Game's changing for home oxygen

Friday, April 1, 2011

ORLANDO - Much has been made of the Medicare reimbursement (or the increasing lack thereof) for home oxygen therapy. But what about the benefits of this therapy, when it’s done right? Shouldn’t physicians, nurses and respiratory therapists be focusing on that? And if they do, won’t reimbursement take care of itself? 
Bob McCoy thinks so. Here’s what McCoy, a respiratory therapist and the managing director of Valley Inspired Products, had to say about this “game-changing” conversation.

HME News: You attended the “Long Term Oxygen Therapy Conference: Separating Fact from Fiction,” March 31-April 1 in Orlando. The goal of that conference was not to talk about reimbursement, but about the benefits of this therapy. That’s a big deal, right?

Bob McCoy: This conference pretty much came out of one of the recommendations at all of the oxygen consensus conferences, which is that we need to do physician/clinician education at all levels. 

HME: What has been the consequence of this lack of education? 

McCoy: Physicians haven’t stayed engaged with this therapy, so they haven’t been observing ineffective therapy and that’s impacting patient care and outcomes. 

HME: What’s wrong with the way home oxygen therapy is being provided?

McCoy: There’s never been a good assessment tool. They’ll do a blood gas or an oxygen saturation test while the patient is in a hospital bed not moving and prescribe 2 liters per minute, which has been the rubber stamp for decades. But that’s not what you want them to do in their home. Then you find patients at home and they’re not oxygenating.

HME: Is there clinical evidence of this problem? 

McCoy: It’s been coming out in several articles and abstracts. One of the presenters at the conference says 60% of the patients that come into her rehab program aren’t oxygenating on the device they have, 20% need an adjustment and 40% are on a piece of equipment that can’t oxygenate them. We hope the conference and the highly-respected pulmonologists involved serves as a wake-up call. 

HME: You mentioned equipment that can’t oxygenate. 

McCoy: We’ve gotten to the point where the market is driving for the 
lightest weight, longest lasting equipment, regardless of whether it 
oxygenates the patients. So we have an awful lot of small pieces of 
equipment or these non-delivery systems or POCs that produce a very small amount of oxygen. 

HME: How can home-based RTs help this conversation along? 

McCoy: We need to get physicians to prescribe therapeutic oxygen therapy, and they’re looking for clinicians in the home to advise them. A lot of the feedback we get is, “The docs don’t know anything about oxygen therapy,” and they don’t really need to. It’s like the saying, “If you don’t know diamonds, know your jeweler.” If you don’t know oxygen therapy, know your RT and trust them. That’s where the RT needs to do more. 

HME: What will be the impact of increased education, better assessment tools, etc. on reimbursement? 

McCoy: If the physician understands the situation and prescribes properly and no one pays for it‹that’s pretty much the way it is right now, but you can’t change the script based on reimbursement. Put the payers’ feet to the fire. Say, “This is what’s therapeutic based on our science. Now if you don’t do it, then it’s your decision. When the patient has an event or is hospitalized, it’s because no one paid for the right therapy.” I think when that happens enough, we’ll start getting appropriate reimbursement.