BARRY WILLIAMS/ Special

Todd Tyson is president of Hi-Tech Healthcare, which supplies medical equipment and respiratory therapy services.

When Todd Tyson graduated from Georgia State University with a degree in cardio-pulmonary science in 1983, like many respiratory therapists, he worked in a large hospital setting. He experienced the rush of providing emergency respiratory therapy for patients and dealing with a variety of situations every day.

But by 1986, he was tired of the pace, and a friend persuaded him to give home health care a try.

"When you treat patients in their home, you get to see how they live," said Tyson, BS, RRT, RCP. "It's very personal. You get to know them and their grandkids. Pretty soon they're sending you home with a bag of tomatoes from the garden. I loved it."

Sleep therapy was being introduced at about that time, and Tyson switched to the Atlanta office of Ambulatory Services Co., a regional firm that supplied CPAP (continuous positive airway pressure) machines and masks to patients who had sleep apnea and other sleep disorders.

"My patients would be tired and irritable from lack of rest. We'd deliver a CPAP machine, and the next day they'd say they felt 18 again. They thought we'd hung the moon, and that was very gratifying," he said.

Wanting more control of how he served patients, Tyson in 1990 started a home-based business, Hi-Tech Healthcare, which supplied medical equipment and respiratory therapy services to home-health patients. Now, with 75 employees, his company has grown to five Georgia locations (with two more coming this spring).

Hi-Tech Healthcare was accredited by the Joint Commission on Accreditation of Healthcare Organizations in 1994.

"For me, it has always been about providing what's best for the patients. For that reason, we have 13 licensed respiratory therapists on staff and a lower patient/staff ratio than many larger companies," Tyson said.

During his years in home health care, Tyson has seen tremendous advances in technology.

"The first time my boss told me to go pick up an oxygen concentrator from a patient, I had to take a driver with me. The thing was as big as a stereo console with speakers. It took two men to lift it. Today, the machine is portable, weighs 4.4 pounds, runs on electricity or battery [power] and is phenomenal," Tyson said.

Medicare changes

While technological advances allow patients to receive better care at home, changes in Medicare reimbursement and reporting are challenging companies that deliver it.

"Home-care providers have seen double-digit-percentage cuts from the Medicare Modernization Act of 2003, a freeze on CPI (consumer price index) increases until 2008, and the institution of a new rent-to-purchase policy for oxygen under the Deficit Reduction Act of 2005," said Tom Ryan, chairman of the American Association for Homecare. "These cuts, freezes and restrictions come at a time when skilled labor [and] operational and fuel costs for delivery of home care continue to rise at unprecedented rates."

Medicare officials are trying to cut cost and improve efficiency, but Tyson believes that two measures, in particular, won't be good for patients or the industry, which is already struggling to accomodate a growing elderly population. The first is a final ruling by the Centers for Medicare and Medicaid Services that caps Medicare payments for the lease of oxygen equipment at 36 months.

The second regulation, which is still pending, replaces the current payment methodology for some durable medical equipment with a competitive bidding process.

"Competitive bidding will likely be implemented in 10 of the nation's largest metropolitan statistical areas this year, but no one knows which cities or equipment, which has patients and providers in Atlanta nervous," Tyson said.

Many officials in the home-care equipment industry believe that the proposed process could eliminate up to half of the companies that provide the services.

Lobbying efforts

Tyson and three other Georgia home-care equipment providers — David Petsch, John Rhodes and Roger Folsom — have been honing their grass-roots political skills to fight the rulings.

They've been lobbying legislators to support the Home Oxygen Patient Protection Act (HR 621), which was proposed by U.S. Rep. Tom Price (R-Ga.) to repeal the 36-month lease limit.

With the loss of Medicare payments to help pay for the lease, many elderly patients with chronic obstructive pulmonary disease — a leading cause of death in the elderly — would be forced to buy their own equipment, which can be costly and dangerous, Tyson said.

"Oxygen therapy is more than a piece of equipment; it's the education, training, assessment of patients, maintenance and repair of equipment that our staff supplies," he said. "Medical oxygen therapy at home costs an average of $7.62 per day in Medicare."

If that service is interrupted or the equipment malfunctions and causes a patient to go to the hospital, the cost in Medicare would be about $4,603 a day, according to American Association for Homecare.

Tyson's company is large enough to survive competitive bidding for home-care equipment, but he fears that it would eliminate many smaller providers in rural areas and would reduce access for many patients in Georgia.

The Hobson-Tanner Medicare Durable Medical Equipment Access Act of 2005 — which would have required the Centers for Medicare Services to address quality standards, access and other issues in the bidding process — failed to come up for a vote.

"We've been told the bill will be reintroduced, and when it does, we'll be talking to legislators and trying to get them to sign on," Tyson said. "I always voted, but now I'm getting a real education in the political process."

Tyson believes that his efforts are important.

"We are doing a good thing by allowing people the freedom and comfort of receiving care at home and being ambulatory. We just want to keep treating them right," he said.