Oxygen Reform Plan Moves Ahead with ‘Provider’ Change Intact

ARLINGTON, Va. — The American Association for Homecare
intends to put its reworked 15-point plan for oxygen reform before
Congress following a “yes” vote by its board, the association said
last week. But during a nationwide call Thursday, it was clear some
stakeholders are not so sure about the move.

“It’s been a long year for us trying to get through [an oxygen
reform plan] that everyone can endure and feel comfortable with,”
AAHomecare Chairman Alan Landauer told conference call listeners.
While there has been a “tremendous amount of compromise,” he
explained, “we obviously have not been successful in getting
everyone to agree on every point.”

Engineered by the New Oxygen Coalition after months of work, the
plan would exempt oxygen from competitive bidding, eliminate the
36-month oxygen cap and recognize 13 specific home oxygen
services.

“The idea is to get us out of a reactive position with respect
to proposed cuts in Congress,” said Tom Ryan of Farmingdale,
N.Y.-based Homecare Concepts and past
AAHomecare chair. “It’s important for us to rationalize the oxygen
benefit to get paid for the patient-centric services we provide and
not rely on the irrational cross-subsidies that the current benefit
supports.”

But the plan would also change status under Medicare’s oxygen
benefit from “supplier” to “provider,” a controversial step some
listeners said they are not prepared to take.

Callers posed a number of questions on the point to a panel of
AAHomecare members:

• Why is it more likely that CMS and elected officials would
  perceive more value for the oxygen benefit if we call ourselves
  “providers,” when so far they have refused to see the value of
  those services?
• Is it true that even as providers, Congress/CMS could cut the
  benefit and increase red tape that would have an effect similar to
  that seen with the oxygen cap and competitive bidding?
• Providers under Medicare are accredited by only three
  organizations, not 10 as for DMEPOS. If a company is a “supplier”
  and a “provider,” would they have to be accredited by one of the
  three?
• Would an oxygen provider have to obtain a separate NPI for
  oxygen therapy?
• Could providers still remain non-participating under the
  plan?

All good questions, panel members responded, but because the
reform plan has not yet been presented to members of Congress,
there are no guarantees on any of its provisions. In a document
supplied to call participants, however, the association addressed
the rationale of transitioning to provider status.

“The primary threat to the home oxygen benefit is the continued
belief by policymakers that the oxygen benefit is simply an
equipment-based benefit, which requires little if any service to
meet patient and physician expectations … We will not be able
to break out of this mindset in Washington if we do not seek
recognition as home oxygen providers, commit ourselves to provide a
core set of services and allow for some form of cost
transparency.

“Simply put, provider status will allow the federal government
to recognize what it is paying for,” the paper said.

Some hold a different view. The National Association of Independent
Medical Equipment Suppliers issued a statement on the plan,
noting, “We do not agree that a move to provider status is the only
path leading to meaningful reform, nor do we believe that such a
move will protect us from further cuts to reimbursement.” The
statement also said NAIMES believes including elimination of
competitive bidding in the plan “will result in an unacceptable cut
to payment if it is to remain budget-neutral.”

Various callers also wondered about other points in the plan,
which would classify patients in three categories and bundle
payments and services in the monthly allowable.

“I get nervous when we allow the government to determine our
cost structure,” commented one. “They have not been friendly to us
in the past.”

Asked another, “What if Congress doesn’t like the bundled
category system? How can the industry be assured once legislation
is passed into law there will not be any burdensome consequences
providers will be forced to abide by that would be a great burden
to small independent providers?”

Again good questions, the panelists said, but there simply are
no answers at this point. Once the plan is written into legislative
language and the hunt for supporters on Capitol Hill begins, many
of those answers should be cleared up as work progresses with
congressional staffers, association officials said.

That’s another rub, according to NAIMES. “While reform of oxygen
may be needed, there are too many unknowns and too many risks to
move this quickly on a plan that could result in dangerous
unintended consequences … There is no assurance that the bill
will end up as we proposed, or that it will reach the final vote as
it leaves committee,” the statement said. (Read the entire NAIMES statement.)

“A lot of things are unknown,” said Karyn Estrella, executive
director of the New
England Medical Equipment Dealers Association, on the call.
“That’s the fear across the states. We know reform involves risk
and we want reform. Whether we want it with 14 points or provider
status, we have questions.”

But while he has questions of his own, commented Tim Pederson,
CEO of WestMed Rehab in Rapid City, S.D., “moving ahead with
any plan is preferable to having no plan.”

“Right now this is just about getting a plan before Congress
that we hope will fly,” said AAHomeCare’s Mike Reinemer, vice
president, communications and policy, following the call. “The
danger is that if we don’t move ahead, we’re not part of the
solution to the perceived overpayment questions and the
equipment-only perception and the Internet pricing myth. If we
can’t counter that with a positive reform package, then we’re
sitting ducks for more cuts.”