EL PASO — No longer the woman she once was, an aged shell, wrinkled by time sits in the center of a plaid loveseat. Her skin, fragile and thin, pours from a hospital gown in gentle, flaking cascades while she watches her afternoon telenovela. Entangled in her hands, a thin clear hose connects her to a machine that pumps oxygen into her nostrils.
All around her there are potted plants, pictures of relatives, and a walker. Several green portable oxygen tanks are stored in a corner, hidden behind the dining table. The balcony of her fourth floor apartment is open and the light shines on her tired eyes.
“Uno no sabe para que le ponen estas cosas,” the woman says. In Spanish, her weak voice she says she doesn’t know why she has to use a portable oxygen machine.
“Fue porque tenía agüita en sus pulmones no, mi’ja,” her grandson said pointing to his own chest as if he were the one with the “tiny bit” of water in his lungs. Victoria Sanchez’s grandson, Tomas travels from Juarez everyday to a government-paid apartment in Segundo Barrio’s Father Pinto Building to care for her.
Sanchez has been on oxygen-assistance since December of last year, Tomas says. She doesn’t want to answer anyone’s questions, because “uno nunca sabe en cuáles problemas los van a poner. Entra uno y otro a preguntarle a uno lo que no sabe ni puede decir.” Apparently too many people hound the woman with questions about her health and living conditions and it makes her uncomfortable. So much so that she says she is over 100 years old making her grandson snicker.
Despite Sanchez’s condition and tough demeanor, she remains in the dark about the greater forces at play when it comes to the tubes connecting her to the bulky machine in the next room. Neither the grandson, Tomas, nor Victoria Sanchez know about a silent war that durable equipment providers are waging on Medicare over budget cuts dating back to 2005 that are just now taking effect.
As part of the Deficit Reduction Act passed by congress in 2005, government spending was scaled back in various programs. Taking a major hit was Medicare, which has since revised the cuts it has made within its program through the Medicare Improvements for Patients and Providers Act in October of last year.
Lawrence Behm, owner of the local durable medical equipment company J&L Behm Inc, said it’s been in the oxygen business since 1993 with Medicare “reducing [compensation to providers] on a consistent basis year-after-year.”
Behm said that the Medicare provisions put oxygen patients on a three-year time limit and then Medicare “will quit paying, but [providers] must still continue providing oxygen at no charge.”
Still covered after the 36-month-“cap” are maintenance and servicing every six-months, as indicated by the Centers for Medicare and Medicaid Services’ website.
Behm said he has no other choice but to change the way the company provides the service to the 70 Medicare-funded oxygen patients his company serves.
“We will no longer respond like we should or used to,” Behm said. He added that this will lead to a rise in hospital stays and calls to 911 because oxygen patients will not be able to call their suppliers for help with routine maintenance such as filter changes or saturation checks.
“Medicare thinks [oxygen] is a commodity like a candy bar,” Behm said.
This is not so, said the Centers for Medicare and Medicaid Services (CMS) in a consumer alert released in December last year.
“A recent Medicare law changes how Medicare pays for oxygen equipment and supplies, but beneficiaries will still have continued Medicare coverage for oxygen equipment and related supplies,” the Washington D.C.-datelined release said.
Furthermore, it specified that suppliers are “required to continue to perform any repairs or provide replacements at no cost to beneficiaries” for five years. A new 36-month rental “cap” period will begin after those five years, the alert explained.
The alert warns patients of potential letters that have been circulating from both suppliers and home care organizations set on having the patients sign petitions to change the current legislation and scare patients with lose of care.
Vincent Perez, press secretary for El Paso Congressman Silvestre Reyes said his office has not received any of these so-called supplier letters or any phone calls regarding the Medicare legislation, which further leads Behm to speculate that the reason is oxygen patients are “too ill, or too advanced in age to want to deal with calling Medicare or any government officials.”
Ellen Griffith, a public affairs specialist for CMS said that most of the complaints come on behalf of the suppliers.
“Generally suppliers have not indicated confusion about [Medicare] policies so much as opposition to them—they would like to be paid more,” Ellen Griffith, CMS public affairs specialist said.
Griffith added that it is during the course of the 36-month rental period that suppliers receive payment for the five-year loan period.
According to a CMS fact sheet for beneficiaries since suppliers retain ownership of the equipment after the cessation of rental payments, the supplier must continue to “take care” of that equipment with no charges to the patient.
Sanchez, who is not a J&L Behm patient, will not cap for another 33 months, making it unnecessary for any worry to set in.
Meanwhile, beyond the tan-colored door with an “Oxygen-in-use” advisement on the fourth floor of the government apartment complex Sanchez calls “home,” millions of home oxygen therapy patients count their breaths and continue to send letters to their congressmen.
