Millions of Americans have a disease that makes it difficult to breathe on their own. Life-threatening conditions such as cystic fibrosis, ALS, respiratory failure, severe sleep apnea, and Chronic Obstructive Pulmonary Disease (COPD), which is the 4th leading cause of death in the United States, often require home-based respiratory care.
As members in the supplemental provider community, we have the privilege of helping these patients live longer, more independent lives. America’s medical equipment suppliers are proud to help patients access the appropriate modality and level of oxygen needed to manage their disease and live actively and comfortably in their own homes. This not only helps lower mortality rates, but also helps improve patients’ independence and quality of life.
In-home respiratory care and supplemental oxygen allow patients to stay home rather than seek care in hospitals, nursing homes, or other facility-based settings. But every day, I hear stories about how certain insurance policies - particularly for older patients on Medicare - are jeopardizing patients’ access to supplemental oxygen at home.
One such policy, called competitive bidding, sounds reasonable at face value but actually undermines the accessibility of certain supplies and equipment. Through a highly technical formula, Medicare’s competitive bidding program forces suppliers to provide liquid oxygen at a lower rate than our cost to serve those patients. While most patients can rely upon gaseous oxygen or portable oxygen concentrators, some patients require liquid oxygen, which offers a continuous, high-liter flow of oxygen.
Since we have many patients to care for and cannot afford to provide equipment and services at below-cost rates, it is increasingly difficult for suppliers to provide liquid oxygen. As a result, many providers have stopped offering liquid oxygen.
Timely access to care is particularly challenging in rural areas where respiratory therapists and suppliers must drive great distances between patients’ homes. We all want to ensure that those who struggle to breathe and sleep because of oxygen-related conditions can receive proper supplemental respiratory care—but Medicare must provide a fair rate.
Recognizing this serious patient access issue, the American Lung Association and other patient advocacy groups alongside industry partners have called for legislation to remove oxygen services and equipment from Medicare’s competitive acquisition program. Such a bill would ensure patients with serious respiratory conditions can receive access to oxygen devices, in addition to providers being adequately reimbursed for delivering treatments.
Earlier this year, bipartisan lawmakers in Congress introduced the Supplemental Oxygen Access Reform (SOAR) Act (S. 3821/H.R. 7829), which continues to gain traction in the House and Senate. If passed, the SOAR Act would stabilize oxygen benefits, enhance access in rural areas, address funding challenges for liquid oxygen, and acknowledge the critical role of respiratory therapists – all together helping increase accessibility and affordability of supplemental oxygen to patients who need it most.
Further, high denial rates of supplemental oxygen care are directly impacting beneficiaries who receive home respiratory therapy. This bill would also ensure the adoption of clear, objective template forms to establish medical necessity for home oxygen therapies in lieu of physician medical record notes, which are confusing and often hard for providers to interpret. In addition to protecting and streamlining documentation, it would further protect access to care for patients who first received home respiratory therapy during the COVID-19 pandemic.
America’s supplemental oxygen suppliers wholeheartedly support quality care for Medicare beneficiaries who need oxygen the most. Passing the SOAR Act would put in place long overdue reforms designed to protect patients and enable them to lead fuller, happier, more active lives.
I encourage lawmakers to support the SOAR Act to improve lives and achieve better respiratory patient outcomes.
Jeff Barnhard is the CEO of Lincare and Chairman of the Council for Quality Respiratory Care (CQRC), the coalition of the nation’s leading home respiratory therapy providers and manufacturing companies.
