizes that all of these issues must be resolved for the benefit of the patient. Regardless of the outcome of the budget bill, we must fight on all fronts to protect patients in need of oxygen therapy.

Kay Cox is president and CEO of the American Association for Homecare, Alexandria, Va. For more information about AAHomecare, visit www.aahomecare.org, or call 703/836-6263.