July 05, 2016

by Dr. Julian Husbands

More Sufficient Data Needed To Evaluate Patient Impact of Home Oxygen Cuts


“DEWEY DEFEATS TRUMAN.” In a classic case of jumping to conclusions, the Chicago Tribune printed more than 150,000 papers bearing this erroneous headline proclaiming the incorrect winner of the 1948 Presidential election. The mistake resulted from a confluence of events related to incomplete data and insufficient time. Several polls predicted a Dewey win and a printer’s strike forced the Tribune to go to press hours before the polls closed and all the votes were in.


This historical example illustrates one very public incident in which quick conclusions based in insufficient information resulted in false declarations. While humiliating for the publication, some decisions based on limited information that draw hurried assumptions stand to have much more dire results.


Despite the lessons we can learn from the Tribune’s mistakes, the Centers for Medicare & Medicaid Services’ (CMS) conclusions about the impact of cuts recently imposed on home-based respiratory therapies are also based on incomplete data and insufficient time. The headline for a recent CMS blog describing beneficiary access to care and outcomes proclaims, “The Proof is in the Numbers.” At the Council for Quality Respiratory Care (CQRC) we agree; the proof is in the numbers, but only when you have complete data across a sufficient time span.


Implementation of CMS’s competitive bidding program for home-based respiratory services and other Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) has been troubled from its start. A recent report from the Office of the Inspector General found that nearly half of audited contract suppliers in Round 2 of the program did not meet State licensure requirements for some of the competitions for which they received a contract. Since it is typically less costly to provide DMEPOS when flouting State requirements, we anticipate these suppliers’ bids were below the true cost of doing business according to State and federal regulations. Yet, the bids from these unlicensed suppliers were used in setting the likely erroneous Medicare payment rate for DMEPOS in the competitive bidding area.


On Jan. 1, CMS began applying these flawed competitive bid rates to rural and other areas that Congress explicitly exempted from competitive bidding. This policy is being phased-in over 6 months and if the complete cut takes effect as scheduled on July 1, it will result in payment cuts of 30-50 percent. In applying these cuts, CMS utilized an accelerated, six-month phased-in, rather than the three-to-four year phase-in it has used to implement much smaller payment reductions for other providers. The full impact of these cuts took effect on July 1, at which time an additional 18 percent cut was implemented.


Home respiratory therapy providers are doing their best to adjust to these greatly reduced payments, which, on average, no longer cover the cost of supplying services, while trying to protect frail and vulnerable Medicare beneficiaries from losing access to vital services. Most of us take for granted the oxygen we breathe, freely available to us wherever we are. Medicare beneficiaries who require oxygen therapy to maintain their health and independence don’t have this luxury. And in the rural communities where these cuts are now hitting hardest, home respiratory therapy providers are serving their neighbors, friends, and family members – fighting to find ways to continue providing this life-sustaining care without going out of business while they work with Congress to find a solution.


So it wasn’t a surprise to us when CMS analyzed only the first four months of partial implementation of these cuts and found that Medicare beneficiaries continue to have access to DMEPOS and detected no changes in health outcomes data. They analyzed incomplete data over an insufficient period of time. Due to the six-month phase-in, the full impact of the cuts was not in force during the 120 days of data CMS reviewed, and the analysis does not consider additional cuts that recently took effect on July 1.


When the Tribune went to press in 1948 with a headline informed by incomplete data and insufficient time, the results were embarrassing. The stakes for CMS and the Medicare beneficiaries who rely on home respiratory therapy are so much higher. This incomplete data over an insufficient time period does not provide the basis for CMS to conclude that drastic payment cuts have no impact on beneficiary access to care and health outcomes. We feel strongly that at least 15 months of data is required to measure the true impact of these reimbursement changes.


Lawmakers need more data and more time to thoughtfully assess the impact of these cuts on beneficiaries, particularly since Congress exempted these areas from competitive bidding when the program was created. Providers also need more time to develop a thoughtful response to the cuts and to create plans for Medicare beneficiaries to ensure continuity of care. The Patient Access to Durable Medical Equipment (PADME) Act addresses both these issues, requiring additional data from CMS to monitor the impact of the cuts and more time to phase-in the cuts.


I strongly urge Congress to promptly pass this legislation when they reconvene this week so that Medicare’s DME cuts are phased in over time. The July 1 cuts must be reversed to ensure we more fully understand how payments cuts affect the frail, vulnerable Medicare beneficiaries whose health depends upon their access to home respiratory therapy services.


Julian Husbands, senior vice president of clinical programs at Apria Healthcare and a member of the Council for Quality Respiratory Care (CQRC).



To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.


Click here to see the original article on The Hill website.



Learn More About Home Respiratory Therapies:

Millions of Americans are living with COPD and Obstructive Sleep Apnea, experiencing acute respiratory failure, or living with neuromuscular diseases. These individuals rely upon home respiratory therapies to remain at home. Learn more about home respiratory therapies and how they can help.

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