This wasn't the "first diary" I had in mind, and I apologize for its length, but I was contacted this afternoon by my late mother's home healthcare company (based in Knoxville, Tennessee) because the Evil Ones,
, are in the process of doing genuine -- potentially fatal -- harm to untold thousands of U.S. citizens suffering from emphysema, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and other chronic/degenerative respiratory diseases that require the use of portable oxygen tanks, oxygen concentrators, and tubing and other supplies.
I'm rushing to post this, so forgive me for not having nailed down the details yet, but the House will be reconsidering certain provisions of this bill when it reconvenes at the end of the month.
While the remainder of this post is lengthy, it provides excellent talking points, including excruciating and heartbreaking details about the problems the new rules will cause home oxygen users.
I've left in the Tennessee delegation members' votes on the deficit reduction bill. The voting breakdown by party will not surprise you in the slightest.
Date: January 6, 2006
To: All Medicare Patients Currently Receiving Oxygen Services in Their Home
Urgent and Important Notice about Your Medicare Oxygen Benefits
We at Lambert's Health Care are devoted to quality health care for all home care patients. A significant and unfair bill passed the U.S. Senate and House of Representatives just before Christmas break that we feel reduces the quality of your health care services and the value of your Medicare benefits. We feel that you, your family, and your physician should be informed about how this legislation will drastically affect your current oxygen benefits. This legislation, recorded as S. 1932 and called the "2005 Deficit Reduction Act", contains a provision within it that will now limit the rental of your oxygen equipment for only 36 months. After that, the used equipment will be transferred to you, and you will have to take over the supervision of its performance and necessary upkeep. You will become personally responsible for all of its repairs, service, maintenance, and keeping up with all records related to the Food and Drug Administration's (FDA) requirements for its continual safe use. You will no longer receive free 24-hour service, free maintenance and service, or free disposable supplies. You also will no longer receive a free emergency backup tank or receive any free inspection and monitoring of the equipment or monitoring of your use of it. This was all previously provided at no extra charge to you as part of your rental program. If you have received any periodic consultation, education, training, or treatments from us by a licensed Respiratory Care Practitioner (Respiratory Therapists), such services would either be discontinued once the equipment is transferred to your care or billable to you as a separate charge should you continue to require them. Any products and services related to your stationary oxygen needs that are provided to you after that time would be billed separately to you and no longer provided on a no-charge basis as before under your rental program. Once your rental is capped and the equipment is transferred to your care, it will then be your responsibility to manage everything.
Our company prides itself in providing fast 24-hour service to all of our patients who receive oxygen rental equipment and the related professional services from us. We know how vital oxygen is to seniors who completely depend on it at all times to maintain health and continue to reside in their own homes. Although we are concerned about the health of our patients and prefer to continue to provide all their needed services, if this section of the bill is not amended, we will be financially unable to prevent this new policy from adversely affecting Medicare patients on oxygen. We do not feel it is fair for you to be responsible for a complex piece of medical equipment such as this, and we also do not feel it is fair for you to have to make up for governmental budget deficits with your very needed oxygen benefits. Unless this legislation is changed, you will either lose important and vital services or you will be forced to pay additional out of pocket expenses for care you previously received under the rental program at no additional charge. The fact is that it is not possible for the government to cut billions of dollars of your benefits as a result of cuts in this legislation without you and other Medicare patients having to make up the loss out of your own pocketbook.
It is not too late for you to help all of us working with home care patients in this country to stop the completion of this legislation. In order for that to happen, however, Congress needs to know how you feel about this cut in your oxygen services voted on without anyone's prior knowledge just days before Christmas. They need to know that patients need additional home care benefits--not less. They need to understand how difficult it would be for patients and families to be physically, mentally, and financially responsible for this very complex equipment that is so vital to the patient's health.
This bill is called the "2005 Deficit Reduction Act"; however, Congress has not budgeted to reduce its spending or reduce the deficit for 2006 at all. They are actually spending billions of dollars more than last year and adding another 781 billion dollars to our total debt over the next 5 years. They are just reducing certain areas (your Medicare oxygen benefit is one) so that they can continue to spend more on others in addition to the 110 billion dollar tax cut they are giving to the top 2% wage earners over the next 5 years. We do not think this is fair to you and all other Medicare beneficiaries who are dependant on their life sustaining oxygen benefits for their health, well-being, and independence.
