The system of delivering supplemental oxygen to the more than 1.5 million people in the U.S. who rely on it is broken, and many patients are not getting the equipment they need or the training in how to use it, according to American Thoracic Society (ATS) experts.
In an , the expert panel outlined significant problems with the current system of supplying supplemental oxygen in the U.S. to adults with respiratory disorders who require it. Workshop panel member David J. Lederer, MD, of Columbia University Medical Center in New York City, characterized the state of supplemental oxygen delivery as a "public health disaster" in an interview with 51˶.
The panel unanimously found that the implementation of competitive bidding for durable medical equipment, including home oxygen, nearly a decade ago by the Centers for Medicare and Medicaid Services (CMS) has led to the crisis.
Lederer explained that the changes incentivized oxygen suppliers to provide the cheapest devices to patients, which are often inadequate for their needs.
A of nearly 2,000 supplemental oxygen users, conducted by the ATS Nursing Assembly, addressed some specific issues related to home oxygen delivery.
The survey found that half of all respondents reported problems with their oxygen, including equipment malfunction, and being too heavy to manage physically and lack of portability, especially when traveling.
Also, 70% reported having no more than 4 hours of portable oxygen, while 81% said they required more than 5 hours' supply.
Patients who reported being hospitalized or going to the emergency department in the last year were more likely to report problems, as were patients who had not received oxygen education from a healthcare professional.
The workshop report cited the "unintended consequences" of the CMS Competitive Bidding Program and reimbursement cuts for durable medical equipment, which have contributed to a 40% decline in durable medical equipment companies over the last 5 years.
Patients with the highest supplemental oxygen needs, such as those with the progressive lung disorder pulmonary fibrosis, have been hit the hardest as portable liquid oxygen has become almost impossible to get in many areas. Without it, patients with the highest needs for supplemental oxygen often become home-bound, tethered to heavy oxygen cylinders of compressed oxygen, or other less portable devices, Bill T. Schmidt, president and CEO of the Pulmonary Fibrosis Foundation, told 51˶.
"In broad swaths of the country, liquid oxygen isn't even available, even though under the current Medicare rules suppliers are contractually bound to provide it if prescribed," he said.
Between 2008 -- before competitive bidding was implemented -- and 2016, the number of Medicare beneficiaries who had access to portable liquid oxygen declined from 74,000 to just over 8,000.
"The market for liquid oxygen has essentially collapsed," Schmidt said. "Liquid requires more frequent delivery and it has to be delivered in trucks that are Hazmat [hazardous materials]-outfitted. Reimbursement has been lowered to the point where I'm guessing suppliers would argue they would be committing financial suicide to continue to deliver it."
Beginning Jan. 1, 2019, CMS will the durable medical equipment competitive bidding program for 2 years to assess it, but it is not clear what this means for liquid oxygen and other supplemental oxygen availability, Schmidt said.
The ATS workshop report identified other impediments to patients' receiving optimal home oxygen therapy, including a lack of knowledge among many healthcare providers of how to best prescribe oxygen delivery devices, and lack of access to innovative approaches to patient education, such as remote monitoring and telemedicine.
"This workshop report documents for the first time an irrefutable consensus that (the current) oxygen system is broken, and in doing so provides the information necessary to advocate for change," workshop chair Susan S. Jacobs, RN, of Stanford University in California, said in a press statement.
Disclosures
The workshop report and survey were funded by ATS.
Jacobs disclosed no relevant relationships with industry. Co-authors disclosed multiple relevant relationships with industry.
Primary Source
AnnalsATS
Jacobs SS, et al "Optimizing home oxygen therapy: An official ATS workshop report" AnnalsATS 2018; DOI:10.1513/AnnalsATS.201809-627WS.