‘Big issue’ looms in respiratory care

WASHINGTON – The Council for Quality Respiratory Care has made it a priority to find out what happens when the waivers expire that have simplified the process for qualifying a patient for home oxygen therapy during the public health emergency. 

“We’ve had several conversations internally and with CMS, but there is a big issue looming if CMS doesn’t act on what’s going to happen post-pandemic with all those patients,” said Crispin Teufel, chairman of the CQRC and CEO of Lincare. “The two extremes are: Every patient needs to be requalified or every patient gets grandfathered. What part of the spectrum will CMS put them in and what does that mean for patients, physicians and suppliers?” 

Teufel would like to see a “decent amount” of grandfathering to ensure continuity of care, with the understanding that a certain number of patients will need to be requalified. For those patients who will need to be requalified, the CQRC has some ideas and would like to serve as a resource to CMS, he says. 

Also high on the CQRC’s priority list: templates for oxygen orders. In September 2021, CMS posted a final national coverage determination for home oxygen that eliminates the CMN requirement, but the council believes it’s important to have a simple document with no room for ambiguity in who qualifies for therapy, Teufel says. 

“We’d appreciate one single order e-template that answers the (qualifying) questions that are necessary and refrains from the further use of the physician’s chart notes,” he said. “That is the main idea to address some of our concerns around the audits resuming and also to address some topics more generally when the PHE is over to make sure everybody is on the same page.” 

In addition to resolving issues with coverage criteria and documentation, the CQRC is prioritizing reimbursement. Teufel says a recent CPI increase of 5.1% is welcome, but it doesn’t come close to offsetting the increased costs from inflation, equipment shortages and higher wages. That’s why it’s important, he says, for all stakeholders to unify around a solution to provide relief to the sector.

“Inflation is significantly outgrowing the price increases needed to create a stable work environment,” he said. “It needs to be addressed through legislation and there needs to be a point made that price increases only through the CPI is not enough to sustain coverage and access to care throughout the DME industry.”