Breathtaking study

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Wednesday, June 30, 2004

ORLANDO, Fla. - While critics of Medicare’s existing reimbursement rule for home oxygen argue that ‘modality neutral’ has hobbled access to ultra lightweight portable systems, clinicans say that is not the case, according to the largest needs assessment survey ever conducted on COPD
B. Thomashow

“I was somewhat surprised by that because, to be honest, that’s not been my experience,” said one of the survey’s analysts, Byron Thomashow, a practicing physician at Columbia University.

Thomashow was among six presenters, including four physicians, who unveiled some of their results at the 100th annual American Thoracic Society meeting May 23. The survey fielded responses to questions from approximately 3,100 COPD patients and persons with emphysema, 523 primary care physicians, 528 pulmonologists and 450 respiratory therapists. A patient-focused advocacy group, the National Emphysema/COPD Association (NECA), commissioned the study in order to develop a deeper understanding of COPD patients’ needs and physicians’ current clinical practices for the COPD community.

The survey also polled physician use of oxygen saturation levels, titration and bi-level CPAP, as well as awareness of guidelines for prescribing home oxygen.

The finding on access to the new portable oxygen systems is particularly relevant now as CMS acts on a legislative mandate to reduce home oxygen reimbursement on the current fee schedule and prepares for the implementation of competitive bidding for DME in 2007.

Easy access to ultra lightweight portable systems is also a surprise to a spokesman for a physician’s association that is advocating for a shift from modality neutral to modality specific so that patients can get access to the new systems.

“If you look at Medicare’s own data, I think that would signal to any reasonable person that there is a question of access,” said the source, who asked not to be identified.

In 2003, Medicare paid $1.57 billion for oxygen concentrators (E1390) and $109 million for stationary liquid oxygen (E0439), according to CMS data obtained by HME News in May. (See related article on page __)

Of the 3,100 patients sampled for this survey, approximately one-third were members of Better Breathing clubs; another third were directed to the survey’s questionnaire over the Internet by various professional associations; and the final third of COPD patients were culled from a national cross sectional “malady list” of patients with specific conditions.

Sixty percent of the COPDers who use the Internet also used home oxygen; 54% of Better Breathing club members were on oxygen but only 30% of the general cross-sectional respondents were on oxygen.

“If there is a take home message for patients, it’s that getting people better connected tends to lead to a higher level of care,” said Thomashow.

The same might also be said of physicians. The survey found that more than 90% of both primary care physicians (PCP) and pulmonologists use oxygen saturation as an indicator for home oxygen therapy, but far fewer - just two-thirds of pulmonologists and about 30% of PCPs - titrate patients for the most appropriate liter-per-minute flow setting.

Even more discouraging was general physician awareness of the guidelines for COPD care. While more than 95% of pulmonologists and 50% of PCPs subscribed to a set of guidelines that defined appropriate therapy, only 18% of pulmonologists and 2% of PCPs were aware of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), one of the most prominent sets of guidelines available and endorsed by the NIH and WHO.

Other survey findings:

- Physicians are prescribing non-invasive ventilation for 20% of their patients with severe but stable COPD, which is not consistent with one of the generally accepted guidelines.

- Neither pulmonologoists or PCPs found it all that difficult to convince COPD patients to use home oxygen.

This finding surprised Thomashow, who has encountered greater reluctance to the adoption of portable oxygen therapy by his patients.

“I wonder whether what’s happening is that patients who are being prescribed oxygen are only using it in the house and not really using it outside,” he said.

The survey’s analysts are currently seeking publication of their findings in a peer-reviewed journal.

The survey, commissioned by NECA, was underwritten by unrestricted grants from the Alpha-1 Foundation, Dey L.P., GlaxoSmithKline, and Pfizer/Boehringer Ingelheim.

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