Expanding Your Oxygen Care and Business Performance

Regardless of the COVID-19 pandemic, the need to serve increasing numbers of home respiratory patients continues to expand. How do HME providers meet that demand?

Oxygen providers services and equipment, find themselves in unique circumstances. They must provide care to long-term oxygen therapy patients during a public health emergency.

Then again, respiratory providers have always found themselves in “interesting” circumstances. They had to respond to the 36-month rental cap. They had to respond to competitive bidding. They had to respond to audits. And while each of these instances hit their funding, each time they’ve deftly adapted.

One thing is clear: even without COVID-19 increasing the need for home oxygen, other disease states that have been served by respiratory providers aren’t going anywhere. In fact, they’re increasing. The total cases of chronic obstructive pulmonary disease (COPD) is expected to grow rapidly in the United States and major European countries over the next decade, according to an analysis by analytics company GlobalData.

In the report, “Chronic Obstructive Pulmonary Disease: Epidemiology Forecast to 2028,” the firm estimated that COPD cases in seven major markets — including the United States, Germany, the United Kingdom, France, Italy, Spain and Japan — will go from 59.3 million in 2018 to 67.2 million in 2028.

The highest number of COPD patients will be located in the United States, where the amount of cases is expected to grow from 26.6 million to 31.1 million over the course of a decade.


There is a market for long-term oxygen therapy beyond Medicare. For instance, there is an increased need for clinical services in the skilled care setting like a hospital or skilled facility.

There are providers getting creative and creating models for value-based purchasing and alternative payment methods with private payers and non-traditional funding sources. They’re marketing to commercial plans and showing what outcomes are possible and actually creating that model for an insurance company and payer.

And in working with private payer funding sources and similar entities, it’s important to note that the territory will still seem somewhat familiar, because most payers look to CMS as a guideline. The majority of third-party payers follow the Medicare template for coverage, and rentals are most common.


A growing way for oxygen to make themselves stand apart to referral partners and payers is remote patient monitoring (RPM). For years now, PAP devices have been monitoring patient performance and feeding that data back to care management systems that physicians can use to see unique health events and tweak care. Those devices can also connect with personal apps that patients use to better manage their care.

Use of remote patient monitoring in sleep has exploded and is poised for more growth. In 2015 market research firm Berg Insight reported the global number of remotely monitored patients grew by 51 percent to 4.9 million. In 2019, ResMed reported that it alone has 10 million users of its cloud-connected devices and it had a database of 4.5 billion nights monitored.

Now remote patient monitoring is starting to find its way into oxygen. The first forays into remote POC monitoring came with devices that were largely founded on the concept of fleet management: providers would remotely monitor POCs to ensure they were being used and that they were functioning properly. Moreover, depending on the situation, providers could remotely diagnose problems.

That soon gave way to the notion of monitoring usage data and now we’re seeing some oxygen equipment also monitor clinical data. HME providers could become champions to both their referral partners and patients, and would benefit from an ever-growing reputation for effectiveness and forward-thinking care that produces results in an outcomes-oriented care environment. That’s a hard value proposition to ignore.


Providers of portable oxygen systems must look beyond the funded market. Medicare and some private payer are clearly important, but the retail market for portable oxygen cannot be ignored — particularly the online market. Type “portable oxygen concentrator” into Google. The results will show a thriving marketplace — a marketplace that most providers currently do not serve.

Retail represents a massive opportunity to providers. It is where customers go when providers don’t give them what they want. This is particularly true of the Baby Boom.

The massive demand for POCs and similar devices should clearly demonstrate that there is a huge population of underserved patients looking for — and buying — those types of systems. Moreover, even if some of those online buyers are already receiving tanks, that should make providers wonder two things: how much wasted cost is built into the business, and on how much retail or funded revenue did they fail to capitalize?

Obviously, selling on a retail basis can be difficult for Medicare providers. They need to have new business infrastructure, they must adhere to a number of legal requirements under Medicare, and the guidelines can sometimes be confusing. Moreover, many providers interested in retail will set up entirely separate businesses in order to serve a retail customer base (and even then there are specific Medicare guidelines regarding referrals between the two businesses, and similar issues) that providers must contend with.


Don’t forget that even with funded patients, there is retail business to realize. For instance, COPD patients using portable oxygen concentrators are mobile, so think about the items that will help them stay mobile. Extended-life batteries and additional batteries, as well as additional chargers, help users stay out of the home longer and even travel to visit their families. Likewise, backpacks, shoulder bags and straps are a great way to ensure that POC users can keep both hands free and almost forget that they’re using an oxygen device.


  • Even during a pandemic, oxygen providers must still come up with ways to develop new revenues and drive increased efficiencies.
  • The market for their services keeps growing. The number of U.S. COPD patients is expected to grow from 26.6 million to 31.1 million over the course of a decade.
  • Providers need to get creative with their funding. Are you reaching out to private payer insurance? Health plans? Facilities such as SNFs? Why not?
  • The retail market is still very much an important opportunity for oxygen devices. This is particularly true of Baby Boom clients who are willing to pay for the exact solution they want or need when the funding might not be there.
  • Even if your oxygen business is mainly funded, you should still pursue a caretailing blend of funded oxygen equipment and retail accessories and upgrades.


To stay on top of key portable oxygen technology trends, make sure to follow our Oxygen Solutions Center.

About the Author

David Kopf is the Publisher HME Business, DME Pharmacy and Mobility Management magazines. He was Executive Editor of HME Business and DME Pharmacy from 2008 to 2023. Follow him on LinkedIn at linkedin.com/in/dkopf/ and on Twitter at @postacutenews.

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