WASHINGTON — In an eerie echo of the summer's frantic bid to derail competitive bidding, HME providers implored federal lawmakers late last week to sign onto a letter to CMS calling for a delay of the 36-month oxygen rental cap.
As of noon Friday, some 70 members of the House of Representatives had agreed to sign the letter, authored by Rep. Heath Shuler, D-N.C, and supported by Rep. Tom Price, R-Ga. In explaining the request to their colleagues, the congressmen said they feared the cap would "hurt the quality of care Medicare patients receive," and they urged CMS to delay the new oxygen payment rules "until Congress is able to legislatively reform the Medicare policy as it is necessary to the survival of the home medical equipment industry and the quality of care they provide to our nation's seniors."
In the letter sent to CMS, addressed to Acting Administrator Kerry Weems, the House members point out that under provisions of the cap, which takes effect Jan. 1, providers will be reimbursed for only one 30-minute routine maintenance visit every six months after the oxygen equipment has capped out. They will also be required to maintain and service the equipment for its "reasonable life" (generally five years under Medicare guidelines) even if the patient moves. As well, they will not be reimbursed for emergency calls or replacement items such as masks.
In their "Dear Colleague" letter, which they titled "Help Protect Home Oxygen Suppliers," Shuler and Price also noted the looming cap coincides with the 9.5 percent reimbursement cut for product categories in Round 1 of bidding, including oxygen. That cut is also set to go into effect Jan. 1.
"Home oxygen suppliers do more than just drop off equipment to a patient. Many suppliers, particularly smaller ones, have staff on call 24 hours a day to make home visits to repair equipment, drop off replacement supplies and ensure that patients are receiving the proper amount of oxygen," the letter reads. "Without adequate recognition of the services that home oxygen providers furnish, the quality of care that patients have come to expect will deteriorate, leading to an increase in the number of emergency room visits."
Cara Bachenheimer, senior vice president of government relations for Invacare, Elyria, Ohio, said the Shuler-Price letter raises the visibility of the industry's concerns about the oxygen cap.
"Members of Congress need to be educated about the incredible shortcomings of the new oxygen rule," she said. "That's really our top priority as an industry. People in Congress are already hearing that. And this does further the message."
The question, she said, is how to fix the problem permanently. "That's not an easy answer. In the short term — the next month or two or three — political pressure is the only way to make it happen," Bachenheimer said. However, she added, "There's not a piece of legislation that's going to be happening in the next three months [to tack the bill to]."
Bachenheimer said there are two possible fixes: an oxygen payment policy reform, which would be "patient-centric, related to patient needs" and is a long-term fix; and a legislative mandate, which would be a short-term fix.
Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers, said the industry must try everything it can to get the cap delayed.
"It's NAIMES' belief that every path should be followed," he said. "I think this is an important attempt to try and delay it. I certainly hope that [the letter] strikes a chord with someone in CMS who realizes that it is a problem."