Industry Voices—Amid pandemic, rural Americans could soon face respiratory care shortages

Woman receiving oxygen
With our nation’s top infectious disease experts predicting that the COVID-19 pandemic will continue into 2021—or beyond—there is a growing consensus that federal regulators must relax regulations that threaten to restrict access to respiratory care during this crisis. (Getty/ozgurkeser)

As America once again sees a dramatic surge in COVID-19 cases, it is clear that the pandemic will continue for the foreseeable future.

Many states, particularly those in the South and West, are experiencing their highest rates of infection to date, causing governors to pause reopening plans and reinstitute strict public health policies. On the whole, these actions will save lives.

On the federal level, Medicare policies have been put in place to ensure continuity of care for patients and protect providers on the front lines of care during the public health emergency (PHE). For example, the existing suspension of Medicare’s Competitive Bidding Program (CBP) for home respiratory equipment for 2020 has allowed providers to drastically increase home oxygen supplies in COVID-19 hot spots.

But, unfortunately, the program is set to resume Jan. 1 amid the backdrop of the largest health crisis in a century. In order to avert shortages and ensure continued access to the lifesaving oxygen equipment—particularly for Americans living in rural areas—Medicare must change course quickly. 

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We are witnessing an unprecedented demand for oxygen concentrators, nebulizers and BiPAP machines. In fact, according to a recent white paper, the nation’s leading respiratory care supply companies saw an increase in the number of patients (mostly acute) being prescribed home respiratory therapy of between 100% and 400% early on in the PHE, which is highly likely to continue as the pandemic worsens.

These types of respiratory care supplies represent a critical pillar for keeping COVID-19 patients alive to sustain recovery in the comfort of their own homes, particularly as hospitals and nursing homes work around the clock to free up capacity as many markets across the country once again surge. For instance, a recent report by the federal Agency for Healthcare Research and Quality found that patients who utilize home respiratory therapies tend to experience better health outcomes than patients who do not.

Utilization of respiratory equipment has skyrocketed since the pandemic began, and global supply chains have struggled to keep up with growing demand. Already, we are seeing a lead time of up to nearly 60 days for new orders for equipment, while an excruciatingly high percentage of orders have been canceled due to dwindling supplies. This is why the World Health Organization recently warned of a worldwide shortage of oxygen concentrators

With our nation’s top infectious disease experts predicting that the COVID-19 pandemic will continue into 2021—or beyond—there is a growing consensus that federal regulators must relax regulations that threaten to restrict access to respiratory care during this crisis. 

Under the CBP set to resume next year, Medicare will implement different rules for urban competitive bidding areas and rural noncompetitive areas. In the former (think cities like Detroit or Chicago), home oxygen suppliers who sign agreements under the program are legally obligated to provide equipment to Medicare beneficiaries who need it.

If there is a shortage of supplies in such cities, suppliers are contractually required to furnish them from another location so that beneficiaries can access care. However, those same Medicare regulations do not require suppliers (either legally or contractually) to provide home respiratory equipment to beneficiaries in rural noncompetitive areas if supplies are hard to come by. 

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This could have a devastating impact on rural America, which has seen some of the sharpest spikes in coronavirus cases. Our community wants to serve all Americans, but in a global shortage, we will be obligated under the CBP to prioritize supplying home oxygen equipment to beneficiaries in urban areas. Doing so will severely hamper our ability to respond to coronavirus hot spots in rural America. 

We are extremely distressed by this looming threat, which is why the home respiratory community is urging Medicare to again suspend the bidding program for 2021.

Given the uncertainty of how long this public health crisis will last, it is inappropriate to push forward with a program that will undoubtedly risk access to care for Americans living in remote and underserved communities. The current suspension of the program has given our community the flexibility needed to quickly meet demand in COVID-19 hot spots, both urban and rural. This flexibility must be maintained so that no American is left behind. 

Crispin Teufel is CEO of Lincare and chair of the Council for Quality Respiratory Care.