By Brian L. Tiep, MD
Director of Pulmonary Rehabilitation
City of Hope National Medical Center
Oxygen therapy has been known or believed to benefit patients with several different illnesses since around the time of the American Revolution. Two major studies performed in the 1970’s, one in the USA and the other in the United Kingdom, showed that in patients whose blood oxygen level was low, administering oxygen improved their survival. Other studies demonstrated an improvement in quality of life. Recent studies showed that many of these patients could benefit from oxygen during exertion (like walking). Pulmonary rehabilitation programs train patients to exercise, which greatly improve their ability to function in life and relieve shortness of breath. Patients who are sedentary tend to do worse, whereas patients who are active tend to do better and enjoy a higher quality of life. Thus, those who require oxygen should have very lightweight and portable systems that enable them to be active. Over the past 30 years, oxygen-conserving technology has enabled the development of the highly portable systems. Two of the devices derived from these developments include: portable oxygen concentrators and small oxygen cylinders that refill from the patient’s home oxygen concentrator.
Until very recently, patients were increasingly enjoying and living the advantages of these developments. However, Medicare has restructured reimbursement to the companies providing oxygen making it much more difficult for patients to have a highly portable system. Because the reimbursement is so low, companies that have won the competitive bid (oxygen from the lowest bidder) may deny or delay the patient from receiving a portable system. However, portable oxygen for patients who can be active is considered standard of care. It is therefore incumbent upon patients and their healthcare providers ensure the use of a truly portable system. Physicians should specify the exact system to the oxygen supplier and carefully fill out Certificate of Medical Necessity so that the equipment providers can be reimbursed for their equipment and service. Once received, the patient should utilize their portable system in public and share the word with their fellow patients – of the benefits of living an active and quality life while on oxygen.