Op-Ed: As COVID emergency ends, don’t lose sight of what worked
By: Timothy Pigg
Supplemental oxygen therapy patients and providers in North Carolina and throughout the country are anxiously awaiting guidance and action from the federal Medicare program as the Public Health Emergency (PHE) connected to the COVID-19 pandemic is set to end on May 11. This includes the more than 525,000 North Carolinians living with Chronic Obstructive Pulmonary Disease (COPD), and other respiratory disease.
One of the biggest questions on the minds of supplemental oxygen therapy patients and providers alike is what will happen to the estimated 1 million new patients who started home oxygen therapy during the PHE. At the onset of the pandemic, Medicare took a wise course of action by loosening some of the more burdensome requirements for patients to prove they have a medical need for oxygen treatments – primarily older patients managing respiratory diseases like COPD. This helped ensure access to care and home oxygen therapy for patients during one of the single biggest challenges our nation’s health care system has ever faced.
Now, however, as the PHE ends and Medicare looks to reinstate some of its requirements they loosened, there is a growing concern among the home oxygen therapy community that those patients who started supplemental oxygen therapy during the pandemic could be required to start this onerous process all over again. If that happens, it could undermine access and disrupt critical oxygen therapies for a massive number of Americans.
Specifically, Medicare suspended its requirement for patients to prove medical necessity based on physicians’ medical record notes. Instead, throughout the PHE, a Medicare patient simply needed Medicare’s standard written order to demonstrate medical need. Simplifying these requirements made sense not only for the difficult times we were living in, but also in a purely practical and logistical sense.
As a practice, relying on medical record notes to prove a patient’s need for treatment has never made much sense. There is no real way to standardize such notes, which means they can and do vary wildly based on the physician or clinician who enters them into a patient’s medical record. As such, prior to the pandemic, Medicare contractors denied thousands of claims due to the highly variable nature of these medical record notes—even if a patient met Medicare requirements for supplemental oxygen.
As the end of the PHE draws closer, it is critical that Medicare clarify that those patients who started home oxygen therapy during the COVID-19 pandemic can continue to receive their treatments uninterrupted, without needing to restart the documentation process from scratch. Otherwise, these patients will have to go through the onerous process of setting up new doctors’ appointments, undergoing additional tests, and paying more in co-payments just to prove that they still have a medical need for home oxygen therapy.
Now is the time for Medicare to provide some clarity and guidance for the roughly 1 million vulnerable patients who started home oxygen therapy treatments during the pandemic. More than that, it is the perfect time to reform, streamline, and simplify documentation requirements for home oxygen therapy patients. The agency should eliminate medical record notes as a requirement altogether and instead create a standard eClinical template that doctors can use to document a patient’s medical need.
By taking these steps now—before the PHE ends in May—Medicare can help protect access to critical home oxygen therapy for patients while ensuring providers are able to continue fulfilling our mission to help provide life-sustaining care for some of our communities’ most at-risk patients.
May 11 is around the corner, so we need help now. To urge immediate action, I encourage North Carolina lawmakers in Congress to ask the Medicare agency to act quickly. They must clarify their guidance to ensure access for our state’s oxygen patients.
Timothy Pigg serves as the CEO and President of Rotech Healthcare, is a national leader in providing ventilators, oxygen, sleep apnea treatment, wound care solutions, and home medical equipment. Pigg resides in Sherrills Ford, NC.
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