The sudden departure of Healthworks exposes tension between Medicare and medical providers.
Last summer, the oxygen guy stopped making periodic visits to the Lea household in Fridley, but Lloyd Lea, 73, didn't realize it because his breathing equipment worked just fine. Then, when one of his oxygen bottles wouldn't stay filled, Lea tried to get in touch with his supplier, Healthworks Home Medical.
No one answered the company's phone. When he contacted his lung clinic and Medicare, which was paying Healthworks, Lea was alarmed that no one seemed to know what to do.
Healthworks Home Medical's owner, Chad Jellum of Kilkenny, Minn., did not return calls from Whistleblower. The company apparently went out of business without notifying its patients or Medicare, according to Renee Wehr, lung specialist at Lea's clinic in Coon Rapids. In 17 years of working with lung patients, Wehr said, she has never seen an oxygen company go under.
The sudden disappearance of Healthworks Home Medical has left an unknown number of patients wondering whether they'll be left gasping if their oxygen machines conk out. Other oxygen suppliers have hesitated to take these patients because of Medicare's reimbursement policy, which requires five years of service but provides monthly payments for only three years.
"You really want to help them," said Colleen Reisdorf, respiratory care manager with Reliable Medical Supply, which has taken three former Healthworks patients. "Some of these people, you'd almost have to take them on for free. It's a sticky situation."
After Whistleblower contacted Medicare, a representative of the agency's ombudsman's office contacted the Leas. Medicare spokeswoman Ellen Griffith said the agency will make sure no oxygen patients are left in the lurch.
"We are geared up to intervene very quickly to get a beneficiary linked up to a supplier," Griffith said.
Still, the problem exposed continuing tensions between Medicare and oxygen suppliers, who have fought nasty battles before Congress over how much the government should pay them. Despite new limits, Medicare still pays some suppliers 10 times more than the equipment would cost if patients bought the devices themselves.
Life on a 50-foot leash
Retired from a steel warehouse, Lloyd Lea is an active guy. Even pulmonary hypertension doesn't slow him down. Since he went on oxygen three years ago, Lea can put a tank in a holster, strap on a breathing tube, and push a lawnmower or a snowblower to help out a neighbor.
In the house, the tube from his oxygen machine gives him a 50-foot leash to move around. Whenever Beulah sees her husband looking a bit purple around the lips, she tells him to hit the tube.
Healthworks Home Medical had been recommended by their clinic, Northwind Lung Specialists and Sleep Center, and until last summer, they were happy with the service. Every two months, someone came by to make sure the compressor and bottle systems worked. Even though no one from Healthworks visited since July, the Leas' records show that Medicare and their supplemental insurer were still paying Healthworks $224 each month through October.
"It's very confusing to us," Beulah Lea said about their predicament. "We're just common people."
Wehr said her clinic has been contacted by five clients of Healthworks, including a woman who hasn't left her home in a week because her portable tanks weren't usable. Wehr said that when the clinic called Medicare, the initial response was: How do you know Healthworks is out of business?
"We're looking to help them, but we're coming up against a wall," Wehr said.
Griffith, the Medicare spokeswoman, said patients in these situations should call the hotline, 1-800-MEDICARE (800-633-4227).
"People there have been dealing with these oxygen issues for at least a year," Griffith said. Callers "are directly filtered to someone who will directly intervene with the beneficiary. We have in fact worked it out every time."
Still, the wrangling between oxygen suppliers and Medicare over the larger issues of reimbursement is likely to continue. Medicare currently pays 80 percent of the cost of oxygen services, and that amounted to $1.8 billion in 2006, the New York Times reported. A provision of the 2005 Deficit Reduction Act authorized oxygen suppliers to receive 36 months of payments for equipment rental and service, but they would have to provide repairs and service for 60 months and afterward give the equipment to the patient. The law changed again in 2008, allowing suppliers to keep their equipment at the end of the five-year period.
Still, oxygen suppliers elsewhere in the country have sent alarming letters to patients, saying that Medicare is no longer going to pay for their oxygen after 36 months and urging them to call Congress. Medicare says that's not true, and has responded with "a vigorous campaign to identify beneficiaries who are having trouble obtaining oxygen equipment and servicing and ensure that they get what they need," Griffith said.