Slow Down Medicare Cuts to Home Oxygen Therapy
By Dr. Julian Husbands
Senior Vice President, Clinical Programs, Apria Healthcare
Member, Health Policy & Innovation Committee, Council for Quality Respiratory Care
For those of us with the fortune of good health, the oxygen we breathe is easy to take for granted. It’s all around us, available when we’re asleep and when we’re awake. Simply take a breath and it’s there – travelling through our lungs, oxygenating our blood, and fueling every cell in our bodies.
But not everyone is so fortunate. For millions of Americans with conditions like Chronic Obstructive Pulmonary Disease (COPD) and sleep apnea, oxygen is a commodity that must be planned for, purchased, and administered with the assistance of professionals. When properly managed, good oxygen therapy allows patients to maintain their independence, quality of life, and even reduces costs to Medicare by keeping patients out of the hospital.
Something as fundamental as life-sustaining oxygen should never be in jeopardy. Yet, more than a million Medicare beneficiaries who depend on home oxygen and sleep therapies could find themselves on the losing end of a short-sighted new Congressional policy aimed at cutting costs.
Beginning in January of this year, Congress dramatically cut reimbursement for home oxygen services by applying competitive bid rates in geographic areas that were previously excluded from competitive bidding. Oxygen suppliers in these primarily rural parts of the country – where the costs of delivering services are already 13 percent higher – must now quickly try to adjust to funding shortfalls that are certain to complicate the lives of very vulnerable patients.
The changes have left service providers scrambling and physicians extremely fearful for their patients’ outcomes, to put it mildly. In contrast to the three to four years that Congress has traditionally provided to phase-in similar (and smaller) cuts, oxygen suppliers have a mere six months to figure out how to absorb their losses and stay in business.
No matter how we try to mitigate the effects, these cuts will ultimately affect vulnerable patients. Already, some providers of home oxygen therapy have started planning for how to stay operational in the face of such drastic shortfalls, which could result in the elimination of many of the critical services upon which our patients have come to depend.
The future of oxygen therapy will likely be one in which there are simply not enough resources to coordinate with hospital discharge planners so that tanks and equipment are available when a patient arrives home after a hospitalization. Access to respiratory therapists, who ensure proper administration of therapies, will be further curtailed. Patients who are accustomed to receiving their supply of oxygen on a set schedule may themselves have to remember to request delivery – which could lead to disaster if overlooked.
Furthermore, our frail patients who live in rural areas – or in areas outside of a provider’s new, restricted delivery area – might no longer receive home delivery of their oxygen or other equipment. Instead, these sick and elderly patients – who often struggle just to breathe – will be forced to find a way to drive distances to a supplier and haul their own supplies back home.
For something as vital as oxygen therapy, it is terrifyingly short sighted – and potentially devastating – to implement such a sweeping reimbursement cut in such a short amount of time. Lawmakers and providers need more than six months to assess the real-life impacts of these cuts and the effects they are certain to have on patient access and care quality.
To ease this burden, Senators John Thune (R-SD) and Heidi Heitkamp (D-ND) have introduced S. 2736, a bill to improve access to durable medical equipment, including home respiratory therapies. The bill would appropriately provide for a longer phase-in so that policymakers and providers can adequately assess the impact of the cut. Their bill would extend the phase-in an additional 15-months and require CMS to publicly report what it finds as it monitors access during the phase-in period.
Our lawmakers should, without hesitation, make necessary changes to allow for a longer phase-in of oxygen therapy cuts. We must ensure the safety of some of Medicare’s most vulnerable patients – those for whom oxygen is something that can never be taken for granted.
Dr. Julian Husbands is senior vice president of clinical programs at Apria Healthcare and a member of the Council for Quality Respiratory Care. The CQRC is a coalition of the nation’s seven leading home oxygen therapy provider and manufacturing companies.