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 "I just wanted to let you know that my company sent out over 400 letters to Medicare beneficiaries we are currently serving or had recently served to inform them of the pending cap on oxygen in the new budget bill. The response from our patients has been tremendous...
"We are receiving 3 to 5 calls per hour from patients either asking for more information about what to say to their congressman or to tell us that they are or have called. For the most part, every patient we have heard from is extremely opposes the O2 cap.
"Several patients have told us that the congressman’s office asked how they were getting this information and that they were “unaware” of this provision being in the bill. We are hearing this every day. I am estimating that at least 50 to 75 of our patients have called their congressman in the past 3 days. Imagine the result if every member did the same thing. 50 calls about the same thing in a short period of time can get some attention, especially coming from Medicare beneficiaries rather that just the providers.
"I truly believe that if we can defeat this bill, it will only be through the voices of our patients. It’s too easy for a senator to think that a provider’s only concern is the money, but when the beneficiaries are making the calls, it becomes a human welfare issue, not a provider cash flow issue.
"Please feel free to forward any or all of this e-mail and encourage anyone that has not made contact with their patients to request a call to their congressman to please, please do so. Yes, it will cost some postage or some time on the phone, but that’s what it takes. Thanks!"
Shawn M. Steffey, RRT
Respiratory Care Associates
813 North Loudoun Street
Winchester, VA 22601
(540) 722-8180
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(related article and information)
Budget Bill S. 1932: Many COPD Caucus Members Voted "Yea"
VGM urges letter writing campaign to these members of Congress
Below you will find the list of Senators and Representatives who voted for the Deficit Reduction Act of 2005, (S. 1932) and who serve on the COPD Caucus. Because they serve on this caucus they may be more aware of the effects oxygen has on improving the quality of life and slowing the disease state.
Nationwide Respiratory president Tom Pontzius commented "This should be a first step in a letter writing campaign. We hope that VGM Group members in these specific districts will send letters, faxes and e-mail. I believe that we only need to have 6-8 votes changed to defeat the bill. This is a more targeted approach. I also hope that our provider members send letters of thanks to those elected officials who voted against the bill, thanking them for caring about those who use oxygen and enlist their help in persuading their other colleagues on this caucus to change their votes."
Talking points and other information follows below. You may also utilize VGM's interactive government relations Website "DC Link" (see link on bottom of vgm.com front page) to contact your representative.
If you have questions or comments, please contact Tom Pontzius, John Gallagher or Mark Higley, at 800.642.6065.
Thank you.
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COPD Caucus Senators who voted for the bill:
Mike Crapo (R-ID)
Thad Cochran (R-MS)
Richard Lugar (R-IN)
Rick Santorum (R-PA)
Susan Collins (R-ME)
COPD Caucus Representatives who voted for the bill:
John Boozman (R-AR)
J.D. Hayworth (R-AZ)
Randy Cunningham (R-CA)
Ray LaHood (R-IL)
Jim Gerlach (R-PA)
Thaddeus McCotter (R-MI)
Paul Gillmor (R-OH)
Todd Platts (R-PA)
George Radanovich (R-CA)
Mike Rogers (R-MI)
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Beneficiary Ownership of Oxygen Equipment
Congressional Staff Has Asserted:
This provision transfers ownership of oxygen equipment to the beneficiary after 36 months
Beneficiaries will now have more control over their oxygen needs, by allowing them to purchase after 36 months.
However, this provision also ensures that all beneficiaries who rely on oxygen are covered.
Medicare currently pays around $200 a month for renting oxygen equipment.
On average Medicare beneficiaries use oxygen for 30 months, which means Medicare pays $6,000 for a beneficiary.
If a beneficiary needs oxygen for longer than 30 months this provision allows the beneficiary to rent for another 6 months.
After 36 months, the beneficiary still receives monthly payments if they use a portable system that requires the delivery of oxygen.
And if maintenance and servicing are required – Medicare will cover repairs and servicing as needed.
However, the beneficiary is given more control to determine when servicing is necessary.
Congress needs to move towards a better payment system that protects our beneficiaries and the integrity of our Medicare program.
Homecare Responses:
Oxygen patients have not asked for any more "control" over their equipment. Long-term oxygen patients cannot walk to their mailboxes without becoming breathless, let alone handle a lot of extra responsibility for maintaining medical equipment they don't understand. Long-term oxygen users are generally very satisfied with their homecare providers as measured by patient satisfaction surveys.
Beneficiaries do not know "when servicing is necessary." Many cannot follow a manufacturer's warranty or recommended maintenance schedule. They have no exposure to product recalls mandated by the FDA and would not know how to comply with a recall if needed. Oxygen is an FDA-regulated drug produced from FDA-regulated medical devices. Homecare providers ensure that they are maintained regularly. Does Congress really want to put humans at risk of death or re-hospitalization due to low oxygen drug saturation levels?