If you are as concerned as we are, please, call your Congressman and senators today and request that your physician and your family members do the same. A list of the Congressmen and senators in Tennessee as well as a record of their initial vote on this is attached with this letter for your convenience. PLEASE CALL YOUR CONGRESMAN FOR YOUR DISTRICT FIRST as they will be voting on this again as soon as they return to Washington after their holiday break. We have also provided you with two detailed information sheets explaining the oxygen benefits you have today and a detailed information sheet explaining the benefits eliminated and how it will now effects you. After reading this information, you will see how dangerous and unwarranted this Medicare cut will be and how it will negatively impact your health and financially burden you and your family. These information sheets describe for you in specific detail the effects this legislation will have on you personally based on the particular type of oxygen equipment you currently are using. We believe that once Congress actually hears from you how this will negatively impact you and your family and put your health in danger, they will vote NO to S. 1932 when it its is reconsidered again in January. Please call them today and let them know your concerns.
Sincerely,
Randy Wolfe, President
Lambert's Health Care
Attachments
CC: AA Homecare Association
American Association for Retired Persons (AARP)
American Lung Association
Knox County Health Department
Knox County Office on Ageing
National Family Caregivers Association
Tennessee Association for Home Care
Tennessee Lung Association
Tennessee Nurses Association
Tennessee Society of Respiratory Care
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Oxygen Concentrators
R E N T A L O V E R V I E W
Summary of Current Program in Place for Patients Renting Oxygen Concentrators in the Home Medicare currently pays a flat fee for the rental of an oxygen concentrator. This single flat fee is described as a "bundled" rental fee under Medicare guidelines that includes the patient's concentrator machine as well the provision of all the related supplies and services associated with the machine. This fee is expected to cover all costs the oxygen provider incurs that are associated with the provision of the rental unit. Among those includes the cost for all necessary internal and external replacement filters, all preventive maintenance service calls, and all repairs needed on the machine while rented. Should the machine become inoperable and unrepairable, this rental fee is to cover the oxygen provider's cost for replacing the machine with another one. A recent oxygen supplier survey in Tennessee taken by the Tennessee Association for Home Care [TAHC] revealed that of the suppliers surveyed between 18% and 40% of the oxygen concentrators on rent are exchanged and replaced each year with different units. These exchanges are made by the providers due to equipment repair, service, and maintenance needs that cannot be reasonably performed in the home. As a rental item, these exchanges are done in the patient's home with no significant inconvenience to the patient. In general, the rental fee covers everything associated with the providing an uninterrupted supply of oxygen to the patient as well all costs for providing the patient with his/her monthly respiratory supplies to be used with the machine. The supplies covered includes oxygen supply tubing, humidifiers, nasal canulas or face masks, water traps, and any other disposable oxygen supply circuits and attachments ordered by the patient's physician that are needed for the delivery of oxygen to the patient. As with all other rented equipment, this bundled fee covers the initial and ongoing training of the patient and/or the family for proper use and care of the equipment. Lastly, this fee is also to cover the oxygen provider's cost for the required ongoing monitoring of the patient's use of the equipment to insure that the equipment is being properly utilized according to the physician's written orders.
The oxygen concentrator is a highly sophisticated, complicated, and sensitive item of equipment. It operates by compressing room air into and through a group of pneumatically sealed containers filled with sieve material that filters the nitrogen out of the room air, leaving a highly enriched oxygen concentration of air that is approximately 93% to 95% pure oxygen. This process is achieved by directing the air through a series of pneumatic pressurized chambers under timed cycles controlled by pressure sensors and gages. At no time can there be any pressure leaks or significant variances in the synchronization of the air exchanges in the system. When variances occur over time, the oxygen concentration will begin to drop. If they persist, the concentration levels can drop as low as 30% to 40% and even as low as normal room air. When the levels drop to substandard oxygen concentration levels over a period of time, the machine can also start to experience other problems including the contamination of the machine's sieve beds. Sieve beds are small granular beads inside the sealed metal chambers or canisters that filter the nitrogen from the air, leaving only highly enriched oxygenated air delivered to the patient. Leaks to the sieve bed chambers can result in an extensive repair cost to the machine but more importantly can cause damage to the patient, as the patient also will not receive adequate oxygen intake once the sieve beds are compromised. If the machine's pre-filters and internal filters are not cleaned and changed according to factory guidelines, the machine will also overheat and begin to destroy the soft pliable hoses within the unit. Once these hoses lose their ability to seal around internal gaskets, the machine will also begin to lose concentration and complete the downward cycle of equipment failure.
