I have worked in the HME industry providing home oxygen for over two decades. The one driving force that insured that the patient received quality and timely service has been that the patient was always free to choose another oxygen provider. Under the new reimbursement system for oxygen, the longer the patient uses the oxygen, the more limited their choices become. In fact, beyond 18 months of service, they will be hard pressed to find any other provider who would be willing to accept them. As they get nearer and nearer the 36 month cap, they simply have no options. If they are not getting good service or want to move out of their oxygen provider’s service area, there is no one that is willing or able to help them, because the reimbursement that remains is not sufficient to cover the new provider’s expense. It’s not that they do not want to help the patient (that’s what we do). It’s that they cannot afford to help the patient.
The other aspect of this is that we are already starting to see companies close their doors as a result of the numerous reductions in reimbursement our industry has endured. In fact, at least one or two of the large national companies are currently teetering on the edge. Once competitive bidding gets started and 70 to 90 percent of the existing providers are left out. There could literally be 10s of thousands of oxygen patients left with no provider to service them. CMS would argue that the winning providers will take them. The reality is that there simply will not be enough capacity among the winning providers to meet that demand, nor will reimbursement be adequate for winning providers to be able to take them and service them properly.
So far, CMS has refused to acknowledge that there is any significant service component to providing oxygen, in spite of the fact that our industry has provided ample and compelling evidence to the contrary. Our industry allows patients with chronic disease to remain in their home at fraction of the cost of hospitals and nursing homes. Over the years the monthly rental fee paid by Medicare insured that the patient received more than just a piece of equipment. The patient received an insurance policy that guaranteed that there would be oxygen flowing into their nose at the prescribed liter flow 24 hours per day 365 days per year and that if there was a problem there would be a trained professional available to help them even in the middle of the night. We’re there during floods, blizzards, power outages, and equipment failures to insure the patient’s needs are met. It’s not the equipment that makes the difference for the patient. It’s the company and the people that stand behind it. The bottom line is oxygen is a service that should never be capped. Our industry has been and remains willing to work with Medicare to reduce costs, but it must be done in a sensible way that does not reduce patient access to care. CMS must be willing to work with our industry if they want to achieve the best solution for both tax payers and patients. Right now the people making the rules know just enough about home oxygen to be dangerous.