Providing Oxygen Sensibly
HME providers who supply home oxygen are under siege. Reimbursement is declining and threats of further cuts occur with increasing frequency. There are constantly changing rules, a rebid of competitive bidding — and the lack of clarity and communication from CMS is truly alarming.
Coupled with these problems is the fact that new oxygen delivery technology continues to be introduced that must be evaluated for purchase, and patients are beginning to request new and different equipment so they can travel with their oxygen on airplanes, rail, bus and cruise ships.
Providers who wish to stay profitable must now be very astute businesspeople. This requires a thorough understanding of the types of oxygen patients they serve, their clinical requirements, referral source preferences for technology and the oxygen modality choices available within the current reimbursement system.
With every new oxygen patient referral, the HME provider must determine what oxygen delivery technology will be the most effective and appropriate for that patient. Their oxygen delivery choices are as follows:
Stationary concentrator only;
Stationary concentrator and multiple aluminum cylinders with an oxygen conserving device (OCD) that has been titrated to meet the patient's clinical requirements and activities of daily living;
Liquid oxygen delivered through one base unit or two base units (tandem system) and one liquid oxygen portable device;
Transfilling concentrator that allows in-home filling of one or more portable cylinders;
Portable oxygen concentrator (POC) that delivers pulse doses only and that weighs less than 10 pounds;
Stationary oxygen concentrator plus POC;
POC capable of pulse dose and continuous flow and that weighs between 10 and 20 pounds.
Some would say that matching the patient with the device is an art. We would suggest it can be based upon empirical data and science.
Types of Oxygen Patients
The entire population of oxygen-dependent patients can be described and placed into four convenient and easy-to-understand groups.
- Nocturnal patients, those that require oxygen only at
These patients have a myriad of clinical disorders that require them to have supplemental oxygen to minimize their oxygen desaturation during sleep.