Vladeck: Home Oxygen Is ‘Nothing but Air’

WASHINGTON — In comments that sparked a televised
rebuttal, a former HCFA administrator asserted last week on C-SPAN
that Congress has
thwarted every attempt to cut HME reimbursement and that home
oxygen is “nothing but air.”

“My former colleagues can tell you it used to drive me crazy
that Medicare pays about three times as much as the Veteran’s
Administration or some private insurance [companies] for machines
that provide people with home oxygen,” said Bruce Vladeck, who
headed the Health Care Financing Administration (CMS’ predecessor)
from 1993-97.

On the Aug. 27 edition of C-SPAN’s “Washington Journal,” Vladeck
said, “I used to run around the office muttering, ‘We are paying $3
billion a year for air,’ because that’s all it really is.”

Added Vladeck, “And yet every effort for the last 20-some years
to reduce Medicare payments for oxygen has run into a large
lobbying campaign from the supplier industry generally organized to
frighten beneficiaries to say, ‘If you let this go ahead, Congress
is literally going to cut off your air supply,’ and Congress has
stepped in to prevent reductions to oxygen payments every single
time.”

The former HCFA chief’s remarks drew a swift rebuttal from the
American
Association for Homecare‘s Michael Reinemer, vice president,
communications and policy, who responded in a blog and an email that was

read by the C-SPAN host on Friday’s edition of the show.

Reinemer, who called the oxygen comments “outrageous,” pointed
out that “Medicare pays for medical oxygen and oxygen devices, both
of which require prescriptions, as well as certain accompanying
services, which Mr. Vladeck chooses to ignore completely.

“The Food and Drug Administration, Department of Transportation,
Department of Homeland Security, local fire authorities and state
licensing boards are just a few of the groups that regulate or
provide oversight to the home oxygen sector,” he said.

Vladeck’s statement that oxygen rates have not been reduced “is
also, of course, patently false, since oxygen rates were cut in
1997, 2003, 2005 and 2008,” Reinemer told C-SPAN. “And the comment
that it’s only ‘air’ is an extremely cavalier and irresponsible
description of the medical oxygen and delivery devices required by
more than a million Medicare beneficiaries.”

Vladeck, now senior adviser to Nexera Consulting, a wholly
owned subsidiary of the Greater New York Hospital Association,
also charged that Congress, under both Republican and Democratic
presidents, has consistently prevented any attempt to “change the
system to eliminate those ridiculous overpayments.”

“This is patently false,” Reinemer said, noting that “Congress
has cut DME payments and changed the payment system in Medicare
numerous times since Vladeck left his job: in the Balanced Budget
Act of 1997, in the Medicare Modernization Act of 2003, in the
Deficit Reduction Act of 2005, and in the Medicare Improvements for
Patients and Providers Act of 2008.”

In separate on-air phone comments, Reinemer also told C-SPAN
viewers about the 9.5 percent reimbursement cut the industry took
to pay for the delay of competitive bidding and the less-than-1
percent growth rate in Medicare spending for HME.

Confronted with Reinemer’s rebuttal, Vladeck said Aug. 28 on the
C-SPAN program he guessed he “misspoke” about cuts to DME and
oxygen. He maintained, however, that “DME is still overpaid” and
that “even with all the ‘cuts,’ Medicare is still significantly
overpaying for in-home oxygen.”

At one point, Vladeck said that cuts made to HME had been
largely “cosmetic,” a charge that Reinemer found offensive.

“He kept talking about the cuts as if these weren’t real or
substantial,” Reinemer told HomeCare Monday. “These were
very substantial cuts and modifications to the whole program.”

Click
here to see the entire Aug. 27 “Washington Journal” segment (1
hr. 4 min.) including Vladeck’s comments. For AAHomecare’s rebuttal
(beginning at the 1:48 mark) on the Aug. 28 show, click
here.

As frustrating and upsetting as Vladeck’s comments were,
Reinemer said, they are even more disturbing because they are
symptomatic of what the HME sector is up against with CMS.

“There is this deep-seated misunderstanding and mistrust about
DME, and I think the roots go back many, many years, because the
farther back some of these people go, the more prejudiced they are
and the less familiar they seem with all of the laws that have been
enacted since,” said Reinemer. “For instance, since Vladeck left
office, you have more standards, accreditation, numerous cuts and,
moreover, we have really taken the lead in terms of finally getting
CMS to take control of fraud and abuse.”

Oxygen stakeholders are currently working on new language for
H.R. 3220, a bill introduced by Rep. Mike Ross, D-Ark., that would
overhaul Medicare’s oxygen benefit. The industry had divided over
various aspects of the bill, but came to a compromise agreement on
its provisions earlier this month. (See Oxygen Stakeholders
on Road to Unity, Aug. 24.)

Ross, a former HME owner, has told H.R. 3220 supporters he would
work to get an oxygen reform plan amended to the House Energy and
Commerce Committee’s health care reform bill. The committee passed
its bill before Congress’ summer recess but still has more than 50
amendments to consider when lawmakers return to Washington Sept.
8.

According to published reports, Energy and Commerce Chair Henry
Waxman, D-Calif., has agreed to consider Ross’ amendment but does
not support it.