Although there are mechanisms and built-in alarms in some models of the machines that can indicate a corruption in the airflow seals and detect significant drops in pressure, they are by no means fool proof. Many of these self-detecting sensors only alarm when the concentration has fallen well below the concentration necessary to provide the patient with his/her prescribed needs. Some machines can appear to be working properly and not show any outward sign of problems until an oxygen analyzer is put on the machine's output to test its concentration levels. The oxygen analyzer is a small calibration device that measures the oxygen concentration output of the machine. This again is one of the routine services oxygen providers perform on all rented concentrators before and during the rental episodes. Preventative maintenance is a service provided at no extra charge by providers and is performed on the rental machines at the patient's home during the rental episode. It is done to prevent future equipment failure and minimize future repair needs. It is also done to further insure that the equipment is producing the prescribed level of oxygen that the physician has ordered. Although preventative maintenance is performed as part of the rental program, it is not in itself a separate Medicare covered charge for equipment owned by patients. Medicare, as well as most health care insurance programs, does not routinely provide benefits for preventative health care services or for preventative equipment that can potentially prevent an illnesses or injury. Examples of items not covered as for preventative value are bathtub benches or grab bars around the bathroom. In keeping with this philosophy, Medicare also does not provide preventative inspection and equipment analysis to patient-owned medical equipment regardless of how beneficial such inspections and preventative care may end up being. This would be a dangerous problem for patients whose oxygen equipment has not shown signs of equipment failure yet is not producing adequate levels of oxygen.
Oxygen concentrators run on electricity. They attach to any well grounded, home utility electrical circuit. During any time of equipment malfunction or equipment failure, continuous use can likely further damage the machine. The machine should be turned off any time the machine alarm sounds or when it appears to be running louder than normal or feeling hot to touch. Under the rental program, patients and families are advised to call their oxygen provider when the machine does not run properly. Although many of the problems with oxygen concentrators are due to improper attachment of tubing or humidifiers to the machine itself, most patients are unable to determine what is wrong without assistance of a medical equipment technician. All rentals of oxygen equipment include, at no extra cost, 24-hour emergency service. Most service calls that require adjustments, repairs, or exchanges will be done within two to four hours of the call. During such equipment failure, patients are advised to change over to their free back-up oxygen gas filled tank until the technician arrives at their house. This back up gas tank is provided by the rental company as a free service as part of its 24 hour-service to patients renting oxygen equipment so that the patient will not have to call 911 for assistance between the time that the equipment first fails and the technician arrives at the patients home.
Oxygen concentrator machines can be damaged over a period of time when placed too close to a wall or piece of furniture which occludes the air intake opening. They can also be damaged by the excessive use of baby powder or other dry particle agents used in a patient room for incontinence. Use of such airborne powders can cause clogging of the pre-filters if not replaced or cleaned frequently in such environments. Restriction of air intake to a concentrator causes the machine to overwork to compensate for the reduced air flow into the machine and eventually will result in overheating and damage to the machine. Patients and caregivers should pay special attention to always ensure that the air intake remains open and unobstructed. When patients plan to travel and take their machine from one residence to another, it is recommended that they always contact their equipment supplier first to make sure it is advisable for the equipment to be moved by their caregivers or through special arrangements made by the oxygen provider. Special attention should always be given to care for the machine when in transit. Certain manufacturers' service and maintenance guidelines state that the machines should never be turned on their side in order to prevent breaking of seals in the airway connectors.
Overall, your machine is a reliable and dependable medical device. However, as with all medical devices covered under the Federal Drug Administration (FDA) Medical Device Tracking Act, it must be monitored and cared for properly in order to insure continual safe use. As a FDA device, the machine is eligible for recall and patient health and safety tracking log reporting of injury or death occurrences caused by its design or other mitigating causes of its manufacturer. As required by law, the supplier maintains compliance with the FDA tracking requirements while the supplier owns the unit. This is another service covered and provided for by law as long as the oxygen provider owns the equipment.
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Oxygen Concentrators
36-MONTH LIMIT RENTAL OVERVIEW
S. 1932 Legislative Bill
Oxygen Equipment and Services Medicare Benefit Cuts Summary
Under the proposed S. 1932 Legislation, Medicare would now only allow patients to rent oxygen concentrators and related oxygen equipment provided with it for up to 36 months. Earlier versions of the bill limited the rental to as little as 18 months. Placing any monthly cap limit on this benefit is a drastic and dangerous change to the oxygen benefit currently in place that now puts no limit on the coverage of oxygen rented to the patient. Current Medicare benefit guidelines as well as those for all major national insurance companies, state Medicaid programs, workman's comp benefit programs, and all home care industry accreditation organizations have always classified oxygen equipment as "high maintenance equipment needing frequent maintenance service which is not recommended or advisable for patients to own".
