Low‑cost oxygen safety device stuck in reimbursement limbo

YARMOUTH, Maine – Thermal fuses can stop oxygen‑related fires before they spread, making them a simple, low‑cost safeguard for home oxygen therapy. But without reimbursement from the Centers for Medicare & Medicaid Services (CMS), many HME providers say they can’t afford to routinely supply them in today’s tight‑margin environment. 

While thermal fuses are relatively inexpensive – less than $5 a piece – it's tough to add another expense amid increasing costs and stagnating reimbursement. 

“They're not very expensive, but it’s still another cost,” says Woody O’Neal, vice president, O’Neal Medical in Pelham, Ala. “Maybe we should offer it as a cash sale. Even when patients understand safety rules, they forget – just like forgetting to buckle a seat belt.” 

About 1.5 million people in the U.S. rely on home oxygen, and experts estimate that up to 750,000 of them continue to smoke while using it. The risk is significant: A home oxygen therapy fire death occurs about every four days, according to the International Fire Chiefs Association. 

Used selectively for high-risk patients willing to pay 

Thermal fuses, which are installed on oxygen tubing and automatically shut off the flow of oxygen if a fire ignites, are stocked at BritKare in Amarillo, Texas. But they are usually used for high-risk patients willing to pay out-of-pocket, says Josh Britten, CEO. 

“Ninety percent of our smokers smoke on oxygen,” he said. “Before competitive bidding, it would’ve been a no-brainer. But now, providers can’t absorb another expense.” 

Education remains frontline of fire prevention 

Providers say they focus heavily on education – even if they don’t routinely supply thermal fuses. 

“We teach them, we leave them with the (warning) signs, and we make sure there are no open flames or heat sources and that detectors are working,” says Casey Toomajian, CEO of Clifton Park,  N.Y.-based Hometown Healthcare. “Best practices matter, like keeping the concentrator at the right distance. But we don’t always have a way to follow up.” 

Some contracts require them – and some providers prefer it 

Brian Wilson, COO of Commonwealth Home Health Care in Danville, Va., has contracts, including with Veterans Affairs, that mandate the use of thermal fuses as part of their bundled services. But he says he’d  choose to provide them regardless. 

“They’re about $3 to $5 each,” he said. “That’s five dollars we’re not putting in our pocket, but it protects the patient. It works, and it’s worth the investment.”