Fix Medicare Policies Harming Rural Respiratory Patients

For all the idyllic scenery and open air of rural America, residents of less-populated parts of the country face shocking disparities in health care. A report from the Centers for Disease Control and Prevention shows that Americans who live in rural areas are much more likely to die from common, chronic maladies like cancer and heart disease than their urban counterparts.

Among the report’s starkest findings was the fact that roughly 71,000 rural deaths, including 11,000 alone due to chronic lower respiratory diseases, were potentially preventable. This dangerous disparity in quality of life between rural and urban Americans should not exist. Moreover, recent polls from the Harvard T.H. Chan School of Public Health and Robert Wood Johnson Foundation show that a quarter of rural Americans have been unable to access necessary health care, even though nearly 90 percent have health insurance.

To help patients with serious respiratory illnesses get the care they deserve, it is critical that the Department of Health and Human Services addresses the structural and financial barriers that make it harder for rural Americans to receive their doctor-prescribed home oxygen therapy. 

Home oxygen supplies and equipment are absolutely critical for a growing number of patients to live. Chronic obstructive pulmonary disease, the third-leading cause of death in the United States, affects an estimated 15 million Americans, including 12 percent of Medicare’s rapidly rising population.

Sadly, COPD is not a curable condition. Instead, oxygen is the only treatment that can extend a patient’s life — making it a vital necessity for millions of Americans, many of who prefer to be treated in the comfort and privacy of their own homes. Home oxygen makes it possible for these vulnerable patients, particularly in rural areas, to maintain their independence and remain close to loved ones, instead of undergoing care for their chronic conditions in institutional settings far from home.

Under current Centers for Medicare and Medicaid Services rules, the rural rates for home oxygen supplies and equipment are inadequate to meet the higher costs of care for treating patients in rural areas. A 2015 study carried out by the Council on Quality Respiratory Care found that costs in rural areas (which are not subject to the competitive bidding program) are 11 percent higher on average than costs in competitive bidding areas. In addition, super rural ZIP codes located in rural counties that are among the lowest 25 percent of all rural counties by population density exhibit 17 percent higher prices, on average, than competitive bidding area rates.

The higher costs in rural areas are exacerbated by the distance between suppliers’ locations and beneficiaries’ homes, the need for higher staffing levels, and fewer beneficiaries to spread fixed costs. Though CMS previously extended the blended rate (blend of 50 percent of the adjusted fee schedule amounts and 50 percent of the unadjusted fee schedule amounts) for rural and remote non-competitive bidding areas, the reimbursement rate is still below the cost of care — creating significant strain on suppliers, 47 percent of which were forced to close between 2013 and 2017 alone. More must be done to ensure rural Americans have access to life-saving home oxygen supplies and that equipment is not undercut.

As Medicare begins to consider bids for Round 2021 of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program, it is critical that the agency gets rural rates right so Americans with serious respiratory diseases can continue getting the home oxygen they need to live. As CMS implements the new methodology, it is important that it addresses the policies that apply the CBP rates to rural areas and ensure that the rural add-on leads to a rate that will protect access to services and stabilize the market, so that more providers are not forced to shut down.

Since the only way to keep Americans with COPD alive is by providing affordable, accessible oxygen supplies and equipment, Medicare must pay special attention to how reimbursement rates will impact such a vulnerable population.


Crispin Teufel is the chief executive officer of Lincare Inc., a member of the Council for Quality Respiratory Care.

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