Bruce Vladeck, former administrator of the Medicare and Medicaid programs during the Clinton Administration (1993-1997), grossly misrepresented recent Medicare history concerning certain Part B services during a segment on C-SPAN’s “Washington Journal” which aired on August 27, 2009.
Specifically, Vladeck said, “Every administrator of what used to be HCFA, it’s now Centers for Medicare and Medicaid Services, going back to the 1980s has tried to change what Medicare pays for durable medical equipment.… Every single time that the executive branch, under both Republican and Democratic presidents, has tried to change the system to eliminate those ridiculous overpayments, the Congress has prevented it.”
This is patently false. Congress has cut durable medical equipment (DME) payments in Medicare numerous times since Vladeck left his job: It was cut in the Balanced Budget Act of 1997, in the Medicare Modernization Act of 2003 (MMA), in the Deficit Reduction Act of 2005, and in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Moreover, Congress has approved competitive bidding for DME in two separate pieces of legislation that were signed into law – MMA in 2003 and MIPPA in 2008. This legislation, in combination, has resulted in reductions in oxygen therapy payments of more than 50 percent since the end of the 1990s when Mr. Vladeck left public office. The cost of treating COPD patients with oxygen therapy at home under Medicare is less than $7 per day.
Commenting about oxygen therapy provided in the homes of beneficiaries, Vladeck said Medicare pays, “$3 billion for air – because that’s all it really is.”
This is an extraordinarily cavalier comment. Medicare pays for medical oxygen and oxygen devices, both of which require prescriptions, as well as certain accompanying services which Mr. Vladeck chooses to ignore completely. Medical oxygen is a highly regulated prescription drug which more than one million Medicare beneficiaries depend on in order to breathe. The Food and Drug Administration, Department of Transportation, Department of Homeland Security, local fire authorities and state licensing boards are just a few of the groups that regulate or provide oversight to the home oxygen sector.
Vladeck also said, “And yet every effort for the last 20 some years to reduce Medicare payments for oxygen has run into a large lobbying campaign from the supplier industry generally organized to frighten beneficiaries to say, you know, if you let this go ahead, Congress is literally going to cut off your air supply. And Congress has stepped in to prevent reductions in oxygen payments every single time.”
This statement also is patently false, and the significant reductions to Medicare oxygen payments cited above are ample proof. The legislation from 2005 and 2008 alone reduced oxygen payments by over $900 million starting this year, bringing the annual total spending down into the low $2 billion range to support over one million frail Medicare beneficiaries at home for less than $7 per day. Vladeck’s description of advocacy efforts by the oxygen provider community is a grotesque distortion of the legitimate concerns that have been expressed not only by oxygen providers but by patient and consumer advocacy groups as well. We find it reprehensible that a former public official should make such reckless and inaccurate statements in a public forum such as C-SPAN.