April 9, 2017
Published by Medpage Today
By Dan Starck
According to a recent analysis of Medicare claims data, the percentage of Medicare patients who receive home oxygen services declined by a whopping 42% between 2008 and 2014. Although this might appear to be good news at first glance – fewer patients requiring supplemental oxygen care – in reality, it's quite the opposite.
That's because during the same time frame, the total Medicare population grew by 19% and the number of Medicare patients diagnosed with chronic obstructive pulmonary disease (COPD) increased by almost 60%. COPD is the main indicator for prescribing home respiratory care, and yet, even with rising numbers of Medicare patients with this condition, the percentage of these patients receiving home oxygen therapy dropped dramatically – from 30% to less than 15%.
It's a confounding and alarming trend for Medicare during a time when policymakers are working to make smart decisions that save precious healthcare dollars. Home oxygen care is cost-effective for taxpayers – by keeping patients out of the hospital. In fact, data show that home oxygen care leads to reductions in costly hospitalizations and readmissions.
Reduced access, therefore, will only lead to more emergency room visits, higher readmission rates and much higher Medicare costs. It will also mean that Medicare beneficiaries, who value independence and would like to age in place, might have difficulty doing so.
So why is home oxygen care on the decline when the number of Americans who need it is rising? The answer is a complicated result of a host of policy changes over the past several years.
First, Medicare has dramatically increased the cost of providing life-sustaining home respiratory therapy services to beneficiaries in recent years. A broken documentation process has resulted in an unsustainable system in which suppliers cannot be paid for legitimate, medically necessary services until they have gone through an arduous and expensive appeals process to prove what was known all along – that patients in fact need home respiratory therapy to remain at home and out of more expensive inpatient settings. The initial denials are the result of medical documentation created by prescribers of the therapy not meeting the contractor's view of what a medical note should say.
The Centers for Medicare & Medicaid Services' own data supports this fact. For example, it found that approximately 45% of home oxygen claims were denied because of inadequate documentation, but only 0.3% of such claims were accurately found to be not medically necessary. These processes increase supplier costs by 40% or more, and jeopardize the continuity of care for beneficiaries whose lives depend on receiving steady and reliable access to home respiratory equipment and services.
Second, Medicare has made large reimbursement rate cuts to home respiratory care. New reimbursement procedures in rural America resulting from Medicare applying the competitive bidding rates used in urban areas to rural communities has led to drastic payment cuts, which in turn has required some providers to scale back on the services they offer to seniors, causing even more disruptions in care.
In light of these challenges, we are asking the new Administration to bring some common-sense changes to the process by which rates in non-competitive bidding areas are set and create a reasonable balance in the process for establishing medical necessity.
Regardless of how we got here, we face a long and expensive road without innovative strategies to improve the outlook for Medicare patients. Providers of home oxygen and respiratory therapies are committed to finding these solutions, so that we can preserve access and quality of life for patients – and achieve Medicare savings for taxpayers.
To that end, we are working to collectively and comprehensively change our practices for the good of the system.
Medicare and the home respiratory community need to move beyond the policies of the past. If stability and balance are achieved, we can work toward developing innovative approaches to care that encourage the delivery of high quality home respiratory care services to reach optimal patient outcomes and prevent declines in health that require seniors to receive care in more expensive care settings.
Our nation's seniors with COPD and other respiratory illnesses – who are increasing in number – should never have to face uncertainties when it comes to the very oxygen they breathe. We are committed to making innovative changes in how we care for our patients so that we can participate in value-based care payment models while continuing to provide quality, uninterrupted access – allowing beneficiaries the opportunity to remain in their own homes and communities, and to continue to enjoy the dignity of living independently as they age.
Dan Starck is chairman of the Council for Quality Respiratory Care (CQRC), a trade group for home respiratory care providers and equipment manufacturers.
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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