Data Drive

There have been countless hours of discussion in the HME industry of late regarding CMS’ newly implemented oxygen policy and payment rules.

By Kelly Riley CRT, RCP

There have been countless hours of discussion in the HME industry of late regarding CMS’ newly implemented oxygen policy and payment rules. Whether you feel that in order to survive it will take payment “reform” or some version of policy repeal (or a combination of both), one issue keeps coming up: the lack of data.

A significant part of what we are missing is information related to the cost of providing care. But other data considered significant is information that is collected in an effort to enhance the care of patients, or data that is “patient-driven.”

That was the purpose of a study conducted by members of The MED Group’s National Respiratory Network in conjunction with Strategic Dynamics. To get a better handle on home oxygen use, data were collected from the orders of 938 new oxygen patients.

With such a large sample, the survey results — gathered from small and large oxygen providers in geographically diverse areas across the country in late 2006 — remain a timely source of information about home oxygen patients, their equipment and referrals.

They also serve as a reminder of the valuable service that HME oxygen companies provide both to their patients and physicians.

Among the project’s objectives were:

  • To determine the age at which patients are first prescribed home oxygen
  • To determine the mix of oxygen patients between males and females
  • To determine the oxygen patient’s diagnosis and ICD-9 code
  • To determine the method by which the physician order was received (telephone, fax etc.)
  • To determine the thoroughness of the written prescription
  • To determine if orders for an oxygen conserving device (OCD) are part of the HME provider’s standard requirements
  • To determine the percentage of patients that receives an OCD
  • To determine whether a specific oxygen modality is prescribed by a referral source
  • To determine the physician type/specialty that writes the most prescriptions for home oxygen
  • To determine the locations from which HME providers receive the most referrals
  • To determine the number of hours of ambulation required for new oxygen referrals
  • To determine the oxygen equipment that is provided to the patient

Here is the information gleaned from the study:

  • Payer Source
    • 71 percent of patients age 65 and older are covered by Medicare. This means that 29 percent of patients are covered by third-party payer sources.

    This data closely approximates the projected national average age of oxygen-dependent patients.

  • Primary Diagnosis
    • 53 percent of patients age 65 and older and 40 percent of patients under 65 are most commonly diagnosed with COPD.

    This means there are other clinical indications of home oxygen. These should be carefully determined, and each provider should target the physician specialty that identifies and/or provides care for these patients.

  • ICD Codes
    • While the ICD-9 codes are required for billing purposes, the patient diagnosis was much more indicative of the patient’s clinical requirement for home oxygen.

  • Prescriptions
    • Most new oxygen prescriptions are written generically.
    • Out of 683 prescriptions, only one was written at rest, exercise and sleep.
    • Most physicians accurately write an oxygen prescription for nocturnal use only, exertion only or a combination of during exertion and nocturnal use only.

  • OCD Prescribed
    • 76 percent of patients over the age of 65 and 82 percent of patients under age 65 were not prescribed an OCD on their order.

    The data shows that it is not common for an HME provider to receive an order for an OCD unless it is part of their intake form. Failure to receive an initial order for an OCD requires that the HME provider spend time and resources to obtain one. This offers providers an opportunity for physician education.

  • Oxygen Modality Prescribed
    • 66 percent of patients over age 65 and 86 percent of patients under age 65 were not prescribed an oxygen modality.

    This means it is up to the HME provider to determine the proper method of oxygen delivery for a typical patient. (This is especially interesting to note, as CMS in numerous documents relates that it is the physician who determines the modality.)

  • Physician Type
    • 77 percent of patients, regardless of age, receive their prescription from a physician other than a pulmonary disease specialist.

    This means the referral relationship should be carefully fostered and grown with non-pulmonary disease physicians.

  • Referral Location
    • Only 46 percent of patient referrals for home oxygen come from a physician office, while 38 percent come from a hospital and 16 percent from other sources.

    Many HME providers are limited in obtaining referrals from a hospital because of contractual arrangements. This means that to be successful, HME providers must clearly understand which physicians are prescribing home oxygen and have a call plan strategy to earn their share of referrals.

    HME providers should ensure they are calling on the “right” physicians and bringing them value in the sales call.

  • Ambulation Requirements
    • In the over-age-65 population, the percent of new patients who ambulate more than 21 hours/week = 21 percent. In the under-age-65 population, the number is 30 percent. If patients are diagnosed earlier, they require more ambulation.

  • Oxygen Equipment Provided
    • The data suggest that the HME providers surveyed are providing home oxygen devices to new patients based upon clinical need and not on what delivery system is the most profitable for them to provide.
    • It also indicates that HME providers are underutilizing new OGPE technology and can improve their financial performance by doing so.

  • The data resulting from this study has important implications for HME providers, physicians, patients and CMS. In comparison to other sectors of health care, this industry is still in its infancy. This is perhaps among the reasons providers’ role is so misunderstood. HME companies are deemed “suppliers,” while doctors, long-term care facilities, hospitals and most others in health care are defined by Medicare as “providers.”

    This survey, however, shows that HME “providers” are a valuable resource to physicians and that they base decisions about systems on their patient’s clinical need, not on the need to make a profit. The benefit of having data is a powerful tool, and one everyone in the HME industry needs to pick up sooner rather than later.

    With more than 25 years of respiratory experience in both institutional and home care settings, Kelly J. Riley, CRT, RCP, is director, National Respiratory Network, for The MED Group, Lubbock, Texas. Previously, she served as COO for At Home Medical (formerly Via Christi at Home) in Ponca City, Okla. You can reach her at [email protected].

    Comparison of Referrals by Location
    Location Age 65+ Under 65
    Physican Office 46% 38%
    Hospital 36% 46%
    Long Term Care Facility 7% 1%
    Sleep Lab 1% 5%
    Home Care Agency 2% 2%
    Other 8% 8%
    Comparison of Equipment Provided by Age Group
    Device Age 65+ Under 65
    Stationary oxygen concentrator 12% 22%
    Stationary oxygen concentrator + multiple cylinders 47% 43%
    Stationary oxygen concentrator + multiple cylinders + OCD 20% 8%
    Liquid oxygen (without OCD) — 1%
    Liquid oxygen (with OCD) 3% 1%
    Stationary oxygen concentrator + liquid oxygen 5% 5%
    Transfilling concentrator 9% 11%
    Dual Purpose concentrator 4% 5%
    Answered incorrectly — 4%

    Data from Across the Country

    The following MED Group Respiratory Network members participated in the survey (some have since changed ownership), and among them, data were gathered from 938 new oxygen patients.

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