Cost Containment in a Hospital Program for Home Oxygen Therapy

Abstract

To the Editor: Longterm home oxygen therapy for patients is costly. This led our hospital to formulate a clear and consistent policy to administer such a program. Medical audit of home oxygen therapy administered by the Veterans Administration Medical Center in Phoenix in 1977 indicated that 56 percent of total patients received the therapy inappropriately, and presumably, without benefit. Thus, for 100 patients who received therapy appropriately, there were an additional 126 patients who received it inappropriately. After 1977, a management protocol was instituted. Documentation of arterial Po2 below 60 mm Hg was required. For patients with borderline results or for the study of patients for sleep or exercise hypoxemia, consultation with the pulmonary specialists was available and their concurrence for home oxygen therapy was necessary. Medical audit in 1979 indicated that implementation of the management protocol resulted in complete elimination of inappropriate therapy. Thus, with 100 patients receiving therapy, there was no additional expense incurred by inappropriate therapy. Based on existing costs to the Veterans Administration Medical Center in Phoenix for oxygen tanks (average cost of $634 per patient per year) and for therapy equipment ($175 per patient per year), it is estimated that implementation of the management protocol resulted in annual savings of more than $100,000. One hundred patients were treated in the 1979 period, at a cost of $80,900 in contrast to a cost of $182,834 which would have been incurred if 126 additional patients had received therapy inappropriately as in 1977. This represents a savings of 56 percent. Oxygen inhalation is being used by patients for symptomatic relief from various forms of respiratory distress in the absence of arterial hypoxemia. There is no evidence that any physiologic benefit accrues from this type of use of supplemental oxygen.1Cugell DW Oxygen therapy.(Questions & Answers) JAMA. 1979; : 241-1732Google Scholar Longterm treatment with oxygen is costly and often public money is expended to sustain this. These considerations demand that we have clear therapeutic objectives in mind and make ourselves accountable for our decision when we employ longterm oxygen therapy. Beneficial effects from longterm oxygen therapy in patients with severe chronic obstructive pulmonary disease have been reported in the literature.2Levin BE Bigelow DB Hamstra RD et al.The role of long-term continuous oxygen administration in patients with chronic airway obstruction with hypoxemia.Ann Intern Med. 1967; 66: 630-650Crossref Scopus (4) Google Scholar, 3Neff TA Petty TL Long-term continuous oxygen therapy in chronic airway obstruction. Mortality in relationship to cor pulmonale, hypoxia, and hypercapnia.Ann Intern Med. 1970; 72: 621-626Crossref PubMed Scopus (110) Google Scholar, 4Stewart BN Hood CI Block AJ Long-term results of continuous oxygen therapy at sea level.Chest. 1975; 68: 486-492Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar An excellent review of patient selection may be found in an editorial by Neff.5Neff TA Selection of patients for oxygen therapy.Chest. 1975; 68: 481-482Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar We have tried to keep our program quite simple so that physicians and patients understand and accept it. This acceptability by all has made it easier to administer. The vast majority of our patients have severe chronic obstructive lung disease. We feel that reduction in the number of patients on home oxygen therapy more than compensates for the time needed to administer the program with the established guidelines and also to conduct the audits. Money saved on an annual basis has been substantial.