Medicare policy is rapidly changing, and keeping abreast of Medicare news and changes can be difficult. Kelly Turner works for People for Quality Care, an advocacy group for people with disabilities, senior Medicare beneficiaries, and their families. The new competitive bidding program can threaten your ability to choose your oxygen products, read on to learn about how these changes can affect you.

Access to healthcare and equipment, choice, quality homecare and a positive relationship with your oxygen provider are important to many Americans who rely on medically necessary oxygen. A new change in Medicare policy threatens those rights for seniors and people with disabilities who rely on Medicare for their durable medical equipment.

The Center for Medicare and Medicaid Services (CMS) implemented a bidding system for medical equipment providers. It requires providers to bid the lowest possible price they are willing to accept for individual pieces of equipment such as power wheelchairs, CPAP machines, oxygen supplies, mail order diabetic supplies and hospital beds. The lowest bidder won the right to contract with CMS at those prices, while the other equipment providers were eliminated from the system. In the Kansas City metro area, 420 original providers available to Medicare beneficiaries were narrowed to 20.

The program known as the DMEPOS Competitive Bidding Program was approved by Congress as a cost-saving measure and is currently being implemented in nine areas of the country. Ninty-one areas are to be added by 2013 and the rest of the country to follow during the next three years. Many Medicare beneficiaries are unaware of the change until new supplies or updates are required, which is creating dire consequences.

Provider shortages create long waits for service and longer hospital stays as caseworkers struggle to find the equipment necessary to discharge patients. Medicare beneficiaries are forced to use lower-quality, cheaper supplies rendering their old equipment of other brands such as oxygen concentrators to be useless. Contract winning providers are located many states away from beneficiaries and may not be experienced in selling and servicing the equipment they won a contract for.

Doug Kaploe from Kansas waited three months to have his scooter repaired because none of the winning providers in the area were capable of servicing his brand of scooter. Lowell Click of Texas was ordered to dispose of his old, better quality diabetic testing machine because the new strips sent to him would not match. They sent him a new machine as well. Oxygen user Earl from Texas, was appalled when the list of oxygen providers available to him hailed from Florida, Ohio and a Texas town located two hours away.

The frustrations of medical equipment providers and their customers have not gone unheard. On March 11, 2011, Congressman Glenn Thompson (R-Pa.) and Congressman Jason Altmire (D-Pa.) officially introduced the bipartisan House bill to repeal “competitive bidding, H.R. 1041, which currently has 145 co-sponsors. Representatives who have not yet signed on and senators who have not moved to create a companion bill are asking for more stories from beneficiaries who are feeling the impacts of provider shortages.

People for Quality Care (PFQC), based out of Waterloo, Iowa, seeks to educate individuals and health advocacy organizations about the change and encourage them to speak out to legislators in opposition of the program by asking them to support H.R. 1041. The organization interviews beneficiaries to gather the stories of delays and frustrations caused by the program.

If you have experienced a delay in receiving medical equipment or service, call People for Quality Care at (888)-544-7913 to help tell the story of how Medicare’s competitive bidding program inhibited your access to quality care. For more information about the cities currently involved, a full list of medical equipment included in the bidding process and the stories of beneficiaries who are speaking out, visit www.peopleforqualitycare.org.

BY Kelly Turner

Flying nowadays is not a picnic, but if you need oxygen, especially when flying overseas, it can get very complicated. Foreign carriers may require that you order oxygen from them, or may allow you to bring in an FAA-approved portable oxygen concentrator (POC), or require that you buy an extra ticket to be able to use a POC. In 2006 and 2007 I decided to travel to scholarly conferences in Poland as I found out that the Polish Airlines LOT offers oxygen at no cost. LOT does not have a medical desk, but there is a medical form with instructions on its website. This form must be filled out by your physician, who must not only sign it but also to affix his stamp. There is a little catch here as the form is good only for two weeks from the day of faxing it to LOT. Therefore, it is very important that the doctor puts on the form that you have a chronic condition and you’re your oxygen needs will be unchanged in two or more weeks. Just in case, bring with you a copy of the form, filled out and faxed by your doctor. At the airport check-in counter remind the clerk about your oxygen reservations and request a wheel chair (it will make it much easier to move through security). I took with me two POCs: SeQual’s Eclipse (to use it as a stationary concentrator and a backup) and AirSep’s FreeStyle for moving around. Both have special attachments that allowed me to use them in the car and on the train (in the U.S. and in Poland). I could plug into the electric outlets at the U.S. and Polish airports as well. That is important, because to catch a direct flight to Warsaw, we took a train to Newark, NJ. We traveled Business Class to make sure that an outlet is available. Eclipse traveled in a suitcase and I carried FreeStyle with me. On the plane they had a battery of D (M15) canisters, each with a shoulder strap. They provided continuous flow with High and Low options. I used the Low option, so each canister lasted two hours. I used four of them. The shoulder straps helped me to move around the cabin. The flight attendants were very helpful. On my second trip to Poland, they allowed me to check the performances of both POCs, which I had with me (Eclipse fit perfectly under the seat). They offered me one of the flight attendant seats next to the flight attendant station. I used the electric outlet there. Both POCs performed well and my oxygen saturation was fine. While in Poland I had no problem with oxygen supply. Both POCs worked without a hitch. For my FreeStyle I had additionally a strap-on battery, which gave me four more hours (total six). FreeStyle did not bother anybody despite its low hum (it blends well with the city noises). I recommend trying the Polish Airlines LOT for overseas flights not just to Poland.

