By DENISSE RAUDA
Scripps Howard News Service
December 16, 2008
The 43-year-old Abilene woman's scoliosis led to a restrictive lung disease that makes breathing assistance a necessity for her.
"I can go without it for short periods if I'm not going to do anything active and (am) being monitored," Felix said. "But if I were to do anything active or have anything else that would restrict my breathing. Then I could drop really fast."
Medicare has covered most of Felix's oxygen costs up until now, but new provisions that take effect Jan. 1 may put a kink in the oxygen tank tubing.
Medicare has determined service providers with patients who have received oxygen for 36 months or longer will no longer be reimbursed for rental of equipment or unscheduled maintenance come January.
This comes after Congress passed the Deficit Reduction Act of 2005 that imposed budget cuts in various programs such as Medicare. Since then, Medicare has readjusted cuts in its release of the Medicare Improvements for Patients and Providers Act in October.
Nevertheless, the revision of the budget still impacts the home oxygen community.
Oxygen and equipment providers will still receive some compensation, according to the Centers for Medicare and Medicaid Services' Web site. The compensation will be for service and maintenance every six months and monthly fees on refills after the cap going into effect in 2009.
For refills, Medicare is just tossing out an amount, said Pat McElrath, director at Hendrick Medical Supply that services Felix's oxygen.
"But it's one payment no matter how much oxygen they receive in a month's time," McElrath said. "The supplier will also then be required to service the equipment and to be available for service anytime the patient needs it without reimbursement."
After the 36-month cap, service providers will be expected to "continue furnishing the equipment, supplies and accessories for any period of medical need for the remainder of the reasonable useful lifetime of the equipment," the Medicare Web site said.
Hendrick Medical Supply has assured Felix she will remain covered, but Felix said she's concerned she may have to start counting her breaths.
"I'll have to think not only do I have to budget for every out-of-town trip I ever make," she said. "But I have to budget any breathing I have to do basically."
Like Felix, many home oxygen patients are worried they're going to lose their benefit come January.
Patients are "afraid that the quality of service that they receive is going to be affected," McElrath said. "And since they depend on the oxygen to breathe, they're afraid they're going to be left in an emergency situation because of the lack of reimbursement for emergency service."
Hendrick Medicare Supply serves about 450 patients, a third of whom will reach the cap by Jan. 1, McElrath estimated.
Despite this, McElrath said Hendrick is "trying to identify the best way to continue to ensure that our patients get quality service."
As for Felix, she said she couldn't believe the government would put oxygen patients aside but give households up to two $40 coupons to buy digital television converters.
"They can sit up there and decide that I don't have the right to breathe as much oxygen as they want to pay for, but everyone deserves to have two perfectly working televisions?" she said.
Distributed to subscribers for publication by
Scripps Howard News Service, http://www.scrippsnews.com
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