The majority of patients receiving oxygen therapy are low-income, non-Hispanic white females about 75 years old with two or more other health conditions, according to a new a study by The University of Texas Medical Branch at Galveston. The results could also demonstrate the impact of the 36-month rental cap for oxygen equipment.

The first study to use a large, nationally representative sample of U.S. patients in order to profile oxygen therapy use among COPD patients, the UTMB research shows considerable change in the COPD population receiving oxygen therapy.

The modern prescription of oxygen therapy has been based on two studies conducted longer than 40 years ago that examined a population largely white males aged approximately 65 years without serious medical comorbidity. The new UTMB study shows a large swing from that original population.

The study examined national trends and factors associated with the use of oxygen therapy in a national sample of 329,482 Medicare beneficiaries with COPD between 2001 and 2010.

Some other key data points:

• In 2008, more than 1.4 million Medicare beneficiaries, of whom 82 percent were diagnosis with COPD, received oxygen therapy at an estimated cost of $2.9 billion. This accounted for more than 45 percent of Medicare’s medical equipment expenditure that year.

• From 2001 to 2008, the number of COPD patients with prescribed oxygen therapy grew by more than 8 percent. A key reason for the growth is that, while the frequency of COPD in the U.S. has remained stable, the survival of COPD patients has improved, especially among women, who have longer life expectancies than men. 

• Since 2007, women affected by COPD have outnumbered men, which may account for the rise in oxygen use in women.

Impact of Medicare Cuts

Also, Medicare reimbursement cuts could be impacting the patient population. After 2008, the percentage of patients receiving any oxygen therapy overall dropped slightly over the next two years. However, the number of patients who received a prescription for oxygen therapy at least 11 months per year declined more steeply, by more than 8 percent.

The post-2008 decline could be chalked up to Medicare policy changes addressing oxygen therapy qualification and reimbursement. A key example would be the 36-month rental cap, which began implementation in 2009.

“Overall, from 2001 to 2010, we report an increase in oxygen therapy”, said Dr. Shawn Nishi, the study’s lead author and assistant professor in the internal medicine Division of Pulmonary, Critical Care and Sleep medicine. “Oxygen use may be increasing because physicians and patients are becoming more aware of the benefits in COPD and there is a decreased perception of oxygen therapy as a stigma.”

Other authors of the study include UTMB’s Wei Zhang, Yong-Fang Kuo and Gulshan Sharma. The research was supported by the Agency for Healthcare and Quality, the Patient Centered Outcomes Research Institute and the National Institutes of Health.