Home Health & Hospice Week

Oxygen, wheelchairs are under the budget ax.

President Bush wants to heap even more reimbursement cuts on suppliers, before the latest round have even taken effect.

Grim news: The President's 2008 budget proposal calls for a new 13-month rental period for power wheelchairs and a reduction to the capped rental period for oxygen from the 36 months passed in 2005 to 13 months.

"Medicare payments for some medical equipment are substantially greater than costs, increasing both taxpayer and beneficiary spending," the President's summary of his budget proposal says. "The Budget proposes to update these policies ... to bring payments for medical equipment more in line with costs."

Rationale: Establishing a 13-month rental period for power wheelchairs would "ensure that Medicare and its beneficiaries no longer pay excessively for the purchase of equipment that could have been rented," the Department of Health and Human Services says in its budget summary.

And reducing the rental period for most oxygen equipment from 36 to 13 months would lower Medicare and beneficiary spending, HHS notes.

More than 95 percent of beneficiaries choose to purchase a power wheelchair, notes the American Association for Homecare. In 2005, the Senate debated imposing a rental period on chairs and decided against it.

Beneficiaries often need wheelchairs for a long time and the chairs are individualized to their needs. "These are not commodity items," AAHomecare argues.

A rental period would reduce beneficiaries' access to the equipment, the trade group adds. "The supplier will be unable to cover the significant up-front service costs that go into the provision of the most appropriate power mobility device to accommodate the beneficiary's needs."

Oxygen Cuts Would Drive Up Hospital Costs, Expert Warns

The reduced rental period for oxygen is too much too soon, the trade group argues. The 36-month rental cap is still new and patients haven't hit the cap time yet. "The Medicare home oxygen benefit is still experiencing the impact of several years of cuts enacted by Congress as part of the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005," warns the Council for Quality Respiratory Care, an alliance of 11 of the country's largest oxygen providers, in a release.

"Home oxygen has been the target of budget cuts for many years," AAHomecare agrees: "Congress has reduced Medicare reimbursement for oxygen therapy by nearly 50 percent over the past 10 years."

The reimbursement cut the proposal calls for is a "potential disaster," warns Thomas Petty, M.D., a leading home oxygen therapy researcher and professor at University of Colorado in Denver and Rush Presbyterian St. Luke's Medical Center in Chicago. Home oxygen "adds quality years of life to over a million Americans," Petty says in the CQRC release. "Any reduced reimbursement will lead to increased hospital costs, and human suffering." 

Note: Details about the Medicare-related budget proposal items are in the HHS budget documents at www.hhs.gov/budget/docbudget.htm.