Asthma has many faces, histories and lives. Some individuals only experience childhood asthma, showing up for the first time during infancy and ending in childhood never to come back. Some will have childhood asthma, live many years of asthma-free life but later would encounter asthma as a result of exposure to chemicals, toxins or disease. Some would experience single or recurring episodes of asthma for the first time during their adulthood. Then there are those (and I am one of them) who would never experience a full blown attack of asthma but share the vulnerabilities, problems and consequences of asthma. The name given for it is “sub-clinical” asthma. It is my hope that future medical tests would be able to identify sub-clinical asthma before it insidiously results into full-fledged Chronic Obstructive Pulmonary Disease (COPD).

In a longitudinal study, “Tucson Epidemiological Study of Airway Obstructive Disease” adults with asthma were found to have a twelve-fold higher risk of acquiring COPD over time than those without asthma.

According to the experts with GOLD (Global Initiative for Chronic Obstructive Lung Disease (GOLD), individuals with asthma who are exposed to noxious agents may also develop irreversible airflow limitation and a mixture of “asthma-like” and “COPD-like” inflammation. Furthermore, longstanding asthma on its own can lead to irreversible airflow limitation. However, there is no conclusive evidence that chronic asthma in adults would lead to COPD.

Whether asthma would be followed by COPD or not could depend on a combination of special circumstances and lifestyles. People with long-term asthma, regular or sub-clinical should view themselves “at-risk” for COPD. You have to be particularly watchful because the process of COPD can be deceptive and misleading and can delay proper diagnosis and care.

Here is an example of how the combination of “asthma-like” and COPD-like” symptoms can be misleading: I dismissed the idea of pulmonary tests for many years in spite of shortness of breath and exertion-related discomfort because at such times I would REMEMBER how good my breathing was at other times. I would ignore the present breathing difficulty and remember my breathing of the times when allergies, pollen, climate, temperature, air quality were ideal, airways were open, inflammation was at the minimum and I could fully utilize remaining lung capacity.

Though I received yogic breath training in my early years and had fair degree of breath awareness, I thought my shortness of breath and discomfort even during moderate exertion was due to the lack of conditioning and exercise. To use an analogy, because I would see sun come out for few seconds, I would dupe myself believing it’s going to be a sunny day! Had it not been for those occasional good breathing “episodes,” perhaps I would have investigated the possibility of advancing lung disease. Likewise, if it was common medical knowledge in the sixties and seventies that continuing elevated levels of esnophils in the blood may be indicative of lung inflammation, appropriate treatment could have been initiated earlier. As they say, ‘Forewarned is forearmed.” Even my lifestyle choices and decisions for relocation would have been different in the knowledge of a dangling sword of COPD over my head. The sword was hanging right over my head all that time and I didn’t know it.

As a lay person without any pretense for medical expertise I want to say you are at risk for COPD if you have or had:

• Long-term history of asthma
• Childhood asthma only to re-surface later in life with recurrent episodes
• Developed asthma in teenage or adulthood
• Tested positive for ongoing constriction and/or inflammation of the airways

* Vijai’s next article will present tips for self-care for people with asthma who are at risk for COPD*

Vijai has developed two stretching and breathing DVDs specially adapted for people with COPD. For self-care tools, DVDs and articles visit his non-commercial website http://www.mindpub.com/copdhome.htm

Is there any sight more comforting on a cold winter evening than a roaring fireplace?

According to recent scientific studies, we should be anything but comforted: wood smoke we now know, is hazardous to our health.

Burning wood creates significant amounts of fine particle pollution. And the more scientists have learned about these tiny particles of soot, the more alarmed they have become.

Numerous studies have linked particle pollution with a host of health problems that include asthma attacks, diminished lung function, emphysema and other respiratory ailments. More recently, particle pollution has been associated with heart attacks and premature death. While particle pollution affects everyone, it is particularly dangerous for children–whose lungs are still developing–and can cause bronchitis, increases in respiratory infections, and impaired lung development.

Residential wood burning is the significant source of winter particle pollution in the United States. So hazardous are these particles that in September 2006, the U.S. Environmental Protection Agency cut by half the allowable levels in the air.

As if that is not bad enough, wood smoke contains toxic and carcinogenic substances that include benzene, polycyclic aromatic hydrocarbons, and dioxin–one of the most toxic substances on earth.

It may seem hard to believe that something so familiar could actually be harmful to our health. But just watch a movie from the 1940s, and you’ll realize that cigarette smoking was also once considered harmless, and just as ubiquitous as wood burning is today. Wood smoke and tobacco smoke contain many of the same harmful particles, resulting from the combustion process.

Fortunately, there are easily available solutions. Gas fireplaces now so convincingly imitate their log burning brethren that it is difficult to tell them apart–and gas is far more convenient and cleaner burning. Electric models offer amazing realism. If gas is not an option, pellet stoves deliver high overall efficiency, and burn relatively cleanly. And with improved woodstove combustion technologies, some newer stoves have certified emissions as low as pellet stoves.

The American Lung Association of California supports controls of wood smoke pollution because of the harmful health effects. Cleaner burning alternatives are available, and the health of our communities depend on it.

Jenny Bard is Regional Air Quality Director for the American Lung Association of California.
www.californialung.org