Under this new pending rule, Medicare will stop paying for the rental, and the provider will no longer be involved the patient's care or management of his/her oxygen concentrator after 36 months. According to Congressional reports, the average patient rents such equipment for 30 months. By capping the units at 36 months, Congress will be cutting off rental benefits to as many as 15 to 20 percent of all Medicare patients on oxygen. Patients will no longer receive free 24-hour service on the equipment, and they will no longer receive any free service. They will have to be financially responsible for each service provided. This includes preventative maintenance and routine inspections of the equipment. Repair and necessary service to the machine will now be billable to the patient and assignment will only be accepted by the oxygen provider on a case-by-case basis. There is also concern that oxygen providers may not accept assignment on the historically low Medicare fees for repair of medical equipment for patients they no longer provide rental services for since some of Medicare's fees do not even cover the provider's wholesale cost.
Some industry experts are concerned for the patients who live far away from the oxygen provider's offices. These patients in particular may find it very difficult to find a provider who will service their owned, used equipment once the equipment has been transferred to the patient. Medicare does not pay for delivery and pick-up charges for such services. This will make it even more difficult for providers to accept assignment on any repairs that would be done in the home. Under the proposed plan once the rental caps, title and all responsibility for the used equipment will simply be transferred to the patient. At that time, the oxygen provider will no longer be responsible for any of its upkeep. If there were any warranty remaining, it would be managed and controlled through the manufacturer of the product. Any warranty claims made would now bypass the provider and ultimately be processed by the manufacturer. As with all factory warranties on sold equipment, this will now have to be processed through the procedures required by the manufacturer. This will likely cause delays in processing repair work for patients or force patients to accept financial responsibility for repairs until warranty authorizations are approved by the factory.
When patient owned non-working equipment is being repaired or reviewed by the factory for a warranty determination, the patient will be financially responsible for the rental of a temporary replacement unit. There is no factory warranty that covers this. Most warranties on oxygen concentrators are only for 3 years from the date the supplier purchases the machine. The net effect will be that after 36 months of rental, the patient will be 100% responsible for managing and caring for the non-warranted item. A three year old oxygen concentrator can have as many as 26,000 hours of use on it at the time it is transferred to the patient. Based on the average life of an oxygen concentrator, this is equivalent to owning a typical American automobile out of warranty with over 100,000 miles on the odometer.
Once the patient owns the equipment, the supplier will have no obligation to provide free 24-hour service on the equipment. This is a service that is provided at no additional charge for rental equipment owned by the supplier. Free emergency backup tanks for power outages and equipment failure will be picked up or billed to the patient privately as this is also a service pertaining to the rental equipment owned by the oxygen provider. Duplicate equipment, such as the backup tank, has never been a covered service billable to Medicare. Patients wanting a backup tank as well as patients wanting to be covered by a 24-hour service contract will have to pay privately for them. Patients who are unable or unwilling to make financial arrangements for 24-hours service capability will be advised to keep several family members aware of their dependence on oxygen and their need for assistance should there be inclement weather or other events that may cause an interruption in electrical power to their home.
Patients who are unable to move freely throughout their home without assistance, who are vision impaired, who have periods of confusion related to their condition, or who live alone will be most affected by this new change. These patients will be in the most risk of being unable to care for their equipment or to know when it needs service or how to manage the new financial arrangements for the service each time it is needed. Such patients are advised to find other family resources or community services to assist them in the managing and monitoring of their equipment needs.
Patient-owned equipment will not be managed for billing of services the way rental equipment is managed. Each time an oxygen provider is called out to check on the equipment, regardless of there being anything wrong with it or not, a separate charge will be billed to the patient. Patients or family members who need re-education and retraining on the use of the equipment will also no longer receive these services free. Service calls after-hours, if available, will be billed at a higher rate than service calls during working hours. Service calls will no longer be free of charge. Equipment that cannot be repaired at the patient's home will have to be retuned to the provider's office for repairs or sent to the factory. All repair parts and labor will be billed separately. Additional charges will also be billed for substitute equipment left with the patient while repairs are done elsewhere. Equipment that cannot be repaired will result in the patient having to be responsible for the purchase of replacement equipment should Medicare not cover the cost of its replacement. Medicare does not provide for the replacement of medical equipment (i.e. wheelchairs, walkers, and hospital beds) that has been owned by the patient unless it has been damaged beyond repair by fire or accident or unless it has been purchased for over five years and then becomes inoperable and unrepairable. As with all other Medicare-covered equipment purchased by Medicare, should the patient want a different brand, model, or type of concentrator once title is transferred for the one they have been renting, they will not be eligible to exchange it for one until their existing unit is no longer repairable. Medicare currently does not recognize the difference in the different types of oxygen concentrators currently available to patients. As new technology arrives in the marketplace, patients will not be able to swap their old units in and receive any reimbursement from Medicare for the upgraded newer unit.
