NAMDRC Legislative and Regulatory Agenda Once Again Focuses on Patient Access

Home Oxygen Therapy: In 1986, Congress revamped the statute governing coverage and payment of home oxygen. Pondering the reality of a segment of pulmonary medicine that has seen dramatic technological improvements and enhancements over the past 30-plus years, coupled with a payment system that is stuck with e-cylinders and competitive bidding, it is no wonder that both patients and physicians experience ongoing frustration trying to match a patient’s needs with an oxygen system that reflects the patient’s needs.

It’s a challenge to even consider where to start a reasonable discussion of home oxygen therapy. While the concept of supplemental oxygen is well accepted, the actual clinical evidence relies heavily on a very small number of studies. While virtually no one challenges the concept of the therapy, the actual science has progressed modestly in 30-plus years. But the technology surrounding oxygen therapy has become an industry all to itself. There are concentrators, portable oxygen concentrators, liquid systems, transfill systems, transtracheal oxygen therapy, and so on.

Add to the environment the growing demand for high flow systems that would deliver continuous flow oxygen at rates in excess of 4 L/min, and you begin to realize that the current payment system is a barrier to access. After all, the current payment system has problematic characteristics:

1. A flawed competitive bidding methodology;

2. Payment tied to liter flow pegged at a baseline of 2 L/min, regardless of actual patient need;

3. The major shift from a “delivery model” of care to a nondelivery model that reflects these newer technologies;

4. Virtual disappearance of liquid system availability as an option for physicians/patients;

5. The total failure of CMS to monitor, let alone act on, patient concerns.

Again, taking the NAMDRC Mission Statement into context, NAMDRC is working with all the key societies to craft a broad strategy to address these problems, acknowledging that it will likely take a mix of legislative and regulatory actions to bring home oxygen therapy into the 21st century, let alone to reflect realities of care in 2018.