A Medical Device Daily

An article that appeared in last Friday’s The New York Times, charging that the Centers for Medicare & Medicaid Services pays considerably more than what a consumer would pay for oxygen over the counter, is drawing ire from many oxygen provider companies.

The article says that a basic setup, including three years of deliveries of small oxygen tanks, can be purchased from pharmacies and other retailers for as little as $3,500, or about $100 a month. But CMS rather than buy oxygen equipment outright, rents it for 36 months before patients take ownership, and pays for a variety of unnecessary services, at a cost of more than $8,200.

According to an analysis of federal data by The Times, oxygen isn’t the only thing that Medicare pays more for. It alleges that Medicare spends billions of dollars each year on products and services that are available at far lower prices from retail pharmacies and online stores.

In response, the American Association for Homecare (AAH; Arlington, Virginia) issued a statement saying that “The fundamental flaw in The New York Times article is the dangerously simplistic assumption that oxygen therapy delivered to Medicare patients in their homes should cost the same as the Internet or eBay price to buy the equipment only.

“The reality of serving this population is very different. A 2006 study by Morrison Informatics gathered and analyzed data from homecare providers that collectively serve more than 600,000 Medicare beneficiaries receiving oxygen therapy in their homes. That number represented more than half of the Medicare population receiving oxygen therapy at home. The study found that nearly three-quarters (72%) of the cost of providing oxygen therapy to Medicare patients in their homes represent services, delivery, and other operational expenses that benefit patients. Only about one-quarter (28%) of the cost represents the oxygen equipment itself. These service costs have not been factored in to any of the government-sanctioned studies.”

The Times also charges that the oxygen providers mobilize their customers to fight federal cutbacks

“[The companies] ask their elderly customers to serve, in effect, as unpaid lobbyists, calling and writing to their representatives in Congress, protesting at rallies, and even participating in political attacks against individual lawmakers who take on the issue,” the article says.

AAH answers that this perspective does not represent “the realities of serving the Medicare population and COPD patients in particular, Congress has enacted numerous cuts to oxygen over the past decade, reducing Medicare payment rates for oxygen therapy by nearly 50%. Moreover, oxygen payments are scheduled to be reduced by an additional 19% over the next two years because of previous legislation, regardless of congressional action this year, it added.

According to AAH, the home oxygen benefit is vital to restraining Medicare’s costs by reducing more serious illness and hospital stays.

“Respiratory therapy in the hospital can cost Medicare more than $4,600 per day. In 2002, there were 673,000 hospitalizations for COPD with an average length of stay of 5.2 days. A government study by the Agency for Healthcare Research and Quality and other multiple clinical studies conclude that once a patient goes on home oxygen therapy, he or she has 10 fewer days in the hospital per year, saving $46,000 per year in hospital costs alone.”

The organization said it makes much more sense “to spend $2,400 to save more than $40,000,” AAH said.

NHLBI reports new decade plan

The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) reported a new strategic plan to guide its next decade of research, training and education to reduce the number of cardiovascular, lung, blood, and sleep disorders.

“This plan sets the institute on a trajectory toward preempting disease by using emerging and sophisticated research approaches, adapting to a rapidly changing health care environment and remaining flexible to invest in new research opportunities that offer the best potential for improving the nation’s health,” said Elizabeth Nabel, MD, director of the NHLBI.

The plan sets forth three major goals that cover the scientific continuum from bench to bedside and address basic, clinical, and translational research.

The agency said that new research approaches in the fields of genetics, genomics, and imaging provide opportunities to achieve the one of the three goals: increased understanding of the molecular and physiological basis of health and disease. An example is a new program that will link genetic data from long-standing groups of clinical study participants with data about their health indicators and characteristics, and then make the data available to researchers.

A second goal, the agency said, is “to enhance knowledge of the clinical mechanisms of disease to identify better approaches to prevention, diagnosis, and treatment via new clinical research networks designed to investigate innovative approaches to promote establishment of standard treatment protocols to test new basic science discoveries and then foster rapid dissemination of research findings to healthcare professionals and the public.”

The final goal is “to improve the translation of research into practice for the benefit of personal and public health by seeking a better understanding of the processes for health behavior change.”