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Home Medical Equipment Concerns in S. 1932, the Budget Reconciliation Bill January 19, 2006
Oxygen is a Prescription Drug: Unregulated Use Poses Dangers and Burdens for Seniors Medical oxygen can only be prescribed by a physician specifically for individual patient use. Oxygen is a drug and can be dangerous if not administered or used properly. Use of medical oxygen equipment is imperative to the overall well-being of patients on oxygen therapy. Homecare companies currently provide 24-hour, emergency on-call service to assist patients with trouble-shooting equipment problems, improper use, or equipment failures. The new rent-to-purchase payment policy for home oxygen equipment proposed in S. 1932 would require that after a 36-month rental period, title and responsibility for maintenance and service for all home oxygen stationary and portable technologies would be transferred to the Medicare beneficiary. With the transfer of ownership of the medical device to the patient, the control over the dosage levels would shift to the patient and the opportunity for self-medication to their own detriment would increase significantly. This is an unreasonable burden and worry for seniors, especially on top of navigating Part D drug benefits.
Costs Related to Home Oxygen Therapy Like many other medical therapies performed in conjunction with medical devices, the equipment cost is only a small fraction of the overall cost associated with the provision of home oxygen therapy. While there is broad language in S. 1932 regarding “payments for oxygen” and “maintenance and service” after the title transfer of the equipment, there are no specifics or assurances. The bill only suggests such payments “may” be available. In the Medicare system today there are no codes or policies governing the maintenance and services for oxygen technologies. S. 1932 provides no guidance for the myriad service components currently required and incorporated into the Medicare oxygen rules and payment, including all patient training, deliveries, disposable accessories, billing, clinical professional support, 24-hour emergency service and equipment replacement.
Nearly One Million Medicare Beneficiaries Receive Oxygen Therapy Oxygen equipment is critical to approximately one million Medicare beneficiaries who suffer from respiratory illnesses such chronic obstructive pulmonary disease (COPD) and who require oxygen therapy for their long-term survival and well-being. Approximately 15 million Americans have been diagnosed with COPD. An estimated 15 million more have undiagnosed COPD.
Home Oxygen Therapy Is Both Clincally Effective and Cost-Effective Oxygen is the only current treatment or drug scientifically proven to extend the life of patients with chronic lung disease. In 2002, there were 673,000 hospitalizations for COPD. Their average length of stay was 5.2 days. The average Medicare cost for one day in the hospital is $3,606, and the average admission for COPD therefore costs more than $18,000. In contrast, the current average annual cost for home oxygen therapy is $2,784, less than the average cost for one day in the hospital. Home oxygen therapy is the most cost-effective and clinically effective treatment for those with COPD and low blood oxygen.
S. 1932 Cuts the 2006 Home Health Update Also, the bill includes a provision that would deprive home health agencies of their 2.8 percent update in 2006. Meanwhile, labor, transportation, and other costs of providing homecare are rising.
Members of Congress Did Not Have Time to Review the Policy Changes Some of the provisions, such as the rental cap on home oxygen equipment, were added by conferees at the eleventh hour with no opportunity for Members of Congress to review the language or consider the consequences to the beneficiaries who would be affected.
Bill Eliminates Beneficiaries’ Option to Continue to Rent Home Medical Equipment The bill eliminates Medicare beneficiaries’ option to continue to rent durable medical equipment, including equipment used for oxygen therapy. Medicare beneficiaries can and do regularly purchase many home medical devices for personal use, including oxygen technologies. Beneficiaries more often choose to rent home medical equipment because renting allows for a continuing patient-provider relationship and professional maintenance of complex equipment.
Proposed Changes are Clinically and Fiscally Unwise Homecare is preferred by seniors, and homecare is by far the most cost-effective setting for healthcare in America, as recognized by U.S. Health and Human Services Secretary Mike Leavitt. These proposed changes and cuts to homecare policy in S. 1932 are clinically and fiscally unwise given the tremendous value of homecare for patients, families, and taxpayers.
S. 1932 Weakens the Nation’s Homecare Infrastructure and Safety Net The American Association for Homecare (AAHomecare) and its members oppose these provisions in the budget reconciliation bill which could endanger homecare patients and further weaken the nation’s homecare infrastructure and safety net, which provide cost-effective care.
Your help in strengthening homecare to ensure safe, effective professional care for older and disabled Americans in their own homes is greatly appreciated. Source |