Battle over Oxygen Continues; Providers Grapple with Unexpected CPI-U Cut

ATLANTA — With Congress adjourned for its summer break,
the national battle over health care reform moves to home
districts, giving HME providers a few more weeks to work on
industry issues before legislators return to Washington Sept.
8.

Among items on the industry’s hit list for lawmakers:

• Putting an end to competitive bidding;
• Keeping elimination of the first-month purchase option for
  standard power wheelchairs out of the Senate Finance
  Committee’s health reform proposal. That committee has not
  yet finalized its bill, but a provision in the House version kills
  the option for standards PWCs;
• Getting rid of the 36-month oxygen cap; and
• No more cuts to oxygen.

Those last two points have mushroomed into a battle of their own
as stakeholders argue over H.R. 3220, a bill offered up by Rep.
Mike Ross, D-Ark., that would reform Medicare’s oxygen
benefit. Opponents say the measure is too complicated to pass, too
burdensome for small providers and perhaps too much to tackle right
now; supporters say it’s the only way the industry will ever
break the cycle of year-after-year cuts to the oxygen benefit.

Although most agree the 36-month cap must end, views on the
matter of oxygen reform sharpened last week in back-and-forth
messages from the American Association for Homecare, which backs
the Ross bill, and the National Association of Independent Medical
Equipment Suppliers, which does not.

Amid calls for industry unity, a planned mid-August meeting
could bring together representatives from both sides to try to
reach some consensus. But the messages from AAHomecare and NAIMES
pointed out their differences.

In an Aug. 4 “editorial comment,” NAIMES President
Wayne Stanfield wrote: “I [agree] that the DME industry must
‘unite,’ but it is debatable as to who is keeping the
sides apart. According to an informal count of suppliers opposing
the Ross bill or advancing it as an amendment, it is clear that
those opposing are in the majority. The question then becomes if
the majority oppose the bill, when will its supporters accept the
fact that they need to reach across the divide to unite. Anyone who
cares to go back over the chronology of the past 7 months can
clearly see how this chasm developed and why small suppliers are
untrusting of the supporters of the HR 3220. At last count the
state associations representing 22 states were opposed to the bill
in its current form.

“It is also debatable whether the Ross bill is the right
path and that the oxygen industry will be in trouble if we don’t
unite behind it. The real trouble is that the 36-month cap is
harming patients and forcing suppliers out of business NOW. We must
end the cap but a large majority of suppliers do not see the Ross
bill as right plan to do that.”

On Aug. 7, under the signatures of seven providers and four
state associations, AAHomecare sent out “An Open Letter to
Oxygen Providers” that stated: “Oxygen providers are in
a battle for survival. The only course of action that will address
both the immediate problems associated with the 36-month cap and
ensure longer term stability of the oxygen benefit is through
legislation in Congress that will reform the Medicare oxygen
program. … While H.R. 3220 will undoubtedly need modification
and certainly be revised during House and Senate negotiations, the
Ross legislative vehicle is the best opportunity for the oxygen
community to get its concerns addressed in this session of
Congress. Congressman Ross has committed to getting his bill
introduced as an amendment to a health care reform bill, and he
will work with us to make changes as health reform moves through
the legislative process.

“Those in the oxygen community who have complaints about
provisions in the Ross bill can point to no other viable
legislative option at this juncture for protecting the oxygen
benefit. We think the best course of action is to work within the
oxygen community to improve the Ross proposal rather than to kill
the entire initiative and hope that something better will surface
in the coming months. Without a viable reform proposal in the
pipeline, oxygen providers face the more likely prospect of further
unmitigated cuts to the benefit when the Senate and House reconvene
in September.”

Add Another Cut to the List

In the meantime, stakeholders have another unexpected cut to
fend off.

Late on July 30, the House Energy and Commerce Committee
approved an amendment to its health reform bill calling for a 0.5
percent cut to the consumer price index-urban (CPI-U) update for
DME from 2010 through 2013. In other words, whatever the CPI-U
updates are slated to be for home medical equipment in those years,
the provision would reduce those updates by one-half of one
percent.

According to AAHomecare, the cut was proposed by Reps. Doris
Matsui, D-Calif., and Gene Green, D-Texas, to pay for Medicare
changes related to adult day health services for seniors and
prompt-pay discounts for drugs and biologicals.

While the association said it does not object to the policy aims
of the Matsui-Green amendment, it strongly opposes using an HME cut
to pay for the amendment. AAHomecare said it will work to get the
cut stripped from the larger House Energy and Commerce health
reform bill.

Lawmakers on the committee will continue work on their bill over
the August recess to deal with more than 50 amendments that still
must be considered, including addition of the Ross bill.