ATLANTA — Working against a ticking health care reform clock, members of the New Oxygen Coalition put out a revised oxygen reform plan last week, but the HME sector is still divided over some of the plan's provisions, stakeholders said Friday.
While discussion on the plan continues, said Rose Schafhauser, executive director of the seven-state Midwest Association of Medical Equipment Services, "we're getting so close to our window of time that it's basically if you support it or don't support it."
The NOC is trying to work swiftly so the plan can be transformed into legislation that would ultimately become a part of the Obama administration's overhaul of the health care system. Time is at a premium as key legislators in both the House and the Senate have pledged a health reform package by August. According to Walt Gorski, vice president of government relations for the American Association for Homecare, the NOC wants to have a final document this week "so that we can start working with our champions on the Hill."
AAHomecare formed the oxygen coalition after stakeholders balked at an initial reform plan crafted with the aid of the Council for Quality Respiratory Care. Following weeks of work that began in February, the NOC's revised version was sent to state associations for feedback from their members and detailed for attendees at Medtrade Spring in Las Vegas last month. (For an outline of that plan and a listing of NOC members, see Industry Scrambles to Unite on Oxygen Reform, March 30.)
Since, the NOC has gotten input from state associations and further changes have been made, but state leaders said there are still three main sticking points:
- Cost reporting and how the results of a cost study would be used by various agencies, including CMS;
- Changing the status from "supplier" to "provider;" and
- Calling for the exemption of home oxygen from any competitive bidding project.
"The 'provider-supplier' is the most contentious issue," said Schafhauser. "The whole … industry would like to say we're not just suppliers, we're providers. The challenge is if you are a 'provider' in one area and just a 'supplier' in another."
"It's a significant issue," agreed Jason Rogers, president of the Georgia Association of Medical Equipment Services. "What they are saying is that we are going to pull oxygen from the DMEPOS supplier category and create a hybrid. It will just be home oxygen therapy 'providers,' and we will define what that means in the statutory language of this bill."
That could create problems for those who deal not only in oxygen but other DMEPOS, Rogers said. For example, as president of Care Medical in Athens, Ga., Rogers questioned whether he would have to have a DMEPOS supplier number and a home oxygen provider number, how claims would be processed since the DME MACs are currently contracted to process only "supplier" claims and whether he would have to be accredited as both a "DMEPOS supplier" and a "home oxygen provider."
"These are questions that might be resolved in a non-harmful way," Rogers said. "But there is not sufficient time to resolve these questions. If we accept this [plan], we would have to do so knowing that there is a range of questions we have no answers to."
Schafhauser, too, said some providers were leery of the plan's numerous unanswered questions. Just since January, the industry has seen implementation of the 36-month oxygen rental cap and a 9.5 percent cut across some DMEPOS product categories. Providers are fearful of more cuts and more mandates that might result from the process of Medicare oxygen reform.
"The challenge we have before us is the unknown," Schafhauser said. "There are no guarantees no matter what. There's no guarantee that if we just sit back and do nothing that we won't get hit again. And there's no guarantee that if we move forward, we're going to get what we want."
And if the industry does get what it wants, at what cost? Rogers said he fears the cost that could be levied against home oxygen providers to get the benefit eliminated from competitive bidding.
"I am concerned that our industry's future is being pegged on this," he said. "We absolutely have to see competitive bidding eliminated. But the question is if this oxygen reform bill that is in the budget-neutral framework is the right place to introduce legislation to eliminate competitive bidding [and if it can do so] without crippling our allowables."
Rogers said he favors two bills, one focusing on reforming the oxygen benefit and another on eliminating competitive bidding for all DMEPOS categories, including oxygen. The latter could be built on the devastating effects of competitive bidding for both patients and providers and it would not need to be budget-neutral, he said.
Gorski said he is hopeful the state associations will support the reform plan. He noted that it had been crafted by a broad spectrum of the industry's top thought-leaders and said the current plan is "the best document that we have been able to come up with.
"We have made extraordinary progress with the NOC," Gorski continued. "There have been significant compromises by all parties involved." But, he pointed out, agreement on the plan is only a first step.
"The HME community needs to recognize that this is not a done deal," Gorski said. "There have been significant discussions among the community, but we have to take it to the broader stakeholders, as well as to Capitol Hill."
The oxygen community "needs to lock arms" and show a unified front, he said.
"Ultimately, this plan is going to be a plan that helps the industry survive and provides for stability within the benefit over the long term," Gorski said. "We can't be in this environment where we don't know how to project revenues for the next year or have the prospect of not being able to provide a service because Medicare says you didn't win a bid."