High-flow patients, providers caught in liquid oxygen squeeze

PELHAM, Ala. – A new survey shines a light on limited access to high-flow home oxygen and the resulting delays in hospital discharges and added costs and risks to patients. O’Neal Medical is among a shrinking number of HME providers still offering it.

Vice President Woody O’Neal says reimbursement changes have made the service increasingly difficult to sustain, even as it remains medically necessary for certain high-flow patients.

HME News: Why does O’Neal Medical continue to offer liquid oxygen?

Woody O’Neal: The reimbursement landscape has gotten to the point that most insurances are reimbursing less than what it costs to actually purchase the liquid oxygen, so the only way we would provide liquid oxygen is if the patient has a specific clinical need that can only be supported by liquid oxygen. Otherwise, patients have other choices that we provide.

HME: Which patients are most likely to require it?

O’Neal: A patient who has a condition like pulmonary fibrosis where they need 8, 10, 12 liters of portable oxygen. That's very difficult to do with gaseous oxygen. Tanks and portable oxygen concentrators simply don't have to have the flow rates to take care of those patients, who are fibrotic. We would not provide liquid oxygen to a stable COPD patient with a lower flow rate requirement.

HME: Why has liquid oxygen become harder to carry?

O’Neal: In the 2000s, 2012 to 2016, the Medicare program decimated the reimbursement structure for liquid oxygen to the point that providers, such as myself, really had no option. You can't go out of business by continuing to support the delivery of liquid oxygen and the small liquid oxygen portable devices simply for patient convenience, and that's unfortunate, because we provided a high level of care to those Medicare patients. When competitive bidding happened, all of that changed.

HME: Could better reimbursement bring providers back into the market?

O’Neal: I think it is possible. Medicare's 36-months rental cap also created an economic disincentive to provide options to the patient. In my estimation, this is a failed exercise in medical policy by the federal government, which, unfortunately, has been adopted by many other Medicare Advantage and commercial insurance companies. For decades, policymakers in this industry have failed to understand the real true service costs that companies like mine burden, including 24-hour a day call, routine equipment checks, the internal cost of providing gas, tires, vans, labor. All of these things have gone up exponentially and the reimbursement structure has not kept pace.

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