Under the new rules, once the used concentrator is owned by the patient, all supply tubing, humidifiers, nasal canulas, water traps, and any other disposable oxygen supply circuits and attachments will be separately billed to the patient. Again, as with repair charges, the acceptance of assignment by suppliers for each item sold will be on a case-by-case basis by each oxygen provider. A provider's decision to accept assignment will be based on the reasonableness of the fee allowed by Medicare for each item. Currently the fees for these items are extremely low and in some cases do not cover the providers' cost.
Under the new rules, patients who move or travel will have to either take their own equipment with them or pay privately for another company to rent them replacement equipment where they will be staying. Under previous rules for oxygen coverage, patients wishing to travel to areas outside their provider's coverage area could do so at no charge to the patient. Their home oxygen provider would continue to bill for monthly rental and make separate arrangements for another company to provide the same equipment and service to the patient in the area the patient is staying (even if out of state). The home company, as required by Medicare, would pay the out of state company for its use on behalf of the patient when the patient stay was to be temporary. This service has been widely used for patients who stay with family one part of the year and with others during other parts of the year. This also has been used for patients visiting other parts of the country for extensive outpatient medical treatments requiring them to stay for weeks or months at a time. Under the old plan, if the patient needed to travel for a longer period of time or move to another area, the patient would simply change suppliers and receive their oxygen equipment and necessary services from a different rental company in the new location. This will no longer be available for patients who own their own equipment. Medicare will no longer pay for the rental of the equipment once the patient owns his or her own equipment.
Requirements necessary for Federal Drug Administration (FDA) tracking would now have to be maintained by the patient or their caregiver should a recall occur for the particular medical device (concentrator) owned by the patient. Providers are required to notify individuals who have purchased medical equipment subject to a recall under the FDA Medical Device Act. Such contact must be made by certified mail and by phone. Unless the provider is given all future address changes for patients, the patient would not receive such a recall notice. Special attention would need to be given to patients and their families who would now be personally responsible for receiving and acknowledging such recall notices. If the patient cannot keep up with such records, he/she would have to appoint a family member or other dependable party to be responsible for such communications.
The following are phone numbers of the Congressional House of Representatives and Senators for Tennessee and a record of how they voted on this legislation at the end of December 2005. Because of a technicality, this legislation will have to be reconsidered by the House of Representatives again for a repeat vote in January 2006. You now have an opportunity to contact them before they vote again and ask them to change any yes vote to a NO VOTE in order to prevent the elimination of your important oxygen service benefits. It is also important to thank and encourage those who voted NO in December.
Tennessee House of Representatives contact information:
Marsha Blackburn (R-7th District) Voted Yes
DC Office 202.225.2811
Franklin Office 615.376.2324
Jim Cooper (D-5th District) Voted NO
DC Office 202.225.4311
Nashville Office 615.736.5295
Lincoln Davis (D-4th District) Voted NO
DC Office 202.225.6831
Columbia Office 931.490.8699
John J. Duncan, Jr. (R-2nd District) Voted Yes
DC Office 202.225.5435
Knoxville Office 865.523.3772
Harold Ford, Jr. (D-9th District) Voted NO
DC Office 202.225.3265
Memphis Office 901.544.4131
Bart Gordon (D-6th District) Voted NO
DC Office 202.225.4231
Murfreesboro Office 615.896.1986
William Jenkins (R-1st District) Voted Yes
DC Office 202.225.6356
Kingsport Office 423.247.8161
John Tanner (D-8th District) Voted NO
DC Office 202.225.4714
Union City Office 731.885.7070
Zach Wamp (R-3rd District) Voted Yes
DC Office 202.225.3271
Chattanooga Office 423.756.2342
Tennessee Senators contact information:
William H. Frist Voted Yes
DC Office 202.224.3344
Nashville Office 615.352.9411
Lamar Alexander Voted Yes
DC Office 202.224.4944
Nashville Office 615.736.5129
Call Congress today and tell your Representatives you do NOT want your home oxygen benefits cut. Tell them to VOTE NO on S. 1932.
(I have to remember to wear something a bit spiff to work tomorrow because I might end up on the local ABC affiliate's newscast. Gulp. Xanax.)