Home oxygen therapy.

Both the efficacy and the indications for LTOT have been well defined. Most of the studies performed have focused on patients with hypoxemia caused by COPD, and the benefits observed are assumed to apply to all patients with correctable hypoxemia. For Medicare patients, oxygen is reimbursed under a prospective payment system with all delivery systems considered to be cost and therapeutically equal. Because there are, in fact, substantial clinical differences in the medical indications for individual oxygen delivery systems, it is imperative that the prescribing physician be prepared to order the therapy that is most appropriate for each patient. Most home oxygen therapy is now being ordered by primary care physicians, often functioning as gatekeepers in managed care organizations. Education of primary care physicians in this area is often inadequate, and decisions for therapy should not be delegated to the equipment suppliers. If the study of home oxygen therapy conducted by the Office of the Inspector General were repeated today, less misuse of home oxygen would probably be found because of more clearly defined indications and requirements for therapy, but it is likely that the study would find that the level of knowledge of the prescribing physician has not maintained pace with the advances in technology. Continuing education for primary care physicians in this area of respiratory care is essential for appropriate medical management now and in the future.