Wednesday, December 31, 2008

Q. We’re trying to control costs by implementing oxygen conserving devices for our ambulatory patients. The problem: We have some doctors who feel they don’t work effectively. What do we do?

A. Fortunately for providers and patients, there have been many advances in devices used to deliver long-term oxygen therapy (LTOT), including oxygen conserving devices. Unfortunately, these advances have occurred in a relatively short period of time, creating a knowledge gap not only for physicians but also HME providers and hospital-based respiratory therapists.

Oxygen conserving devices entered the market driven by providers who wanted to control the costs of providing ambulatory oxygen and by patients who wanted lighter systems that lasted longer. Manufacturers determined the volume at which to provide gas at each setting and often reported it to be the equivalent to continuous flow. But tests found that one device set on 4 was giving 66 ml of oxygen per breath, while another unit set at the same volume was giving 34 ml (For more information, see 2007 Guide to Understanding Oxygen Conserving Devices, Valley Inspired Products). This created confusion and a misperception, mostly among physicians, that the devices didn’t work properly.

The American Association of Respiratory Care (AARC) recognized this in August 2007, when it released a revised version of Clinical Patient Guidelines for Oxygen Therapy in the Home or Alternate Site Health Care Facility. The AARC’s message is simply stated: “Match the patient to the device.” An excerpt from the AARC’s guidelines reads: “Measurements of oxygen saturation also should be made to determine appropriate oxygen flow or PDOD/DODS setting for ambulation, exercise, or sleep.”

Showing that the patient is staying oxygenated while using a conserving device should address the physician’s concerns and result in cost reductions for the provider.

Kelly Riley is director of The MED Group’s National Respiratory Network. Reach her at kriley@medgr