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 
PUROSE


This report identifies trends in the use of home program. 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 198 LIQUID 11.54 11.43 11.36 16, 12 : GAS 22.08 14.76 10.51 5.84 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 VOLUME USAGE OF OXYGEN BY 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_.._.. I 2 313 

000 r---------

- ---______n__------ H5()----------- -.., 0._--­ 685 

;- 1 500 

fj 1
 000

500 

1986 1987 1988
 1989

.. TOTAL LZ CONCENTRATORS


GAS LIQUID

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 

increased in absolute terms. Oxygen concentrator usage increased both in absolute 

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.