The relationship between Medicare and nocturnal oxygen usage has been a tenuous one.
Nocturnal oxygen, or oxygen that is used during the night, is a basic requirement in treating chronic obstructive pulmonary disease (COPD) as well as other lung conditions. About 15 million people in the United States have been diagnosed with COPD, with an estimated 12 to 15 million more undiagnosed. The United States spends more than $29 billion yearly in medical costs for this condition. COPD is the fourth leading cause of death among adults in the United States and ranks third in Medicare recipient hospital admissions. Hypoxemia, a low level of oxygen in the blood, can be life-threatening. Historically, Medicare has not fully supported nocturnal oxygen. With rising costs of this therapy, it has been scrutinized by legislators and critics, and Medicare has focused budget cuts on long-term oxygen therapy for over 20 years.
Nocturnal Oxygen
In the early 1980s, the Nocturnal Oxygen Therapy Trial, or NOTT, determined the importance of low-flow oxygen therapy in the treatment of severe hypoxemia. Even now, this study is frequently referenced and provides the basis for prescribing nocturnal oxygen therapy for patients with COPD and other lung conditions. Its use has led to less frequent and shorter hospital stays.
Medicare Guidelines
Medicare introduced guidelines for long-term oxygen therapy partially as a result of the NOTT trial. Patients with a PaO2 level of 56 to 59 mmHg (millimeters of mercury) who also have dependent edema, pulmonary hypertension or a hematocrit higher than 56 percent, are eligible for Medicare coverage. PaO2 refers to the amount of oxygen in the arterial blood. At 60 percent PaO2, patients need special approval to receive coverage.
Future Considerations
Because of rising expenditures, Medicare continues to scrutinize nocturnal oxygen therapy. With an aging population and increasing numbers of patients using nocturnal oxygen, rising costs will demand more attention from the government. Nocturnal oxygen has historically been targeted as an area for budget cuts, and as Medicare continues its attempt to reduce spending, it is expected that nocturnal oxygen will become even more scrutinized. It is becoming more important than ever for the government to recognize the true cost/benefit of long-term nocturnal oxygen therapy.
