CMS assumes that frail seniors on home oxygen and/or their caregivers will be able to handle routine maintenance.

Just when you think things can’t get worse for the HME industry, CMS publishes its proposed new payment method for home oxygen. The proposal leaves many issues unresolved and raises numerous questions. But there is one question more compelling than all the others. What about the patient?  

There is absolutely no recognition in the proposal that home oxygen therapy is the delivery of a life-sustaining prescription drug to people with chronic, often debilitating medical conditions. After digesting the entire proposed regulation and CMS’ explanation of why and how it is proposing the new payment system, the single most glaring omission is any consideration for the safety and well-being of the beneficiary.

CMS has crafted a proposed payment rule that focuses exclusively on equipment. There is no recognition of the purpose of home oxygen therapy and no acknowledgement of the necessary clinical support, emergency maintenance calls, and numerous services that home oxygen providers are required to give beneficiaries.

CMS has ignored the need for a financial foundation to support the ongoing relationships between patients and providers that referring physicians rely on to receive critical information about a patient’s condition and compliance with a prescribed therapeutic regimen. Similarly, CMS is proposing to pay only for maintenance and service on beneficiary-owned equipment when an “authorized technician’s” services are required. CMS’ example of such services is “breaking down sealed parts.” Otherwise, CMS assumes that frail seniors on home oxygen and/or their caregivers will be able to handle routine maintenance. In fact, CMS states that Medicare will not cover “routine maintenance or periodic servicing of purchased equipment such as testing, cleaning, regulating, changing filters, and general inspection of beneficiary-owned DME.”

CMS predicates its proposal on the belief that “the beneficiary and/or caregiver should be very knowledgeable regarding the routine maintenance required.” CMS ignores power outages and natural disasters. The agency responsible for seeing that seniors receive adequate health care envisions them calmly (and safely) changing the regulator on backup oxygen cylinders during a blackout!

Forget for a moment the financial implications for providers. CMS seems to be unwilling or unable to consider the well-being of beneficiaries. Since the agency can’t, or won’t, the industry must speak for the people it serves.

Providing comments on the proposed rule is easy. Simply log on to the CMS Web site, www.cms.hhs.gov/eRulemaking, and click on the link “Submit electronic comments on CMS Regulations with an open comment period.” The item is CMS-1304-P, and you can draft comments directly or cut and paste a predrafted comment. Express your concerns about how this proposed regulation puts the safety and clinical well-being of the patients you serve at risk. It’s important!

The latest CMS proposal is not the only thing that deserves your immediate attention. This summer, bills were introduced in the House and Senate that would repeal all the oxygen provisions of the Deficit Reduction Act including the forced beneficiary ownership of oxygen equipment. These bills, HR 5513 and S 3814, are entitled the Home Oxygen Patient Protection Act (HOPPA), and they would do just what the title says.  

The House bill has momentum, gaining more than 40 cosponsors since its June introduction. The industry must engage in an all-out effort to increase that number. Why? Increas-ing the number of cosponsors improves the chances of HOPPA becoming law on its own or as part of a “must pass” piece of legislation.

In reality, the CMS “maintenance” proposal provides a great opportunity to educate Congress about the ill effects of forcing home oxygen patients to own the equipment their doctor has prescribed. The image of frail Medicare beneficiaries performing what CMS refers to as “routine maintenance procedures” is enough to get many members to sign on as cosponsors of HOPPA. There will be a vehicle that will pass this year to which members of Congress (those that are aware and supportive) can attach the provisions of HOPPA.

Stop what you are doing, call your elected representatives, and ask them to sign on as cosponsors of these important bills. Call (202) 224-3121 and ask for the office of your Senator or Representative by name. Let the patients you serve know what CMS is proposing and urge them to call their representatives to ask them to support HOPPA. Ultimately, this debate is not about money. It is about the safety and well-being of patients.

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