The demographics and economics of long-term oxygen therapy.

Home oxygen therapy represents a scientifically validated and universally accepted therapeutic regimen for the treatment of chronic hypoxemia secondary to COPD. The clinical benefits of home oxygen, including a decrease in morbidity and often a concomitant increase in the quality of life have been repeatedly confirmed through rigorous worldwide trials, studies, and investigations. However, since home oxygen is an expensive treatment modality, important questions continue to be raised about the overall cost-benefit of the intervention. Such scrutiny is expected to continue, especially in the United States, as the entire issue of health care cost-containment remains atop the domestic political agenda. Providers of home oxygen therapy have traditionally realized quite favorable reimbursement for home oxygen equipment, especially for those patient-customers covered under the Medicare program. However, recent Medicare reimbursement reductions of more than 30% have raised serious questions about the ability of home oxygen providers, especially those with annual revenues less than $1 million, to sustain their historical high level of support services to home oxygen patient-customers. Of particular concern is the economic hardship of supplying portable oxygen, especially for those patient-customers with unusually high ambulatory needs. The use of oxygen-conserving devices is viewed by some as one strategy to better control the costs of supplying portable oxygen, although there are those who still question whether or not oxygen-conserving devices can effectively forestall arterial oxygen desaturation across the entire spectrum of ambulation. Given the evidence now being reported that compliance in using home oxygen as prescribed may well be much lower than originally believed, the time is probably right to revisit the role played by home oxygen providers in determining continuing need through the performance of periodic reassessments. Such reassessments, if designed according to prescribed and validated protocols and conducted by home respiratory therapists under orders of the prescribing physician, would be a valuable tool to ensure continued medical need and identifying noncompliance. This would help ensure that those needing and using home oxygen would continue to receive the benefit. At the same time, patient-customers who, for one reason or another, stop using their oxygen equipment despite repeated encouragement, would have the equipment removed. The net result would be that reimbursement dollars currently wasted on home oxygen equipment that is not being used could be reallocated for those patient-customers willing and able to use the equipment as prescribed.