By Dan Starck
It’s not often that a health care provider can say they offer one of the essential elements required for life. But that’s exactly what home respiratory therapy providers offer the more than 1 million Medicare beneficiaries who rely on our services and equipment for home oxygen therapy.
Members of the Council for Quality Respiratory Care, such as my organization, Apria Healthcare, deliver patient-centered services in coordination with other providers to reduce costs for Medicare and other payers. By providing the services and equipment necessary to treat Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea at home, our services are in direct alignment with the administration’s goal of reducing the total cost of care. The products and services we provide help reduce emergency room utilization, hospital and nursing home length of stay, and hospitalizations. In patients with COPD, oxygen therapy can be used to prevent or slow the progression of heart failure, a diagnosis on which Medicare has focused due to its high costs. Overall, we play a critical role in reducing health care spending while helping beneficiaries maintain their independence and enhance their quality of life.
But right now, despite our ability to be part of the answer in the quest to reduce the total cost of care, home respiratory therapy providers continue to face cuts that do not take into account the cost of providing care to patients. Home respiratory therapy providers are struggling to respond to the rapid phase-in of substantial cuts to Medicare reimbursement for the critical services we provide. Despite the fact that Congress originally expressly excluded some, mostly rural, areas from competitive bidding for these services, the Centers for Medicare & Medicaid Services (CMS) has now decided to apply competitive bidding rates in these exempted areas. The bidding rates are already below the cost of supplying services in the competitive bidding areas, on average, and the cost of supplying services in the exempt areas is much higher, in part due to greater travel distances given their rural nature. While CMS does provide a minimal payment increase to account for some of these higher costs, the net reimbursement amount still falls well short of our providers’ costs.
Furthermore, CMS offered only a six-month phase-in for providers and suppliers to prepare for and adjust to these drastic cuts. CMS could easily extend this timeline using existing authority, yet they are currently unbending in their drive to reduce reimbursement rates and potentially put hundreds of thousands Medicare beneficiaries in danger of not being able to access high-quality home oxygen therapy. For example, CMS recently provided dialysis facilities with a three-to-four year phase-in timeline of much smaller reimbursement reductions.
We are very concerned about our industry’s ability to quickly respond to the short timeframe of these significant cuts in a way that does not significantly impact patient access to the high-quality, in-home respiratory therapy on which many of their lives depend. Providers are already being forced to consider the elimination of high-quality services that go beyond Medicare’s requirements in order to accurately reflect what Medicare pays for under a reduced rate. Some of the enhanced services that providers must consider for elimination include coordinating with hospital discharge planners, provision of services when it is convenient for beneficiaries, rather than on a set schedule, and delivery of home oxygen and other medical equipment in rural areas or beyond a short distance from a branch location. Unfortunately, we all lose (patients, caregivers and taxpayers) when Medicare beneficiaries are forced to remain in an acute care facility instead of being able to transition to their home due to a lack of access to home care products and services.
Lawmakers need more time to responsibly determine 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 patient access and continuity of care.
To provide that time, I urge Congress to pass the Patient Access to Durable Medical Equipment Act (S. 2736), which would require a longer phase-in of these cuts. The legislation would extend the phase-in of new rates for 15 months and require CMS to publicly report the impact on beneficiary access to care during the phase-in. The 15-month extension is fully paid for through changes to other durable medical equipment competitive bidding programs.
Congress exempted these areas from competitive bidding for a reason. We need more time to thoughtfully consider the impact of reimbursement reductions and develop a response that does not jeopardize patient access to home respiratory therapy services and supplies. I urge lawmakers to protect beneficiary access to one of the essential elements required for life – oxygen.
Starck is CEO of Apria Healthcare and Chairman of the Council for Quality Respiratory Care.
To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.
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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