the only approach to reforming our healthcare system that has any chance of making a difference is this: Find out what is inefficient and fix it and find out what is working well and structure the healthcare system around it. Home Medical Equipment certainly falls into the latter category, particularly home oxygen therapy. Since reimbursements have, for the most part, been the same for all providers, we have been competing with each other on the basis of service. Prior to the 36-month cap, we would do whatever it took to keep our patients satisfied (and maybe even entice a few of another provider’s clients to switch over to us.) If another provider started providing the latest in oxygen technology, the market would force us to do likewise. Regardless of what we would like to think, there is no way that any of us are going to provide that level of service in the future. CMS has eliminated a large percentage of the profitability (maybe that’s a bad word to some) of the Medicare oxygen patient. Many of the things that we have traditionally done to make our patients’ lives fuller and easier are things that are “above and beyond” what is required. CMS can mandate minimum standards, but they cannot mandate “above and beyond.” CMS hasn’t thought this out. Between NCB and this oxygen debacle, the HME industry is going to be decimated before this is over. It will still be here, but the level of service (and caring) will never be what it once was. If the analyst is right, and Lincare is the only survivor, homecare’s capacity to be the best hope for the future of healthcare will be sorely diminished. An intelligent approach to healthcare reform would be to invest heavily in home healthcare and build from there. Instead, CMS (and Congress) will have taken something that truly works and thrown it out.