Comparative Information on Medicare and VA Patients, Services, and Payment Rates for Home Oxygen

HEHS-97-151R: Published: Jun 6, 1997. Publicly Released: Jun 9, 1997.

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William J. Scanlon
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Pursuant to a congressional request, GAO provided information on GAO's analysis of the Medicare and Department of Veterans Affairs' (VA) payment rates, focusing on: (1) the comparability of the Medicare and VA home oxygen patient populations used in GAO's analysis; (2) differences in the frequency and quality of services Medicare and VA expect from their suppliers; (3) differences in the use of portable oxygen equipment and supplies by Medicare and VA patients; and (4) the rates paid for home oxygen by other insurers.

GAO noted that: (1) the medical criteria used by Medicare and VA to determine patient eligibility for home oxygen use are the same; (2) experts confirmed that there are no clinical or demographic differences between Medicare and VA home oxygen patients that would affect their treatment; (3) GAO's analysis showed that suppliers serving VA patients must meet accreditation standards, comply with the service and quality requirements of their contracts, and are subject to quality controls; (4) Medicare does not have comparable requirements for its home oxygen suppliers; (5) regarding access to portable equipment, only 75 percent of the Medicare population is provided portable equipment compared with over 97 percent of the VA patients in GAO's sample; (6) the VA patients also received more refills for their portable equipment that the Medicare patients in GAO's sample; and (7) finally, GAO did not compare Medicare's home oxygen payment rates with those of other insurers primarily because GAO could not find any other insurer with a sufficiently large patient population on home oxygen.

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