Rep Bill Thomas (R-Calif) is a persuasive salesman and a horse trader of the first order. It is entirely believable that he could persuade enough members, hungry for funding for their own special projects, to join him in supporting a 13-month oxygen cap.

While the industry reels from the Deficit Reduction Act (DRA) provision capping payment for home oxygen services at 36 months, the president’s budget proposes a new cap of 13 months. Many industry advocates, busy with the work that needs to be done before competitive bidding goes into effect in January 2007, are writing off the new oxygen cap proposal as something that is “impossible to get done in an election year.” This sentiment would be valid if the provision had to be part of a massive Medicare restructuring bill. However, the cap proposal can be cast as a minor correction to work already started in the DRA.

Keep in mind that this proposal was vetted by CMS before becoming part of the president’s budget and therefore has some credibility, at least in the halls of Congress. As Congress scrambles to find cash to pay for such things as the war in Iraq, unanticipated costs of the prescription drug initiative, deficit reduction, or fixing the physician payment formula, they will find the multibillion-dollar savings projected from this policy change attractive. Further, as long as they see oxygen as a commodity rather than a service, Congress and CMS feel obliged to pay only for the equipment.

Next, industry nemesis Rep Bill Thomas (R-Calif), chairman of the Ways and Means Committee, finds this new proposal not only attractive but defensible. In what may be his last attack on the industry, he is talking up this outrageous proposal with his colleagues. Thomas is a persuasive salesman and a horse trader of the first order. It is entirely believable that he could persuade enough members, hungry for funding for their own special projects, to join him in supporting a 13-month oxygen cap.

Thomas began this assault before the president’s budget was printed. On January 13, 2006, he published an epistle under the heading “Reforming the Medicare Oxygen Payment System Is Good Government.” It appears that this document was written to rebuff industry efforts to challenge capping oxygen payments at 36 months. In it he asserts that an oxygen concentrator costs $1,000 (he found that out by doing a froogle.google.com search), says that Medicare pays at a rate of $200 per month, and points out that at the end of 36 months the beneficiary pays up to $1,440 in co-payments—more than the cost of a concentrator. Thomas also points out that 93% of the people receiving home oxygen therapy get their oxygen from a concentrator.

Thomas now champions the president’s proposal by telling colleagues that Medicare continues to overpay for oxygen equipment. He does not provide any information about maintenance, required services, or the cost of doing business with Medicare. By manipulating the numbers, he leaves a clear impression that the program and the beneficiary are paying $7,200 for a $1,000 item.

Finally, it is likely that Congress will not complete work on all 13 appropriations bills before the elections this November. They will come back after Thanksgiving to complete this legislation or to pass a continuing resolution. Congress is also inclined to help the physician community by doing a “doc fix” that would change the Medicare payment formula for physicians, after the November elections. This is when things get dangerous.

It would be relatively easy to include a provision capping payment for home oxygen at 13 months in a “doc fix.” Moreover, a 13-month cap on oxygen payments would pay for half the “doc fix.”

Although the HME industry is mired in the minutia surrounding implementation of competitive bidding, changes to the power wheelchair benefit, carrier changes, and other issues, it must take the proposal to cap oxygen payments at 13 months seriously. The simplistic arguments being put forth in support of this proposal must be thoroughly rebutted at every juncture.

Every member of Congress, House and Senate alike, must be convinced that this is a bad idea that will have disastrous effects on patient well-being. This is an election year, and every member seeking reelection is feeling the heat of a nationwide consensus that Congress is not paying attention to the people. The industry must take advantage of this and make a concerted effort to educate consumers to make sure that they understand the consequences of this proposal. The best way to make sure that payment for home oxygen services is not capped at 13 months is to inundate every congressional office with calls and letters from constituents who oppose such a move.

The HME industry has a lot of important issues on its plate. They all require time and attention, and most of them can have a disastrous impact on a provider’s bottom line. There is no issue that speaks to the truth of that last statement more than the proposal to cap oxygen payments at 13 months. 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.