The Council for Quality Respiratory Care (CQRC)—a coalition of oxygen therapy providers and manufacturers—commended lawmakers in the House Ways & Means Health Subcommittee for reviewing legislation to improve the Medicare program, including the Patient Access to Durable Medical Equipment Act (PADME). The PADME Act—bipartisan legislation widely supported by the respiratory care community—will extend the implementation of severe Medicare cuts to durable medical equipment (DME).
The PADME Act delays cuts to home oxygen supplies and services that began on January 1 and are scheduled for full implementation on July 1. The cuts are the result of the Centers for Medicare & Medicaid Services (CMS) applying competitive bid rates used in urban areas to rural and other noncompetitive bid areas that Congress specifically excluded from the DME competitive program. The CQRC warns that more time is needed to observe and analyze the impact of the cuts on beneficiary access before additional cuts take effect. While home oxygen leaders caution cuts could put access to high-quality home respiratory therapy at risk, they also warn cuts could result in higher overall Medicare spending due to increased hospital admissions.
“In many parts of the country, the amount paid for these services doesn’t cover the cost so it could decrease availability,” says Congressman Tom Price, MD— referencing a 20% decrease in the number of DME providers in his home state of Georgia. “Patients’ lives are literally at risk,” he adds. “The National Minority Quality Forum has data that demonstrates it is driving up costs by avoidable hospital bills and increasing out of pocket payments by patients. It has led to increased mortality and hospitalizations and higher costs for Medicare beneficiaries.”
Home oxygen leaders stress the importance of consistent and uninterrupted access to home respiratory care, particularly for patients managing chronic obstructive pulmonary disease who are vulnerable to hospitalizations and readmissions and reside heavily in rural areas. The CQRC and other leaders across the DME provider and supplier communities have warned that: “Six months is not enough time to monitor disruption in Medicare beneficiaries’ access to the DME items they need, and to evaluate what impact major reductions in payment have on their access to life-sustaining equipment and services.”
Further underscoring the need to slow down these cuts through the PADME Act is a new report from the Office of the Inspector General, which raises serious concerns about the appropriateness of the current competitive bidding rates because unqualified suppliers’ bids were included to set the rate. The OIG found that 43% of the awarded contracts were given to suppliers that had not met state licensure requirements. If non-licensed providers had been excluded from the program when the rates were set, the competitive bidding rates would be higher than those that CMS is trying to apply on July 1.