Oxygen cap arrives

In the first weeks after the 36-month cap on oxygen kicked in, providers walked a tightrope of caring for patients without the safety net of specific guidelines.

Even with additional guidance issued Jan. 27 (See story page 1), providers like Glenn Steinke were treading cautiously.

“I have patients whose concentrators have capped, but the POC has not,” said Steinke, owner of Bishop Calif.-based Airway Medical. “Oxygen is just a total nightmare.”

Many of the questions providers have are ones they've had all along: How are they supposed to help patients who relocate, either temporarily or permanently; how are refills billed; what documentation is required once the five year reasonable lifetime of the equipment is met.

About half of Lee Guay's oxygen patients will reach the 60-month mark this year. He still has questions, including whether they need new prescriptions, but he's just plowing ahead.

“As long as they give me the track to run on, I'll figure out a way,” said Guay, coordinator for Helena, Mont.-based Apex of St. Peters.

While providers grappled with the immediate details, they also worried about what will happen as the number of beneficiaries capping out rises. They expect repercussions to ripple throughout the industry.

“We are hearing reports of companies going out of business and patients can't get their oxygen,” said Cynthia Jarman, director of operations for Albemarle, N.C.-based Alliance Medical. “Physicians are calling and asking us to take these patients, but if we are not going to get any money, we can't afford to do that.”

Beneficiaries are feeling the effects in smaller ways too, said provider Keith Blankenship.

“One of our capped patients was interested in trying portable oxygen,” said Blankenship, co-owner of Jackson, Ohio-based Family Oxygen. “I explained to him that our hands were tied and that he has to make do with what he has. I gave him the number to our local elected representative.”