Sharp Drop in Portable Oxygen Access Blamed on Provider Pay Changes

Lung groups call on CMS to abandon competitive bidding.

A coalition of pulmonary health groups called on the Centers for Medicare & Medicaid Services (CMS) to change its supplemental oxygen reimbursement policy to remove liquid oxygen from competitive bidding requirements.

The American Lung Association (ALA), the American Thoracic Society, the COPD Foundation, and 17 other groups said that competitive bidding has dramatically reduced access to portable liquid oxygen among oxygen-dependent patients with the most severe lung diseases, leaving thousands of patients home-bound and tethered to home-based high liter flow oxygen systems.

On Thursday, the groups sent a letter to CMS commending the agency for recognizing the scope of the problem, while recommending specific changes to improve access to portable oxygen for those who need it most.

“Over the last 10 to 12 years the changes in reimbursements to (oxygen) suppliers, most notably competitive bidding, have represented something of a perfect storm resulting in the most dependent patients not getting the types of oxygen they need to meet their clinical needs and their quality-of-life needs,” ALA spokesperson Erika Sward told MedPage Today.

Liquid oxygen is required for people who need high liter flows of oxygen (>6 liters/min), and is most often prescribed to patients with advanced chronic obstructive pulmonary disease, pulmonary fibrosis, or other advanced lung diseases.

Home-based high-flow systems typically require bulky ancillary humidification systems. Without access to portable liquid oxygen, patients who require high-flow oxygen are mostly home-bound.

Sward noted that by reducing compensation to suppliers, competitive bidding has been largely responsible for a 10-fold reduction in the number of Medicare recipients receiving portable liquid oxygen.

According to Medicare records, just 8,141 Medicare recipients with advanced lung diseases received portable liquid oxygen in 2016, compared with 80,571 in 2004.

In the letter sent to CMS, the 20 lung health groups noted that there has been no change in respiratory disease patterns that would explain the sharp decrease in utilization of liquid oxygen systems.

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