WASHINGTON, Nov. 30 /PRNewswire-USNewswire/ -- Today's New York Times
story on home oxygen therapy omits salient facts about home oxygen therapy
and the critical role it plays in keeping some of Medicare's sickest
beneficiaries in their own homes as they manage the effects of debilitating
and irreversible lung disease.



    The story inappropriately treats home oxygen therapy as though it is
nothing more than the rental of inert equipment, when in fact home oxygen
is a prescribed therapy, that when properly administered, requires both
medical devices and myriad patient services. Oxygen providers deliver
critical services that help this oft-overlooked beneficiary segment manage
their chronic disease and therapy between physician visits, which in turn
helps to avoid costly hospital admissions, serious complications, and
sometimes even death. Home oxygen providers are often the physician's eyes
and ears in the patient's home setting.



    Home Oxygen Therapy is an important and cost-effective treatment for
COPD. Every year, millions of Medicare beneficiaries are treated for the
effects of chronic obstructive pulmonary disease, or COPD. COPD is a
progressive, non-curable disease that causes irreversible loss of lung
function and threatens the ability of patients to perform even routine,
daily tasks. COPD is the fourth largest killer in the United States. The
average home oxygen patient is a 73-year old, frail female who lives alone,
does not drive and takes multiple medications for multiple disease
conditions. The sickest COPD patients need oxygen therapy to breathe and
remain stable at home. Oxygen therapy providers are often the first line of
care for these patients -- helping to maintain proper patient compliance
with their prescribed oxygen therapy, thereby helping to slow lung
degeneration and avoid hospitalizations.



    These points were reinforced in a separate article reported in the
Wednesday, November 28th New York Times story by Denise Grady on COPD which
states:



    "Although incurable, it is treatable, but many patients, and some
doctors, mistakenly think little can be done for it. As a result, patients
miss out on therapies that could help them feel better and possibly live
longer. The therapies vary, but may include drugs, exercise programs,
oxygen and lung surgery. Incorrectly treated, many fall needlessly into a
cycle of worsening illness and disability, and wind up in the emergency
room over and over again with pneumonia and other exacerbations --
breathing crises like the one that put Ms. Rommes in the hospital -- that
might have been averted."



    Medicare's home oxygen benefit helps keep beneficiaries out of
expensive health care settings. The home oxygen benefit is vital to
restraining Medicare's costs, and any immediate budget savings resulting
from reducing reimbursement will come at a far greater cost to Medicare and
its beneficiaries. Respiratory therapy in the hospital can cost Medicare
over $4,600 per day. In 2002, there were 673,000 hospitalizations for COPD
with an average length of stay of 5.2 days. A government study by the
Agency for Healthcare Research and Quality and other multiple clinical
studies conclude that once a patient goes on home oxygen therapy, he or she
has 10 fewer days in the hospital per year, saving $46,000 per year in
hospital costs alone. Few would argue it makes sense to spend $2,400 to
save more than $40,000.



    Recent Medicare cuts to home oxygen have yet to be realized. Over the
past decade, beginning with the 1997 Balanced Budget Act, Congress cut
Medicare funding for oxygen therapy multiple times -- resulting in a 39
percent reduction in payments, according to the New York Times. What the
story does not lay out is that the biggest cuts haven't even taken effect.
In 2009, this Medicare benefit will be cut by nearly 20 percent without any
further Congressional action. If new cuts being proposed by lawmakers take
effect, total reductions in 2009 will exceed 25 percent. No health care
provider can sustain cuts of this magnitude without eroding important
patient services.



    Mishandled, oxygen can be dangerous. Both oxygen and the medical
devices that create oxygen are regulated by the Food and Drug
Administration, the Centers for Medicare and Medicaid Services and the
Department of Transportation. Oxygen equipment is only available by
physician's prescription and can only be sold by individuals or companies
that meet local licensure requirements dictating the filling, use and
transportation of flammable gas. Medicare has historically relied on a
rental system for home oxygen to ensure that control over the medical
device and oversight of the equipment in a potentially hazardous home
setting remains in the hands of trained professionals. When medical devices
are purchased over the Internet, control of the device and dosing shifts to
the patient, increasing the risks of inappropriate self-medication and harm
from mishandling, such as burns. Self medication is further complicated by
the fact that oxygen is odorless and colorless, and patients cannot know
whether the purity or flow is correct without instruments that require
frequent calibration. Shifting the responsibility for maintaining complex
medical equipment from the provider to the elderly or disabled Medicare
beneficiary -- or to unqualified individuals -- can have dangerous
consequences. For example, elderly patients being transported away from
Hurricane Rita died a tragic death after an oxygen tank exploded on their
bus.



    At a time when Congress is under pressure to balance limited funding
with the needs of a growing Medicare population, the focus of public policy
for the home oxygen therapy benefit should shift to thoughtful reform of
the system. We believe that providers, policymakers, and patients must come
together to evaluate the appropriate array of services required to meet the
needs of an expanding population of patients with chronic lung diseases.

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