August 25, 2017
By Tim Pigg
Despite the many advances that have been made in managing and treating chronic illnesses, there are some conditions that have no immediate cure.
Chronic Obstructive Pulmonary Disease (COPD) is one of them. Though there is no cure, COPD is treatable with a mix of prevention, infection control, and supplemental oxygen therapy. Unfortunately, the sad reality is that once oxygen therapy is prescribed, the patient will remain on it permanently. That’s why it’s important that these patients deserve the best care they can get.
Eleven million Americans are living with COPD – including 55 million Medicare beneficiaries. And although the rate of COPD among Americans over 65 are on the rise, Medicare claims for home respiratory therapy have alarmingly declined over the years. In fact, according to data from the Centers for Medicare & Medicaid Services (CMS), the percentage of Medicare patients receiving home oxygen services declined by 42 percent between 2008 and 2014, while during that same period, the total Medicare population grew by 19 percent and COPD diagnoses among the same group grew by 59 percent.
Although we would like to attribute these declining home oxygen numbers to an emerging cure, or to a new and novel treatment option, the truth is something quite different. It’s a canary in the coal mine: Utilization is on the decline because of Medicare payment cuts have reduced access and impacted beneficiaries in a number of negative ways.
Reimbursement cuts resulting from flawed methodologies in Medicare’s competitive bidding program for home respiratory care have been steadily chipping away at the level of services that beneficiaries have come to depend upon. In some cases, providers are opting to suspend services in specific geographic areas, particularly in rural and remote communities. And while providers have been able to insulate patients from much of the impact, those days are coming to an end. In addition to the greater number of Medicare patients who need home oxygen but aren’t getting it, there are other signs of things going terribly awry.
Nationally, the number of home oxygen suppliers is on the decline. Smaller suppliers are leaving the business, large regional and national companies are leaving states, and closures and consolidations are resulting in thousands of layoffs. For example, one national home respiratory supplier has closed 87 locations in non-competitive bidding areas (CBAs), 44 locations in CBAs, and has laid-off 3,000 employees since the implementation of Medicare’s Modified Fee Schedule. Another large supplier has closed nearly 200 locations in non CBAs, and at least one national supplier has reduced or stopped providing services in rural areas across 24 states.
The unfortunate result, of course, is that there will be a growing numbers of Medicare beneficiaries who will not be able to get the care they need, or can’t get it in a timely fashion. In the most drastic cases, delayed oxygen therapy is keeping patients hospitalized longer. In one rural area, the local hospital couldn’t find an oxygen supplier willing to take on new Medicare patients at the reduced reimbursement rate, delaying patient discharge by several days.
The Centers for Medicare and Medicaid Services (CMS) who oversees the nation’s Medicare program has reported that there has been no access to care issues. We were surprised by that declaration, given CMS’s own data show a marked decline in service, while the population has increased. Our own experience in these markets reflects the same.
In discussions with CMS, the way they measure access to care does not take into account whether a patient can actually access care. CMS measures the “acceptance of assignment” of remaining providers, after a competitor exits the market. However, this does not mean that the patient actually secures access to care. Our own experience with purchasing the assets of liquidated providers shows that approximately 50 percent of the patients maintain access to care after being stranded by their previous provider.
This leaves the remaining patients without care, putting them at risk for respiratory exacerbations and hospitalization. The expense to the healthcare system of one day in the hospital is over 100 times the monthly allowable reimbursement cost for oxygen therapy, so this current policy makes absolutely no practical sense for the patient or the taxpayer who funds the Medicare program.
So why is CMS sticking to policies that could drive patients back into the hospital when in fact it is less expensive to take care of a patient at home? Much of the situation we currently find ourselves in is attributable to the way CMS defines “access.” The Council for Quality Respiratory Care (CQRC) believes that “access” to quality home respiratory therapy means having enough home respiratory therapy providers to give patients a real choice. It means having a reimbursement policy that allows providers to offer a full range of services without having their rates reduced to levels that require major cutbacks. And it means aligning trends in key quality indicators that other Medicare beneficiaries or commercial insurance patients are experiencing.
The CQRC is committed to working with CMS to reform payment policies so that the reimbursement adequately covers the full costs of caring for Medicare’s COPD population while enabling providers to deliver quality care to all patients regardless of their location. And because, as we know, there is no cure for COPD – true quality care and access means ensuring beneficiaries diagnosed with COPD receive the home respiratory therapy they require as the disease progresses, for as long as they need it.
Mr Pigg is President and CEO of Rotech and a board Member of the Council for Quality Respiratory Care.
To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.
Millions of Americans are living with COPD and Obstructive Sleep Apnea, experiencing acute respiratory failure, or living with neuromuscular diseases. These individuals rely upon home respiratory therapies to remain at home. Learn more about home respiratory therapies and how they can help.
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