Raising the Noise Level

As we move into mid-summer, the committees of jurisdiction on Capitol Hill are beginning the process of putting together their proposed legislative packages of Medicare policy and payment changes. This is the initial step in the process that could result in a final Medicare package that Congress passes into law before the end of the calendar year.

This year’s Medicare package is driven largely by Congress’ desire to change, or “fix,” the Medicare payment formula for physician services to avoid an approximate 10 percent cut in physician payments in January 2008. Since Congress agreed early this year on “pay-go” rules, meaning that any piece of legislation that costs money must at the same time contain provisions to pay for those costs, other Medicare provider and payment cuts are also on the table.

As House Ways and Means Committee, Subcommittee on Health Chairman Pete Stark, D-Calif., has said, no Medicare provider or payer should consider themselves “off the list” of potential cuts. That means that DME and oxygen are potentially on the list. How do we ensure that oxygen and DME payment cuts get off the list?

While national associations and coalitions such as the American Association for Homecare and the Council for Quality Respiratory Care are conducting vigorous lobbying efforts at both the national and local levels, the activity needs to broaden to include all providers with the same message.

Quite literally, every single home oxygen and DME provider across the country has a big stake in this issue. We need to collectively raise the noise level so that all members of Congress become familiar with our issues and understand they each have a personal stake in making sure our industry is “off the table” and avoids further cuts to the home oxygen and DME benefits.

Last September, the Office of Inspector General issued a report that examined the acquisition cost of a home oxygen concentrator. That narrow analysis has ballooned to a simple sound bite on Capitol Hill: Medicare pays $200 a month for an item that costs $800. The real story, as you well know, is far more complicated. Our challenge is to relay our story effectively in short and simple sound bites so that Congress understands that providing home oxygen therapy to Medicare beneficiaries is far more complex than the OIG sound bite. The story we have to tell is compelling:

• Home oxygen therapy is cost-effective. For about $7 a day, home oxygen providers take care of approximately one million Medicare beneficiaries with chronic respiratory diseases. In contrast, one visit to the emergency room (with an overnight stay) for a patient with chronic obstructive pulmonary disease will cost the Medicare program about $4,000.
• Home oxygen therapy is the only available therapy proven to prolong and improve the quality of life of those who suffer from chronic lung diseases such as COPD and emphysema.
• The Morrison Informatics Study issued last year demonstrated that equipment acquisition cost is only 28 percent of a provider’s total costs of providing home oxygen therapy.
• In the last 10 years, home oxygen provider payments have been cut almost 50 percent.
• In the next two years, oxygen payments are scheduled for further reductions: 10-20 percent in 2008 as a result of competitive bidding and an additional 22 percent in 2009 as the Deficit Reduction Act’s 36-month payment cap goes into effect.
• The American Lung Association in January 2006 wrote every member of Congress expressing serious concern about the payment cap and ownership transfer mandate of the DRA. The ALA cited many problematic issues that will arise after ownership transfers: What happens with beneficiaries with changing medical conditions? What maintenance and service will Medicare pay for? What happens if equipment fails?

Wrap these thoughts into a letter today to your senators and representatives. Make sure you describe fully your company, the various services it provides, how many consumers you serve, your geographic reach and the impact that cuts to home oxygen and DME benefits would have on your company and its ability to serve your patients.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at [email protected].