What will happen when a patient movesout of the provider’s service area in month 33? Which provider would take on that patient for 3 months of payment beforelosing its inventory?

For years we have preached the need to ensure that consumers are at the heart of our industry’s lobbying efforts. Congress’ recent changes to home oxygen payment have set the stage for the industry to follow this course.

The Deficit Reduction Omnibus Reconciliation Act of 2005 includes a provision that will have dramatic negative impacts on beneficiaries who are long-term users of supplemental oxygen therapy. After a 36-month rental period, all home stationary and portable oxygen technologies will be considered “purchased,” and the title of the equipment, along with most of the responsibilities for maintenance, service, and repair, will be transferred to the Medicare beneficiary. This provision virtually eliminates the home oxygen benefit after a 36-month period of medical need. If there ever was a policy change that could impact consumers’ lives, this is it.

This policy change means that elderly and medically fragile patients become wholly responsible for the management of their oxygen equipment and therapy. This is a drastic, unprecedented, inappropriate, and unrealistic shifting of the burden of maintaining oxygen equipment from providers to patients.

As we know, oxygen is a Federal legend drug, and oxygen devices are dispensed by prescription only. The oxygen technologies used to produce and/or deliver the drug are technical components associated with the overall provision of home oxygen therapy. Transferring the burden of maintenance and repair of sophisticated oxygen technology to the patient—and therefore the total management of their home oxygen therapy regimen—presents a serious risk to patient safety and care. This will clearly produce the undesired effect of unmonitored and unregulated dispensing and distribution of a prescription drug.

Beyond 24-7 access, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other independent accrediting bodies include standards that ensure safe and effective clinical respiratory services are delivered in the home. The oxygen provision in the budget bill is in direct violation of quality standards that have been in existence since the late 1980s, and that CMS is currently considering for adoption under competitive bidding.

From what we know now, it is impossible to predict how CMS will establish a maintenance and service and/or repair payment methodology. This, coupled with the insufficiency of the portable fee for ambulatory, means that there will likely be no financial foundation to support a supplier who wishes to deliver and replenish empty tanks of compressed gas or liquid oxygen, or to provide ongoing respiratory therapist support, emergency, and other services that beneficiaries currently rely on.

With more than 1 million Medicare beneficiaries on home oxygen therapy for chronic obstructive pulmonary disease (COPD) or other chronic respiratory conditions, there are plenty of consumers across the country who may be willing, in conjunction with their families, to communicate with policy makers about the ill effects of this oxygen policy.

So what should you do? Educate your home oxygen consumers about the many unanswered questions this policy raises. Meet with your state and local chapters of AARP, Grey Panthers, and other seniors’ organizations. Make sure you provide the facts by telling patients what we know—and what we don’t know—about the impact of this policy.

For example, once ownership transfers to the beneficiary, we really do not know the answers to such questions as: What will happen when a patient moves out of the provider’s service area in month 33? What provider would take on that patient for 3 months of payment before losing its inventory? What will happen in emergency situations that occur after month 36?

In the event of a power outage, how will beneficiaries receive extra tanks of oxygen to get them through the outage? Providers are unlikely to provide this service for the minimal portable fee. For the sickest and frailest of patients who do not use a portable oxygen system, how will these patients obtain service for their concentrators after ownership transfers and there is no legal relationship between provider and patient?

These are but a sample of the many issues raised by this ill-advised policy. Now is the time to communicate with the consumers who will ultimately be most affected by this oxygen provision. DP

Cara C. Bachenheimer, JD, is vice president of government relations for Invacare Corp, Elyria, Ohio. David T. Williams is a political and legislative strategy consultant.