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Opinion

Medicare Cuts Will Disproportionately Harm COPD Patients

Chronic Obstructive Pulmonary Disease (COPD) is a terrible, yet misunderstood condition that is highly common among Medicare beneficiaries.  Twelve percent of Medicare fee-for-service beneficiaries live with COPD, which is more than those fighting Alzheimer’s Disease (11 percent), cancer (8 percent), osteoporosis (7 percent), asthma (5 percent), and stroke (4 percent).   COPD is the third leading cause of death in the U.S., according to the Centers for Medicare & Medicaid Services (CMS).

To better understand the severity of COPD, I challenge you to complete an exercise my elderly medical school professor asked my classmates and I to do on our first day of class.  Living with COPD himself, he explained his disease so we could better understand, empathize with and treat our future COPD patients.

Take a deep breath.  Without exhaling, take another.  Without exhaling, take another.  Do that again.  It’s uncomfortable, frustrating and scary.  That’s how it feels every minute of every day for individuals living with COPD.  This isn’t just the case when they are experiencing difficulties, this is each and every day.

But there are effective care options. Home oxygen therapy services that are readily and affordably available for Medicare’s COPD patients can greatly improve quality of life while simultaneously reducing patients’ risk for adverse health events and related complications.  Home oxygen ensures that patients receive appropriate oxygen flow to the brain, improving functionality.

COPD can be effectively managed through oxygen therapy and sleep therapy to improve outcomes and reduce overall Medicare expenditures. The proper management of COPD in the home is critical to reducing emergency room (ER) visits and hospital readmissions.  Data show long-term use of oxygen therapy measurably reduces readmissions.

Despite all of these facts, the CMS has chosen to deeply reduce Medicare payments for the home oxygen services required to keep COPD patients healthy and out of the hospital and other costly facilities.  On January 1, CMS began applying the competitive bid rates used in urban areas to rural and other non-competitive bid areas.  This policy is being phased-in over only a 6-month period, taking full effect on July 1 and resulting in a 30-50 percent cut to home respiratory therapy. Additionally, another set of cuts of approximately 18 percent was just applied on July 1.

Across the healthcare world, we consistently hear about the Triple Aim – a widely supported policy goal that seeks to improve the patient experience of care, improve the health of populations and reduce the cost of health care. Home oxygen care is a vital tool to achieving these goals, however Medicare policies that reduce payment put patient access to oxygen supplies and services at risk, hindering the ability of oxygen suppliers and providers to effectively support the goals of the Triple Aim and manage a potentially deadly medical condition.

We know that COPD imposes a significant economic burden on the Medicare program, so why aren’t we investing more in oxygen services that are proven to reduce costs by preventing readmissions?  Considering20 percent of patients hospitalized with COPD exacerbations are readmitted to the hospital within 30 days, which costs an estimated $35 billion in annual COPD expenditures, it’s clear we need to do a better job managing COPD patients in the home.

This is particularly true among COPD patients living in rural America, who are more likely to receive a COPD diagnoses than their urban counterparts.  The competitive bidding rates fully applied by CMS on July 1 stand to have the greatest impact on individuals in rural areas whose oxygen delivery costs are higher and healthcare options are fewer.

To protect Medicare’s COPD patients – and others who rely on home-based respiratory care services – Congress should act quickly to pass the Patient Access to Durable Medical Equipment (PADME) Act.  By doing so, lawmakers and CMS can gather the sufficient information needed to determine if the application of further cuts will not – as CMS predicts – harm patient care.

As physicians – and health policy decision makers – it’s important for us to put ourselves in the place of our patients.  How will cuts to home oxygen potentially impact the care and lives of the estimated 24 million Americans living with COPD?  If we don’t ask ourselves these hard questions, and use credible data to support our conclusions, we risk harming the patients who need help the most.

Unfortunately, Congress failed to act before the July 1 cuts took effect, but it’s not too late. Congress must now come together to pass the PADME Act and halt dangerous cuts to home oxygen.

Michael Fleming, MD, FAAFP is a retired practicing family physician, and past president of the American Academy of Family Physicians.