Pending Issues

Letter to the New York Times from Jon Tiger, President

My name is Jon Tiger and I am the President of the National Home Oxygen Patients' Association (NHOPA). Our purpose is to improve the lives of patients requiring supplementary oxygen (O2). In pursuit of our purpose, the NHOPA takes steps to get our members involved in influencing the direction of administrative and legislative decisions that affect O2 patients. Our motive is different from the suppliers and we don't use 'fear' but the results may appear the same.

I found Mr. Duhigg's November 30, 2007 New York Times article, "Oxygen Suppliers Fight to Keep a Medicare Boon", reminiscent of the 1980's reporting on the $900 pair of pliers that Boeing sold to the DOD. The reporters covered only Boeing's part as the seller without addressing the DOD responsibility in writing the specifications for the pliers and agreeing to the price. The difference between these scenarios is that no individuals were affected as a result of the pliers purchase. There are over a million individuals affected by changes in the payment structure for prescription oxygen.

As a 12-year, full-time O2 user who works full-time, I don't want to see my tax dollars wasted on anything. And I agree there is plenty of room for improvement in Medicare reimbursement. Approximately 80-85% of O2 patients in the United States are on Medicare. Oxygen and O2-related equipment are controlled by physician order and medical prescription. Oxygen is frequently prescribed to people who are hospitalized for acute medical conditions, and sometimes there is an underlying chronic ailment, most commonly chronic obstructive pulmonary disease (COPD). Upon discharge, the releasing physician continues the O2 prescription for home use. Suppliers are required to fill the prescription and there is no requirement that the patient be retested to determine if continued O2 use is needed. We believe that probably 30% of people receiving O2 have no on-going medical necessity. Patients whose initial O2 prescription is due to hospitalization should be retested between 60 and 120 days following discharge. We (along with pulmonary medicine societies) made this recommendation to Congress and CMS over a year ago and no action has been taken.

Mr. Duhigg states that "Medicare pays the same rental amount to provide each patient…regardless of how often they are used", and "…Medicare overpays for the many patients who require less…” There are basically three classes of equipment - stationary, portable, and ambulatory. Along with the physician societies we proposed to Congress and CMS that reimbursement should be aligned with those classes to reflect actual patient need. Our intent is to maintain a cost-neutral position yet reimburse patients differently in relation to their medical diagnosis and the prescribing physician's recommendation. Physician groups have committed to write the protocols differentiating these classes. This plan would pay a lesser amount for homebound patients who require stationary equipment, and more for active patients who require ambulatory equipment. CMS chose to take no action on this proposal either. Congressional action is still possible, although admittedly wishful, considering that suppliers oppose this realignment.

It appears the intent of this article was to cast a poor reflection on the supplier community, and Mr. Duhigg has succeeded. Unfortunately in doing so, he has painted the patients with the same brush. Rest assured that no one wants to be on supplemental oxygen. It is a traumatic experience that is reinforced daily by the tether one wears and by the CMS payment structure which continuously shorts the radius.

Original Article in New York Times, Nov. 30, 2007: http://www.nytimes.com/2007/11/30/business/30golden.html

Additional Information: Principles Supported by NHOPA Regarding Medicare Coverage & Payment of Oxygen Therapy