The indications for long-term oxygen therapy (LTOT) are generally well recognized, although there are no commonly accepted clinical indications for prescribing a specific type of portable oxygen system. Both the use of portable systems and the organizational models for health care delivery may vary from one provider to the next and from one region of the country to the next.

There are no evidence-based reliable data on the number of patients who actually use or who might benefit from using portable oxygen systems. There are differing views among professionals and the public on what constitutes appropriate access to portable oxygen systems. Health professionals do not have conclusive scientific evidence to make informed decisions about patient-specific selection and therapeutic prescription for portable systems.

In generally well-documented studies, long-term oxygen therapy has been proven to increase life expectancy in patients with COPD who require LTOT. Accurate identification of hypoxemia requires arterial blood gas (ABG) measurements, and pulse oximetry can be used to measure trends in oxygenation, oxygen needs, and oxygen requirements during exercise and sleep. However, there are no measures to determine the type of portable oxygen system for a specific patient.

A detailed oxygen prescription indicates: 1) the oxygen dose (L/min); 2) the number of hours per day that oxygen therapy is required; 3) the dose required during exercise; 4) the oxygen supply system: concentrator, compressed gas cylinder, or liquid oxygen reservoir; and (5) the delivery device: nasal cannula, demand-flow device, reservoir cannula, or transtracheal oxygen catheter.

Although the benefits of LTOT are generally well known, there are differing beliefs concerning the potential benefits of portable oxygen therapy in terms of survival and quality of life. We review the variables that may help identify the most optimal portable oxygen system based on specific patient need. And we determine selection criteria for patients who would benefit from portable oxygen systems.

Portable systems are intended to increase a patient’s mobility and ability to participate in activities outside the home, which would apparently contribute to increasing compliance with treatment. This would in turn improve length and quality of life. CMS coverage criteria for portable oxygen currently restrict use to in the home, and do not allow additional reimbursement for varying types of new portable systems for use outside the home. Whereas the criteria for prescribing LTOT are almost universally accepted, none exists for portable oxygen therapy.

Unless indicated on a prescription, the choice for the most beneficial type of oxygen system for a patient is determined by the DME/HME provider. No data have ever been systematically gathered on use, cost, health/economic outcomes, or quality of care. Reported use of portable oxygen therapy also varies widely, but there are no precise figures available.

How Do Providers Choose?
Do patients who require LTOT have access to lightweight portable oxygen systems? Our review of a random sample of patient data from multiple geographic locations revealed information related to the type of oxygen systems patients use and the factors that determine a provider’s selection. We approached our review based on the belief that competitive forces in the market drive the use of the lightweight systems—thus eliminating the perceived notion that patients do not have access.

Vernon R. Pertelle, MBA, RRT

Our Findings
The results identified unique variables that could be used proactively to establish selection criteria for patients who are prescribed LTOT. The results also showed that patients who benefit from lightweight portable systems receive them when deemed safe and appropriate. In addition, the data demonstrate that when a patient is not set up on a lightweight portable oxygen system, there is usually a good reason.

Patients who require LTOT experience declines in their physical status, thus the implications of our review show the need for ongoing evaluation by the HME provider to assure the appropriate system is used to meet the oxygenation needs of patients who are prescribed LTOT.

This illustrates the need for appropriate reimbursement to allow for the ongoing monitoring and evaluation of appropriate oxygen systems, particularly if a patient is initially provided a lightweight system with an OCD. COPD is a progressive disease, and as a patient’s disease progresses, oxygen needs change. In the absence of appropriate clinical services to assess the need for change in prescription, a patient is left in a potentially “unsafe” position to fend for himself to determine the most appropriate oxygen delivery system.

Given the current challenges with reimbursement and the lack of understanding regarding the types of systems that are available to patients, as well as the need for education of the prescribing physician, providers must begin to conduct internal reviews and quantify data to assist in defending against further reductions.

HME providers are integral to the ongoing monitoring and evaluation of patients who receive LTOT to ensure the therapy for the patient is appropriate. Available evidence does not allow for any firm conclusions to be drawn concerning the effectiveness of portable (or ambulatory) oxygen systems, and the benefits of using one system over another in patients with COPD.

Further studies are required to understand the role of specific portable oxygen systems in the management of patients with COPD on long-term oxygen therapy. DP

Vernon R. Pertelle, MBA, RRT, is senior director/assistant vice president for Tri-City Hospital District, Home Care/Hospice, San Diego. He can be reached via e-mail: vrpertelle@aol.com. 

Jim Dudley, RRT, is division clinical manager for Apria Healthcare, Central Division, Lake Forest, Calif. He can be reached via e-mail: Jim_Dudley@apria.com.