A coalition of pulmonary health groups called on the Centers for Medicare & Medicaid Services (CMS) to change its supplemental oxygen reimbursement policy to remove liquid oxygen from competitive bidding requirements.
The American Lung Association (ALA), the American Thoracic Society, the COPD Foundation, and 17 other groups said that competitive bidding has dramatically reduced access to portable liquid oxygen among oxygen-dependent patients with the most severe lung diseases, leaving thousands of patients home-bound and tethered to home-based high liter flow oxygen systems.
On Thursday, the groups sent a letter to CMS commending the agency for recognizing the scope of the problem, while recommending specific changes to improve access to portable oxygen for those who need it most.
“Over the last 10 to 12 years the changes in reimbursements to (oxygen) suppliers, most notably competitive bidding, have represented something of a perfect storm resulting in the most dependent patients not getting the types of oxygen they need to meet their clinical needs and their quality-of-life needs,” ALA spokesperson Erika Sward told MedPage Today.
Liquid oxygen is required for people who need high liter flows of oxygen (>6 liters/min), and is most often prescribed to patients with advanced chronic obstructive pulmonary disease, pulmonary fibrosis, or other advanced lung diseases.
Home-based high-flow systems typically require bulky ancillary humidification systems. Without access to portable liquid oxygen, patients who require high-flow oxygen are mostly home-bound.
Sward noted that by reducing compensation to suppliers, competitive bidding has been largely responsible for a 10-fold reduction in the number of Medicare recipients receiving portable liquid oxygen.
According to Medicare records, just 8,141 Medicare recipients with advanced lung diseases received portable liquid oxygen in 2016, compared with 80,571 in 2004.
In the letter sent to CMS, the 20 lung health groups noted that there has been no change in respiratory disease patterns that would explain the sharp decrease in utilization of liquid oxygen systems.
“No differences or advancements in treatment of respiratory disease can explain the decrease; nor has there been a new ‘disruptive’ innovation or technology that has pushed liquid oxygen systems aside for a more novel technology,” the letter stated.
Karen L. Erickson of the Alpha-1 Foundation, who is a double-lung transplant recipient, has seen first hand the hardships patients with high-flow oxygen needs have faced due to lack of access to portable liquid oxygen: “We heard from someone who had been getting portable systems, and all of a sudden one day the provider dropped off a five-foot tank with a 50-foot hose,” she told MedPage Today. “[The patient] was suddenly tethered to an oxygen supply and couldn’t do much of anything. She could reach the bathroom, but not the laundry.”
Late last month, the U.S. Government Accountability Office released a report examining CMS competitive bidding programs, including supplemental oxygen. The report identified a 10% decline in supplemental oxygen suppliers in the U.S. between 2015 and 2016 alone.
Sward said while provider reimbursement is largely responsible for reduced access to portable liquid oxygen, the problem has been exacerbated by lack of enforcement of requirements that suppliers provide the oxygen when physicians order it.
The health groups addressed this in their letter to CMS: “We believe there is a huge disconnect between statutory requirements, contractual requirements, and the actual delivery of supplemental oxygen therapy in general, and more specifically as it relates to liquid oxygen,” the groups wrote. “Competitive bidding contracts stipulate that suppliers MUST provide liquid when ordered by a physician and is clinically justified by that physician.”
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