Conference surveys state of LTOT, suggests improvements

Sunday, September 4, 2005

DENVER - The Sixth Oxygen Consensus Conference ended Aug. 28 after three days of high-level, often spirited discussion with attendees recommending strategies for improving all aspects of long-term oxygen therapy.

If you want to know what those recommendations are, however, you'll have to wait. Conference leaders will not discuss them publicly until first publishing them in a clinical or academic journal.

"I hope that will be sooner than later," said Dr. Dennis Doherty. Doherty co-chaired the conference with Dr. Tom Petty, the acknowledged father of LTOT.

Despite the wall of silence surrounding the consensus recommendations, the conference provided plenty of take away and food for thought.

Here's a smattering of what conference speakers had to say:

- Providers will be happy to know that when it comes to competitive bidding they have an ally in home respiratory patients. Like HME providers, patients also believe it is a bad idea. While it may cut Medicare expenditures, it could also allow a low-cost provider to scoop up a bunch of business and offset the reimbursement cut by severely limiting access to high-end portable units.

"A lot of people are afraid of competitive bidding," said oxygen patient Pete Wilson.

If bidding does go forward, the mandatory accreditation component for providers is extremely important to insure a high quality of care, Wilson said.

-- LTOT provides many benefits to the patient, said Dr. William Bailey, director of the Lung Health Center at the University of Alabama at Birmingham. Those benefits include decreased mortality, decreased depression, improved quality of life and enhanced exercise capacity. Despite those obvious benefits, there's still a dearth of research on the impact of LTOT on patients. For example, the more hours a day that a patient uses oxygen the better. But does that mean he should use it 24/7? And what is it exactly about oxygen that improves a COPD patient's condition? "We don't know," Bailey said.

-- Mary Burns, executive vice president of the Pulmonary Education Research Foundation in Lomita, Calif., recounted multiple examples of the benefits of respiratory rehabilitation: COPD patients barely able to walk improving to the point that they are able to participate in road races, go dancing, do yard work and do handyman jobs around the house.

- Joe Lewarski , vice president of clinical and government affairs for Inogen, noted the need for providers to reduce delivery costs if they want to succeed in a climate of dwindling reimbursement. Lewarski added to the industry's legion of acronyms by coining a phrase for portable oxygen concentrators like the one Inogen makes: Non Delivery Oxygen Technology or NDOTs.

- The exact number of people on LTOT in the United States is elusive but estimated to be about one million, with Medicare beneficiaries representing 80% of that number, said consultant Patrick Dunne of Healthcare Productions in Fullerton, Calif. Of that one million, about 70% are assigned to stationary systems either because their doctors aren't aware of ambulatory systems or because HMEs choose to maximize profits by providing less costly technology. That will change, however, said Dunne, and ambulatory oxygen will become the standard of care. "Boomers are surfing the net," he said. "They know what is out there and they will not be denied."

- The Veteran's Administration serves six million vets and 19% of them have COPD, said Dr. Peter Almenoff, the VA's National Program Director/Pulmonary. About 33% of veterans smoke compared to 23% of the general public. About 50% of the military personnel in Iraq smoke. Overall, the VA spends 11% of its annual budget treating vets with COPD, Almenoff said.

- CMS spent $671 million for LTOT services in April through June 2005 and for the year expects to spend $2.7 billion, said DMERC Medical Director Dr. Adrian Oleck. Of the 995,000 beneficiaries on oxygen in the most recent quarter, 75% had portable systems - 87% of those gaseous systems, 12% liquid and 1% portable concentrators. Of those beneficiaries, 94% also had concentrators; 6% had liquid stationary systems and less than 1% had a gaseous system. While the HME industry claims treating COPD patients at home reduces hospital costs, that is "extraordinarily difficult to prove," Oleck said.

- If managed care is to provide more care by decreasing costs and being more efficient, patients are going to have to share the costs, said Patricia Tanquary, executive director of the Contra Costa Health Plan in northern California. One way to do that is through a benefit upgrade. For example, if a patient wants all-terrain tires on a power wheelchair that comes with standard tires, he'll have to pay more for the upgrade. The question she said, is how do we pay for this benefit without adding to the current taxation and future costs? "We will not solve our problems by saying we need more money," she said.