When the coronavirus first hit our shores, the home respiratory care community was ready. As suppliers of home oxygen equipment, including ventilators, we have decades of experience delivering life-sustaining devices to Americans with chronic respiratory disease in every corner of the country. Facing an unprecedented surge in demand, the Department of Health and Human Services (HHS) took rapid action to empower us to help patients with acute cases of COVID-19 and relax certain onerous regulations that had previously undermined frontline health care providers.
The decision to ease regulations was practical and decisive. By giving providers flexibility, HHS allowed us to quickly ramp up supplies and operations, which in turn expanded patient access and allowed our sector to meet the skyrocketing demand for home respiratory care. This approach helped us save countless lives and enabled Medicare beneficiaries to receive care in the comfort of their own homes – a win not only for patients, but also hospitals, which were scrambling to free up desperately needed bed space.
But now, all of this is set to change. The Centers for Medicare & Medicaid Services (CMS) – the agency which oversees the Medicare program – restarted Medicare audits on Aug. 3, despite COVID-19’s continued threats to patients and providers. With cases surging to record highs almost every day – pushing forward with auditing procedures that focus on paperwork would constrain the work of home respiratory suppliers and prescribers who continue to be overwhelmed by taking care of patients during the pandemic. Despite the agency’s good intentions, CMS must recognize this policy undermines providers and their patients in the midst of a public health crisis.
Specifically, CMS has discontinued exercising enforcement discretion for post-payment review audits. While the home respiratory care sector shares the same values of transparency, accountability, and integrity as CMS, it worries that the resumption of audits in the midst of a public health emergency will impose heavy burdens at precisely the wrong time.
Existing auditing procedures were already cumbersome during peacetime. But now during the pandemic, the elimination of the discretion creates a substantial risk that the requirements to produce detailed medical record documentation and progress notes will force suppliers and physicians on the front lines to devote a frustrating amount of time and financial resources to filling out paperwork.
The situation becomes more complicated considering that home oxygen suppliers, like many other sectors of America’s health care economy, are being battered by strong economic headwinds. In order to remain solvent and sustainable, they must maintain a steady cash flow. Unfortunately, suppliers have had no choice but to cover the growing cost of caring for patients, which includes obtaining scarce personal protective equipment to keep patients and employees safe. Meanwhile, the World Health Organization has warned of global shortages of critical home respiratory equipment and suppliers have been impacted by supply chain disruptions, long wait times, cancelled contracts, and rising costs.
These concerns over supply shortages are due to a surge in demand unseen in our sector’s history. Since March, the nation’s largest suppliers have seen an overall increase of nearly 30% in new starts for acute respiratory patients across all payers, while the percentage of new start acute patients under the Medicare program has increased exponentially. Suppliers are tasked with this influx of new patients while facing challenges of their own, including a diminished workforce due to coronavirus-positive employees.
All of this comes on top of chronic respiratory patients fighting to maintain access to lifesaving equipment. Given rising demand and diminishing supply, the laws of economics predict a coming economic and health reckoning. As we work to ensure vulnerable patients can access their doctor-prescribed home respiratory treatments, the heavy-handed resumption of audits is extremely unhelpful.
CMS must change course. The most immediate way Medicare can address these concerns is to reinstate the pause in auditing for the duration of the public health emergency. As home respiratory suppliers work around the clock to provide care, we are afraid that we will be overwhelmed by post-payment audits, which divert our attention away from patients.
CMS has already shown its willingness to listen to our sector’s concerns – something for which we are enormously grateful. We only ask that the agency follow through with these commonsense adjustments so that we are best equipped to do our part in the war against COVID-19.
Tim Pigg is president and CEO of Rotech Healthcare Inc. and a member of the Council for Quality Respiratory Care.