A Necessary Challenge

The HME sector has embarked on a challenging campaign to reform the oxygen benefit, which will require perseverance on legislative, regulatory and lobbying fronts. But the advantages of reforming the Medicare home oxygen benefit will far outweigh the hardships of the effort, and it will provide long-term value for patients, providers, physicians and the health care system. Through this effort we will preserve the integrity of oxygen reimbursement by showing that it is more than an equipment-based benefit.

Our task is to marshal broad support in Congress to assure that oxygen reform is included in the health care reform bill. It will require the full participation and immediate action of the HME community due to the short congressional timeline for tackling a sweeping health care reform agenda.

The oxygen reform proposal, which received careful scrutiny by HME stakeholders, was overwhelmingly approved by the AAHomecare board of directors. This proposal will exempt oxygen from competitive bidding, eliminate the 36-month cap on oxygen payments and achieve recognition of the critical services oxygen providers furnish to patients.

The proposal will also build into the oxygen benefit a recognition of the services required for providing medical oxygen therapy in a beneficiary’s home. The end result will be a stable benefit that patients and providers can rely upon. But what specifically does this entail?

In addition to the goals outlined, the program will specifically define the services that home oxygen providers will be required to provide. This will improve the quality of care provided by creating a standard set of patient-centered services that Medicare beneficiaries and physicians can expect to receive while also protecting oxygen providers from the misperception that the benefit is simply equipment-based.

The reimbursement system will be revised, moving from an equipment-focused system to one that takes into account patient needs and is based primarily on patients’ ambulation requirements — as ambulation is the largest driver of costs.

The reform proposal will also allow for greater transparency through the establishment of a cost report developed in consultation with an advisory panel that will include home oxygen providers. These reports will allow oxygen providers to show the true costs of providing oxygen therapy. Currently, when Congress enacts mandatory requirements such as surety bonds or accreditation, these additional costs are never reflected in payment rates. But under this proposal, these and other costs can be accounted for under reform.

The association, working with a broad group of oxygen stakeholders, is now moving to the legislative phase of the effort. Legislation will be introduced allowing physicians, patient advocacy groups and the home care community to rally behind meaningful reform. Members of Congress with jurisdiction over Medicare have called for a health care bill by August. The HME sector must have its proposal in front of legislators by this time to be considered in the health care legislation.

However, it is critical that the HME sector work together during these initial stages to garner support among a large number of legislators in order to ensure the oxygen reform package will be placed in the health care reform bill.

This plan is crucial to eliminating the cycle of cuts we have been facing on an annual basis. The primary threat to the home oxygen benefit is the continued belief by policymakers that the oxygen benefit is overpaid and requires little, if any, service to meet patient and physician expectations. It is unlikely, despite our best efforts, that we will beable to dispel this thinking while remaining DMEPOS suppliers of oxygen.

As home oxygen providers, we will elevate oxygen providers to a new level by defining the services provided, committing to providing a core set of services and allowing for some form of cost transparency. Simply put, provider status will allow the federal government to formally recognize what it is paying for. Together we must take a stand for oxygen providers.

Read more AAHomecare Update columns.

Tyler J. Wilson is president and CEO of the American Association for Homecare, headquartered in Arlington, Va. You can reach him at [email protected]. For more information on critical home care issues, visit the association’s Web site at www.aahomecare.org.