New Medicare rules on home-oxygen affect patients, businesses

Nov 24 2009

The Wall Street Journal: "New Medicare rules designed to reduce waste and fraud in medical-equipment reimbursements are driving some home-oxygen suppliers out of business and leaving patients scrambling to find new providers." The rules - scheduled to go into effect January 1, apply to people  "who rely on Medicare to pay for oxygen services, which relieve the symptoms of conditions such as emphysema and chronic obstructive pulmonary disease."

"Under the new rules, Medicare pays suppliers at the prevailing rate—an average of $200 a month, paid 80% by Medicare, 20% by patients—for the first three years after a patient begins coverage." From that point on, suppliers are required "to continue providing oxygen services to patients for an additional two years" at a reduced rate. "After that, patients are entitled to receive new equipment." This step is part of efforts by the Centers for Medicare and Medicaid Services, as well as Congress, "to address waste and fraud in reimbursements for so-called durable medical equipment." CMS, which predicts resulting savings of about $220 million in the current fiscal year, maintains that Medicare's payments for oxygen equipment have been too high, and "that payments for the first three years should cover service costs for the two-year gap. Suppliers say those calculations don't account for how much it actually costs to provide services, such as delivering oxygen tanks" (Merrick, 11/24).

Meanwhile, a group of Centers for Disease Control and Prevention ethicists approved a "draft ethical framework" to advise local public health officials about how to allocate resources in a severe influenza pandemic, ProPublica reports. The step moves officials closer to answering - with an anticipated final guidance - "the difficult question of how to apportion mechanical ventilators in a severe influenza pandemic when the demand far exceeds the availability of the treatment," ProPublica reports. The ethicists voted to approve their document during a teleconference Monday. The group also took questions from two members of the public. One caller leapt on the guidance as an example of officials "categorizing patients into what she referred to as 'polite terms for lives not worthy to live'" (Fink, 11/23).