Contrary to some Congressional staffers' beliefs, homecare providers WILL NOT buy used oxygen equipment back from beneficiaries. Most do not even buy used equipment from qualified equipment brokers today; they buy new to take care of patients. Patients will not maintain proof of maintenance, cleaning, service or recall management, and providers will not be willing to risk future Medicare oxygen patients' health by purchasing such equipment. Patients cannot "donate" the equipment back to for-profit entities either. This is a misguided assumption.
Medicare Part B premiums are rising largely due to an increase in physician office visits and related costs, not higher homecare costs. Attributing higher Medicare premiums to homecare is a fallacy. Homecare remains the most cost-effective treatment option for chronically ill patients.
Today, oxygen patients who learn about new oxygen technology such as Homefill and portable devices call their homecare provider to learn more about it and see if it meets their clinical and quality of life needs. Once the new provision goes into effect, any beneficiary with purchased oxygen equipment will have zero access to new technologies since it is likely that the Medicare program will only "buy" one concentrator per a certain time period, which is how nebulizers and CPAPs are handled today. This will cause great beneficiary dissatisfaction, and the provider will be in the middle.
While the average length of stay for Medicare oxygen patients may be 30 months, there are thousands of patients who last five or more years on oxygen. How will their clinical needs, equipment maintenance/servicing and other needs be met as their COPD worsens and they become incapacitated at home in the last phase of their chronic, terminal illness? These are the very patients who need in-home visits by respiratory therapists and other intervention. With zero reimbursement today for an in-home visit by a respiratory therapist, how would providers support such a request from the patient?
Medicare does not pay $6000 for equipment alone. Even the proposed quality standards for competitive bidding for oxygen, developed by CMS consultants, explicitly acknowledge that an array of support services must be available and provided to oxygen patients around the clock. These patients receive in-home deliveries of portable tanks -- sometimes twice a month -- as well as patient education, equipment maintenance/troubleshooting, equipment exchange at no charge, emergency and disaster assistance during natural and manmade disasters, extra supplies, 24/7 on-call services and the labor-intensive Medicare and secondary insurance billing on their behalf. It is grossly misleading to suggest that Medicare pays that amount for the equipment alone. Even past OIG reports on the subject have acknowledged that Medicare billing and administrative service costs are 30% higher than for either the VA or private sector.
Today most providers simply exchange faulty equipment -- they do not repair it in the home. Assumptions made about maintenance and service frequency are drawn from a faulty OIG survey on this subject, which looked at only a small portion of the total maintenance and service functions performed for beneficiaries, and discounted a great number of survey responses.
Medicare has not established a fair and equitable fee schedule for maintenance and repairs as of this date. No research has been performed to suggest that these services will continue to be available should the 36-month cap go forward.
America's landfills and flea markets will be full of used, unsanitary, unmaintained FDA medical devices. Is that what the Congress desires?
Most patients and caregivers want to return the equipment as soon as their loved one dies or they no longer need it. Today, the provider picks it up at almost any time of any day after a death in the home. How does Congress expect a frail Medicare beneficiary or caregiver to dispose of a heavy metal hospital bed or oxygen concentrator?
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Talking Points for a Call or Email to Urge NO Vote on Budget Bill
Please urge [Congressman / Congresswoman _________] to vote no on the budget reconciliation bill.
I am [name, title] of [name of organization] located in [city or service area]. We provide home medical equipment and services to about [number] patients in [state or Congressional district].
The budget bill that was approved by the House on December 19 contained many provisions that will hurt older Americans who depend on homecare equipment and services.
The bill eliminates the option of older and disabled Americans to continue to rent home medical equipment, including oxygen equipment, under Medicare. Medicare beneficiaries prefer to rent this medical equipment rather than purchase it because renting generally lowers costs to seniors and ensures easy access to maintenance. Forcing seniors to take title of complex medical equipment after a “capped rental” period is unfair and potentially dangerous. It puts a burden on beneficiaries to arrange for maintaining equipment, deal with disruptions, and budget for maintenance and repair.
Oxygen equipment in particular is an integral part of a life-sustaining therapy and any change to this policy should be made in consultation with the home medical community. The budget bill conferees added this unwarranted and dangerous change to oxygen policy at the last minute with no warning or discussion. Also, the conferees inserted a provision in the conference report that would deprive home health agencies of their 2.8 percent update in 2006. Homecare is the preferred by seniors and is the most cost-effective setting for healthcare in America so a cut to home health agencies is unwise given the increasing demand and increasing costs for healthcare in the U.S.
Again, please ask the Congressman / Congresswoman to vote NO on the budget bill.
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