The goal of long-term oxygen therapy (LTOT) in the home is to provide oxygen products and services that allow the patient to live as normal a lifestyle as possible with oxygen levels in the blood that are therapeutic and safe. This seems like a reasonable goal yet has been difficult to achieve since LTOT became a standard practice in the home.
In the early 1970s, oxygen products were cumbersome, bulky and expensive because the products were designed for hospital application. As the technology improved and more patients received home oxygen products, costs increased and the payment for LTOT equipment decreased. Today, we have a complex problem of new technology, reduced payment for technology, no recognition for necessary services provided by professional respiratory clinicians, and little focus on the effectiveness of therapy and outcomes. LTOT patients have become lost in the political and economic battle for health care dollars.
Why Put Patients First?
The patient is the reason for LTOT in the home. If we are not meeting the patient’s needs with oxygen therapy products and services that keep them active and well oxygenated, why are we going through the motions in the first place?
Many patients have expressed concern that the oxygen equipment shows up at their homes and there is little explanation of safety issues and how the equipment works. The reason the provider does not provide the extra service is because payors only reimburse the provider for the equipment; there is no payment for professional services. How does this help the patient?
The patients are left with the challenge to learn how they can adapt the equipment to meet their lifestyle needs. They do the research for themselves, test new methods and determine what works and doesn’t. Isn’t that the professional’s job?
New Technology
New technology can address the provider’s economic needs and the patient’s lifestyle needs. Smaller, lighter, portable oxygen systems are available to help patients ambulate, while oxygen systems that fill portable oxygen containers in the home help reduce the provider’s distribution costs. These solutions can help with the continuing reduction in payment for LTOT equipment, yet the concern is that there is little clinical evidence of how these systems work and their effectiveness.
Oxygen patients have started to purchase oximeters to monitor their oxygen levels during different activities to determine what oxygen dose setting is best for their applications. Some patients learn that the oxygen system cannot meet their needs at certain activities. Once again, isn’t that what the professionals are supposed to do?
Oxygen Patients
Today’s oxygen patient has access to previously unavailable information. The Internet has provided resources for information on equipment and therapy that helps the patient understand his or her disease and treatment options. The Internet also provides the opportunity to network with other patients from Web sites and servers that help the patient ask questions and share solutions. The patient has become better informed on the effectiveness of oxygen therapy and what oxygen equipment can meet his or her needs.
Home oxygen therapy initially evolved as a means to free the patients from the hospital when all they required was supplemental oxygen to maintain proper oxygen saturation. This was a patient-focused issue. Times have changed. Now, there are so many patients on oxygen that economics has become the major issue. There is not an easy answer, since costs have risen dramatically. Yet targeting equipment as the only means to control costs has left a void in determining the effectiveness of therapy and overall patient outcomes.
Oxygen patients know what works best for them, and they are more concerned about their therapy and lifestyle than clinicians, payors and providers. These patients will become more informed and active regarding whom they choose to manage their health care, provide oxygen equipment and who they vote for.
Focusing on the patient first will have a lasting effect when all the economic issues are resolved.
