The development of home oxygen systems has been a revolution in the care of patients with advanced chronic obstructive pulmonary disease and a deficiency in oxygen. Other patients with similar states of oxygen deficiency (known medically as hypoxemia) are also benefited. Fortunately there is an excellent body of science that supports the use of oxygen. Most of this began in Denver, Colorado in 1965 when we embarked upon our first studies of liquid portable oxygen. These studies clearly showed that oxygen could reduce the pressures through the lungs and strain on the right heart, as well as excess blood formation. These studies also showed a marked improvement in exercise tolerance and a tremendous gain in quality of life. I personally observed all of the original patients in the original Denver studies. These, in fact, were my patients and I made house calls on them regularly to observe their progress.
Later, we embarked upon controlled clinical trials of oxygen in the late seventies. We were comparing oxygen given by a concentrator or other stationary source for approximately 12 hours including the hours of sleep, with more continuous oxygen given by a liquid portable system averaging 17 or more hours per day. It was our intent for patients who were assigned to continuous oxygen to receive it all of the time and many did. Continuous ambulatory oxygen proved to be far superior to nocturnal oxygen delivered by stationary sources. The differences in outcome could have been the duration of oxygen therapy or the method. My own view is that the ambulatory capability made exercise and normal activities of daily living possible, which created a state of physical fitness. There was also psycho-social value which contributed to quality of life.
Unfortunately, oxygen is under attack today. The "bean counters" at HCFA are threatening to reduce the reimbursement by as much as 40%. This will make it virtually impossible for many oxygen suppliers to stay in business. Hit particularly hard would be liquid portable oxygen, the only practical ambulatory system. With oxygen reimbursement under attack, many are frankly worried that large numbers of patients will suffer. I am amongst the group that shares these concerns. If patients are denied ambulatory systems, they will have to be housebound or else risk the consequences of hypoxemia when away from home. In plain language, this is unfair, unethical and immoral. Thus, I hope that everyone who reads this letter will campaign vigorously to maintain oxygen reimbursement at a reasonable level, so that suppliers can stay in business. Why oxygen is being singled out for cuts is not clear to me. I do know that suppliers are guilty of abuses sometimes. Thus, everyone, i.e., physicians, suppliers, and third party payers, must look reasonably and responsibly at the oxygen supply and reimbursement problem. Our job is to serve our patients based upon science and technology for the improvement of patients' well being. It would be wrong to do anything less.
I will be in touch next month!
Thomas Petty, MD