Chest
Volume 139, Issue 2, February 2011, Pages 430-434
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Topics in Practice Management
Long-term Oxygen Therapy

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This article provides an overview of the status of long-term oxygen therapy (LTOT). In the United States, payment cutbacks are occurring as a result of congressionally mandated competitive bidding and capped rental programs. These Medicare programs are discussed. These legislative and regulatory changes may result in reduced patient access to appropriate oxygen-delivery systems that meet medical needs, including optimal ambulation. Prescribing LTOT is addressed in this article, as is the need for adequate patient education. The importance of appropriate monitoring and reassessment is presented. The use of an LTOT collaborative care model is discussed. Although the new intermittent flow oxygen-delivery systems have potential benefits, there is consensus that each patient should be tested on the specific device because of variability in delivery and patient response. Feasible locations for patient education and monitoring are identified.

Section snippets

Competitive Bidding

CMS, as required by federal law, has begun implementing the Medicare National Competitive Bidding Program for durable medical equipment (DME).13 This category includes home oxygen-delivery devices and related supplies. Simply stated, CMS will only reimburse LTOT suppliers who submit the most cost-effective bids for delivery of a minimum standard of service as defined by CMS. The “roll out” in metropolitan service areas is occurring currently in 10 selected cities and will then be expanded

Capped Rental

The congressionally mandated Medicare National Capped Rental Program for Oxygen16 is in effect. Under the current law, CMS stops payments to homecare suppliers after the 36th month of patient use (rental). After the 36-month payment cap, the homecare supplier must continue to provide any needed oxygen supplies without additional reimbursement. This period begins at month 37 and continues through month 60. CMS will pay limited additional reimbursement for emergency and periodic repairs until the

Clinical Considerations

The physician reimbursement structure for LTOT is unchanged and falls under the 2010 Current Procedural Terminology guidelines and related fee structures. The codes have been used in the direct face-to-face management of patients with other chronic diseases and disorders resulting in hyperglycemia, hypertension, and hyperlipidemia, which in many ways are analogous to chronic hypoxemia.

It has been shown that a prescribed continuous use of supplemental oxygen improves survival9 and some

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    For editorial comment see page 238

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