EFFORTS - P. O. Box 20241 Kansas City, Mo. 64195-0241 Ph: 1-866-END-COPD

Self-Advocacy:

Medicare Payment for Oxygen and Oxygen Equipment


The numerous changes in Medicare billing rules for oxygen equipment over the past several months have left patients uneasy and confused. As providers, manufacturers and the medical community make their concerns known to our legislators, we ask that you also contact your Senators and Representatives and help make patients concerns known as well.

One option for writing your Senator or Representative is to go the Congress.org Web site and use their tools to search for your elected representative and send an email. You will have to register on the site first and then you can enter your zip code to locate the address(es) of your Senators and Representative. You will then be able to either email your letter or print it our for postal delivery. EFFORTS does not, of course, endorse any Web site.

Alternatively, you can the Write Your Representative page from the White House's Website. Select your state, enter your Zip Code and follow the prompts to generate an email to your elected Representative.

Enter your concerns in the text area of the email or use the following as a model:

As a COPD patient and member of EFFORTS, an internet advocacy and support group for people with COPD (Chronic Obstructive Pulmonary Disease), I am writing to ask that you consider the ultimate effects of the Oxygen therapy provisions upon the patients as you enact the necessary legislative changes in the CMS final rule as mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

A single visit to the Emergency Room by a COPD patient costs $3500 - $8,000. An uncomplicated stay in acute care for three days of treatment for an uncomplicated exacerbation of COPD is around $12,000. Severe complications can raise the costs up to over $20,000. An ICU stay of four days or more hospital time, acute care for a week or more and inpatient rehab for an additional week COPD with complications can cost up to $120,000 for a single episode.

All of these high cost courses of treatment can be avoided by providing adequate and proper Long Term Oxygen Therapy (LTOT) equipment and professional respiratory services at a cost of approximately $250 per month per patient. Patients on LTOT rely on durable medical equipment (DME) for the oxygen that sustains each breath and affords us a productive and active quality of life.<

Because LTOT greatly reduces emergency room trips and hospitalizations and because it increases our ability to fully participate in work and social activities, it is very cost effective, and results in a healthier, more active and more productive life style

I am concerned about how these billing changes will further restrict the life of a person on oxygen. As it is now, there are many inequities in what is available from one patient to the next. Some have no emergency back-up, some have little or no portable equipment, and some do not have enough oxygen for exercise or even realize that they should.

We ask you to consider these optimum provisions for LTOT.

Supplemental Oxygen is a prescription medication and must be ordered by and administered under the direction of Medical Doctor.

Each patient must be evaluated and the individually suitable stationery and portable equipment shall be provided under the supervision of a Respiratory Therapist.

The Provider must supply all durable medical equipment and accessory items such as tubing and cannulas. They must also coordinate delivery and patient instruction about the proper use of equipment with a Respiratory Technologist in accordance with the physician's orders.<

A Respiratory Therapist should perform a periodic check of patient welfare to insure that the equipment is in good working order and is the optimum for the individual patient.

Back up equipment must be provided for all oxygen systems; gas, liquid, compressed O2 and home units.

Oxygen equipment should be made available to the patient, in such a manner as to allow the patient to have as active and healthy a lifestyle as they are capable of; including the ability to participate in family events or activities outside the home.

Many oxygen patients live in fear of having their equipment removed. Many are totally dependant on their equipment suppliers, for whatever knowledge or advice they need to use the equipment properly. Some do not have an adequate supply of hoses, which harden and crack and need to be changed routinely to avoid infection, some have no portable equipment. If you have the opportunity to make changes in the way this equipment is currently billed and handled, I hope you will keep the consequences to the patient in mind.


That's it. You've just written to you Senators and Representative. We thank you for your participation. Please drop Linda  a note so we can add your letters to our count.