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Statement of National Home Oxygen Patients Association
The National Home Oxygen
Patients Association (NHOPA) welcomes the opportunity to comment on competitive
bidding as it affects our members, users of home oxygen therapy.
Our comments focus on what we
have seen so far as implemented by the Centers for Medicare and Medicaid
Services (CMS), what we have not seen, and what we anticipate will occur July 1st
and thereafter based on competitive bidding for home oxygen therapy.
First and foremost, we must
strongly emphasize that bidding for oxygen and related services is, by
definition, a flawed process because the current payment methodology for home
oxygen is seriously flawed. Competitive bidding for oxygen will likely
exacerbate the situation, not improve it. Under current statute, payment for
new technologies such as lightweight liquid systems, portable oxygen
concentrators, and transfilling systems is based on the pricing for stationary
concentrators. Simply stated, the statute that ties the payment of devices
that today cost approximately $2500-$3500 to devices that cost $450 is
irreparably flawed. Access to these lightweight technologies is critical to
the oxygen user population, and any effort to reduce payment for these devices
will unquestionably put a greater strain on access to these technologies.
For example, in non
competitive bidding areas, stationary concentrators trigger a $199 payment,
with an “add-on” of either $31 or $51 for the newer technologies. The former
costs a supplier around $450, while the latter costs $2500-$3500. The very
appropriate downward pressure on payment for stationary concentrators has the
unfortunate effect of reducing payment for other devices, making access to them
even more problematic.
Secondly, we were quite
chagrined by CMS’ claim at the public hearing on May 6th indicating
that its advisory committee, the PAOC, served as an important liaison for input
from the consumer community. Oxygen is far and away the largest single
component of the durable medical equipment benefit, yet CMS did not include
either an oxygen user or a pulmonary physician as part of its advisory board.
Our views have, bluntly, been ignored by CMS.
Additionally, in 2007 we were
approached by CMS contractor Abt Associates to assist in the development of a
questionnaire/survey instrument to help assess the impact of competitive
bidding, yet Abt ended that process before completion. It is very difficult to
believe that there will be an accurate and appropriate assessment of
competitive bidding unless there is an accurate picture of access and quality
prior
to competitive bidding in the 10 MSAs where competitive bidding is slated to
begin July 1st, 2008. Simply, one cannot assess impact unless one
has a fair picture of the provision of oxygen and related services prior to
July 1st.
With competitive bidding less
than 8 weeks away, to our knowledge there has been no direct outreach to oxygen
users in any affected MSA. If we understand the program correctly, a beneficiary
whose supplier is not a winning bidder and chooses not to accept the winning
bid under the “grandfather” provisions, will be required to find a new supplier.
That new supplier is unlikely to provide the identical oxygen system, and we
understand and appreciate that some educational information will need to be
provided regarding new stationary systems, new portable systems, and new oxygen
conserving devices. NHOPA has already begun that effort, but we see no
movement by CMS to educate beneficiaries.
The beneficiary who must find
a new supplier will likely have a chaotic July 1st as new equipment
arrives and old equipment disappears. While a seamless process is possible, we
are not exactly confident that such a transition will occur. Once the old supplier
pulls his equipment from the home, unless the new equipment is present and
ready for use, there could be significant clinical risk.
In terms of replacement
equipment by the new supplier, CMS’ own pilot study of competitive
bidding/oxygen usage in Polk County, FL and San Antonio, TX saw a reduction of
30% in access to lightweight oxygen systems. CMS has never pursued our
concerns regarding that matter, and implementation of this program absent such
program changes will unquestionably trigger similar, dramatic access issues.
There is already some evidence that access to liquid oxygen systems in
competitive bidding areas may be problematic, and this is of major concern to
NHOPA.
There has been important
discussion within the oxygen community regarding a slow down of Phase Two of
competitive bidding. We believe that it is appropriate to implement Phase Two
once there has been a reasonable and accurate assessment of the impact of Phase
One of competitive bidding AND time for CMS to adjust the program based upon
that assessment. We find it hard to believe that such an assessment could
occur in time for a January 1, 2009 commencement date. We also believe that
there are ways to achieve ample savings within the Medicare home oxygen therapy
benefit that would, in the aggregate, save Medicare, and the
Congress/taxpayers, millions. By establishment of a payment system that bases
payment on a patient’s clinical need as determined by the prescribing physician
rather than the supplier, and basing those payments to align on the cost
associated with acquisition, delivery, etc., significant savings could be
achieved. It would take, however, aggressive action by the Congress to
implement such changes.
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