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CQRC Statement on the NY Times Article on Medicare's Home Oxygen Benefit

WASHINGTON, Nov. 30 /PRNewswire-USNewswire/ -- Today's New York Times story on home oxygen therapy omits salient facts about home oxygen therapy and the critical role it plays in keeping some of Medicare's sickest beneficiaries in their own homes as they manage the effects of debilitating and irreversible lung disease.

The story inappropriately treats home oxygen therapy as though it is nothing more than the rental of inert equipment, when in fact home oxygen is a prescribed therapy, that when properly administered, requires both medical devices and myriad patient services. Oxygen providers deliver critical services that help this oft-overlooked beneficiary segment manage their chronic disease and therapy between physician visits, which in turn helps to avoid costly hospital admissions, serious complications, and sometimes even death. Home oxygen providers are often the physician's eyes and ears in the patient's home setting.

Home Oxygen Therapy is an important and cost-effective treatment for COPD. Every year, millions of Medicare beneficiaries are treated for the effects of chronic obstructive pulmonary disease, or COPD. COPD is a progressive, non-curable disease that causes irreversible loss of lung function and threatens the ability of patients to perform even routine, daily tasks. COPD is the fourth largest killer in the United States. The average home oxygen patient is a 73-year old, frail female who lives alone, does not drive and takes multiple medications for multiple disease conditions. The sickest COPD patients need oxygen therapy to breathe and remain stable at home. Oxygen therapy providers are often the first line of care for these patients -- helping to maintain proper patient compliance with their prescribed oxygen therapy, thereby helping to slow lung degeneration and avoid hospitalizations.

These points were reinforced in a separate article reported in the Wednesday, November 28th New York Times story by Denise Grady on COPD which states:

"Although incurable, it is treatable, but many patients, and some doctors, mistakenly think little can be done for it. As a result, patients miss out on therapies that could help them feel better and possibly live longer. The therapies vary, but may include drugs, exercise programs, oxygen and lung surgery. Incorrectly treated, many fall needlessly into a cycle of worsening illness and disability, and wind up in the emergency room over and over again with pneumonia and other exacerbations -- breathing crises like the one that put Ms. Rommes in the hospital -- that might have been averted."

Medicare's home oxygen benefit helps keep beneficiaries out of expensive health care settings. The home oxygen benefit is vital to restraining Medicare's costs, and any immediate budget savings resulting from reducing reimbursement will come at a far greater cost to Medicare and its beneficiaries. Respiratory therapy in the hospital can cost Medicare over $4,600 per day. In 2002, there were 673,000 hospitalizations for COPD with an average length of stay of 5.2 days. A government study by the Agency for Healthcare Research and Quality and other multiple clinical studies conclude that once a patient goes on home oxygen therapy, he or she has 10 fewer days in the hospital per year, saving $46,000 per year in hospital costs alone. Few would argue it makes sense to spend $2,400 to save more than $40,000.

Recent Medicare cuts to home oxygen have yet to be realized. Over the past decade, beginning with the 1997 Balanced Budget Act, Congress cut Medicare funding for oxygen therapy multiple times -- resulting in a 39 percent reduction in payments, according to the New York Times. What the story does not lay out is that the biggest cuts haven't even taken effect. In 2009, this Medicare benefit will be cut by nearly 20 percent without any further Congressional action. If new cuts being proposed by lawmakers take effect, total reductions in 2009 will exceed 25 percent. No health care provider can sustain cuts of this magnitude without eroding important patient services.

Mishandled, oxygen can be dangerous. Both oxygen and the medical devices that create oxygen are regulated by the Food and Drug Administration, the Centers for Medicare and Medicaid Services and the Department of Transportation. Oxygen equipment is only available by physician's prescription and can only be sold by individuals or companies that meet local licensure requirements dictating the filling, use and transportation of flammable gas. Medicare has historically relied on a rental system for home oxygen to ensure that control over the medical device and oversight of the equipment in a potentially hazardous home setting remains in the hands of trained professionals. When medical devices are purchased over the Internet, control of the device and dosing shifts to the patient, increasing the risks of inappropriate self-medication and harm from mishandling, such as burns. Self medication is further complicated by the fact that oxygen is odorless and colorless, and patients cannot know whether the purity or flow is correct without instruments that require frequent calibration. Shifting the responsibility for maintaining complex medical equipment from the provider to the elderly or disabled Medicare beneficiary -- or to unqualified individuals -- can have dangerous consequences. For example, elderly patients being transported away from Hurricane Rita died a tragic death after an oxygen tank exploded on their bus.

At a time when Congress is under pressure to balance limited funding with the needs of a growing Medicare population, the focus of public policy for the home oxygen therapy benefit should shift to thoughtful reform of the system. We believe that providers, policymakers, and patients must come together to evaluate the appropriate array of services required to meet the needs of an expanding population of patients with chronic lung diseases.

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