Gray Matters: Medicare oxygen policy short of breadth

Like tossing out the baby with the bath water, Medicare is saving money for the taxpayers by depriving seriously ill people of life-giving oxygen, forgetting that taxpayers are also patients.

That's what made Kenneth C. Martin, of Cape Girardeau, Mo., so angry that he fired off letters to newspapers and federal lawmakers on July 10, "to make the public aware of how dangerous our Medicare system really is to its patients."

Martin, who runs a small medical equipment company, was called to a hospital a few days earlier to provide oxygen to Patricia Cox, 76, of Thebes, Ill.

She had passed out because her oxygen equipment was not working properly and her supplier, Lincare, had not responded to her call to fix the equipment, according to Martin.

Martin explained, "Thanks to recent Medicare cuts in oxygen therapy . . . she was a 'capped' patient so the company, though owning the equipment, was not being paid by Medicare to go to her home and fix the equipment."

Cox spent a week in the hospital ($4,000 paid for by Medicare), Martin said, and switched her oxygen service to his company.

Cox's daughter, Mandy Schnepper, told me that Lincare called her mother only after the incident to find out why she had switched suppliers.

Lincare was supposed to inspect the equipment at least every six months, but Schnepper said the most recent inspection tag on the equipment was dated Oct. 16 (2008).

In an e-mail answer to my e-mail to Lincare asking for comment, the company responded: "We have looked into the matter and do not believe that your facts with respect to Lincare are correct. We do not expect to correspond with you further on this matter.  . . . we respect patient privacy, as it is required by law." It was signed: "Sincerely, Lincare."

Cox is one of thousands of oxygen-dependent Medicare beneficiaries who are in danger from coverage guidelines, which, among other things, limit required maintenance visits by suppliers to once every six months, instead of monthly, which had been required. That's one of several money-saving changes affecting 1 million Medicare beneficiaries who depend on oxygen to keep breathing.

Public relations consultant Crystal Wright speaks for small, independent medical equipment and oxygen providers, like Martin.

They are threatened, she said, by the money-saving changes passed under the 2005 Deficit Reduction Act (DRA) that placed limits on Medicare benefits, including oxygen therapy.

Lawmakers who were hostile toward Medicare concluded that Medicare was paying too much for oxygen equipment and maintenance.

As a result, the Centers for Medicare & Medicaid Services in January 2006, imposed a 36-month "cap" on payments to suppliers. But they were required to continue the service for two more years, with maintenance visits only every six months.

Thus, instead of simply changing the price structure for providing and maintaining oxygen therapy, Medicare reduced the cost of oxygen by paying for 36 months but requiring suppliers to provide two more years of service, without payment and with fewer maintenance visits. This amounted to a 30 percent cut for oxygen suppliers.

As of Jan. 1, said Wright, the 36 months were up and, as a result, providers will remain unpaid for two more years, after which time they and their patients must go through the process of applying through their doctors, and perhaps taking breathing tests, to obtain a continuation of their oxygen.

Wright's client, the National Association of Independent Medical Equipment Suppliers, wants legislation to return to former provisions, when Medicare paid most of the cost of the rental of oxygen equipment and a relatively small monthly maintenance fee.

The nonpartisan Center for Medicare Advocacy said in April, "Many beneficiaries are frightened by supplier uncertainty.

Suppliers are concerned about payment and maintenance of oxygen and oxygen equipment."

Lawmakers in this congress agree that current regulations and guidelines are cumbersome and confusing for patients and suppliers.

But the large national companies seek legislation that would continue the cap and the cuts and the competitive bidding that gives the big companies an economic advantage, Wright said.

Martin wrote, "In a year, when my father retires he will become a hostage to this whole system we call Medicare . . . He's an oxygen patient and will rely on the same ridiculous Medicare 'reimbursement' scam that the woman that prompted this letter nearly died from."