If you think it is bad now, just give it a little time and you will see how bad it can really get. Congress passed a law and handed it down to CMS to enforce and they have made it clear that there are no exceptions to the law. I fully understand the intent but I also think I might have a clearer picture of what is coming than you do in regards to this specific legislation.

On January 1, 2009 Medicare stopped paying the monthly rental fee for every Oxygen patient that has been on service since on or before January 1, 2006. This is the dreaded 36 month oxygen rental cap. The Home medical equipment supplier will retain ownership of the equipment and will be responsible for servicing the equipment and the patient 24 hours a day 7 days a week for the next 2 years. If the patient moves from Fort Worth to Santa Fe, I am bound by federal law to continue to service that patient and equipment for at least the next 2 years. I am sure that I am not licensed to do business in New Mexico. I realize that congress was trying to save some money but I firmly believe that just the opposite is about to happen.

There will be a number of DME dealers that are overly dependent on Medicare as their primary Payor that will simply be forced out of business. I can assure you that every patient that is serviced by every supplier that goes out of business will be forced to look for a new supplier. I am wondering just who you think will take a patient and supply equipment and service to that patient for $0.00 reimbursement for the rest of their life. I can assure you that the patient will be turned away and will not have any choice of where to go except to the hospital. Now we can start spending some money. Instead of paying $2,000.00 per year for round the clock service (24/7) you will get to pay $2,000.00 per hour for simply letting the patient breath hospital supplied oxygen while they try unsuccessfully to find a new DME dealer to service that patient.

You have made it to where the surviving DME dealers have no choice except to refuse the capped out patient. The patient will suffer and the supplier will suffer and when enough of them are out of business, then what are you going to do. Even National Service Providers like Apria or Lincare will not take a patient that has capped 36 months on oxygen if they will not be paid for servicing the patient and supplying the equipment.

My offices are across the street from the hospital. I know for a fact that the hospital stays full and that there are patients in the hall waiting for rooms. I am not talking about a little backwoods hospital I am talking about one of the biggest hospitals in the state of Texas. There is a push daily to get patients discharged and home so that they can move people from the hallway to even a semiprivate room.

Just exactly where do you think these suffocating, oxygen dependent, patients are supposed to go. I can assure you that the ambulance trip and single emergency room visit alone will cost more than what we are paid for 24/7/365 service to supply oxygen to the patient at home.

Someone needs to take the time to step up and listen and truly address this issue BEFORE it crashes and creates an even bigger mess. As DME dealers across the country realize that their reimbursement is not enough to cover the cost of servicing their patients and that they cannot pay their vendors or meet their other financial obligations, they will be forced to close their doors. They would love to stay in business; they simply cannot afford to stay in business. Other people will think that they can get into the DME business and provide service to oxygen patients. They will quickly do the math and figure out that it is impossible to purchase the equipment, deliver and setup the equipment, perform routine maintenance on the equipment, provide backup or portable systems to the patient, deliver filled tanks to the patient when theirs are empty due to use or the inability to turn off the valve correctly, answer all respiratory questions and concerns that the patient might have, provide 24 hour a day emergency service to the older patient that cannot seem to unscrew a humidifier bottle and then screw it back on without cross threading the threads, provide customer service to the patients, correctly gather information and required documentation so that we can legally bill for the services that we provide, maintain a warehouse that meets the requirements of Medicare standards, provide for liability insurance in case one of the patients (that signed a form and promised that they would not smoke while on oxygen) burns themselves up in the privacy of their own living room, pay for salaries of all the supporting staff, including storefront, marketing, customer service, billing, respiratory, delivery personnel to name a few.

It is possible that you are thinking that DME dealers are simply greedy money hoarding thieves. I can assure you that just the opposite is true. I have a dedicated staff that fights daily to do everything they can to service our patients during a time of falling reimbursement and economic collapse.

I agree with the need for consistency within the program but it is equally important to be realistic about what is happening. It is not just a piece of equipment that provides oxygen. It is a program that provides a real way for Medicare to save money. Driving the DME dealers out of business is counterproductive and will have dramatic results if careful steps are not taken now.

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