Richard P. Kusserow 
INSPECTOR GENERA 
'0 
AUGUST 1991   Department of Health and 
Human 
Services

OFFICE OF

INSPECTOR GENERAL

TRENDS IN HOME OXYGEN USE

MANAGEMENT ADVISORY REPORT 
Richard P. Kusserow 
INSPECTOR GENERAL 
'~~aa 
OEI-03-91-00710  pPUROrSE
ogram. 
This report identifies trends in the use of home oxygen systems for the Medicare
BACKGROUN 
This study was requested by HCF A staff in connection with their examination of the 
Medicare fee schedule for oxygen servces during budget deliberations. 
Liquid oxygen systems provide the highest purity of oxygen. They are 
prescribed for patients requiring a large amount of oxygen, generally more 
than four liters per minute (LPM). 
Gaseous tank systems are supplied to patients who require up to two LPM or 
do not require a continuous flow of oxygen.

Concentrators are stationary machines which operate electronically to generate 
higher concentrations of oxygen from room atmosphere. They are designed
for patients requiring a continuous flow of oxygen of up to four LPM and who 
are house-bound or have minimal portabilty needs. 
Our inspection focused only on trends in the use of home stationary systems. We
did not analyze costs or reimbursement. 
METHODOLOGY 
We started with the 1 percent file of the Part B Medicare Annual Data (BMA)
fies, including local carrier codes. They provided 
consistent data for the entire 4
year period of the inspection, from 1986 through 1989, and they had been validated 
by an independent consultant and by HCF A. As a further step, we contacted 
Medicare carriers representing seven States to refine and independently 
validate the 
data. 
We limited our review to non-purchased home stationary equipment and contents. 
FIING 
There has been a shif towards use of oxygen concentratoTS. 
Oxygen concentrator usage has increased since 1986, both in absolute terms and as a 
percentage of total services for all tyes of systems.  .,............. ..."..............."......"......'....:............... ..:............................... ...".......................................................................................................................................................-.. ..-.. ..-.. ..-.. ..-.. ..-.. ..-.. ..-.". ..-".. .."-.. .."-.. .."-... '.-.-.. ."-... ."- "-" -" -" -" -" -" "- "- - - - - - --
Relatie Usage

The changes in relative usage are shown below: 
RELATIVE OXYGEN USAGE

BY TYPE

PERCENTAGE 
100 
'dd"'"  ddd'. 
2 0 

1986  1987  1988  1989 
LIQUID 
GAS CONCENTRATOR 
-----8---_  "'.""d'" 
PERCENTAGE OF TOTAL 

198 
1987 1988 
LIQUID  198
: GAS 22.
11.54 117.463  11.36 16,84
08 14. 10.51 5.12
CONCENTRTOR 66.
38 73.81 78.13 78.
04 
From 1986 to 1988, oxygen concentrator usage increased, while gaseous system usage 
decreased, and liquid system usage remained constant.  ,-
,,.  --- -- -------- --------- ---- ----- ------ - ------ ---------.-.--.
In 1989, oxygen concentrator usage remained constant at the 1988 level, while 
gaseous system usage continued decreasing, and liquid system usage increased. 
Growth in Volume 
The actual number of home oxygen servces rose throughout the 4-year period of our 
review. Total usage grew from 1 685 000 to 2 312 900, an increase of 37 percent. 
Oxygen concentrators were the most frequently used delivery system during that 
period. 
I 2 
USAGE OF OXYGEN BY 
I VOLUME  313 
TYPE 
500  I"_n_n_n_n_n_n_n_n_n_n_n_n_n_n_n_n_n_n_n_n__'_.._n_n_n-n_n_.._n_n_n_n_n_n__'_n_n__'_.._.._n_n_n_n_n_n_.._..
685 
000  - ---______n__------ H5()----------- -.., 0._--
r---------
500 
;- 1 
000
fj 1

500 
1986 1987 
1988
 1989
.. TOTAL LZ CONCENTRATORS

LIQUID
GAS 
As shown above, servces for concentrators and liquid systems increased in absolute 
terms, while gaseous systems declined in the same period. 
CONCLUSION 
From 1986 to 1989 the use of home stationary oxygen equipment and contents has 
Oxygen concentrator usage increased both in absolute 
increased in absolute terms. 
terms and as a percentage of total servces. We hope this information will be 
helpful to HCF A as they consider 
possible adjustments to the fee schedule.