Editor's Note

A Response to The NY Times

• By Elisha Bury
• Jan 01, 2008

I was appalled and disheartened by the misinformation represented in the Nov. 30 article by Charles Duhigg in The New York Times. Unfortunately, my position prevents me from responding to the article directly, but I encourage you to respond to Duhigg. Below are some points I would make if I were able. We can no longer afford to ignore such harsh criticism of our industry.

The backbone of our industry is not the multi-million dollar corporation but the small-business owner that provides services above and beyond the call of duty. These hard-working, self-less business owners respond to elderly patients who are incapable of servicing their own equipment. This is not the judgment of a senator but a physician. The average oxygen user is a 73-year-old woman whose oxygen equipment must be serviced in her home. The result is numerous business expenses not incurred by other health care modalities.

Without oxygen, these patients will die. That is not an exploitation of elderly, disabled voters but a medical reality. If your life depended on oxygen, you'd think twice about ordering equipment online, which comes without the lifeline of knowledgeable clinicians. Ordering specialized equipment such as oxygen concentrators, CPAP machines requires a lot more than clicking "Order." These devices are fitted to a patient as a tailor would fit a person to a suit.

Offering added services to patients is not a justification of higher fees, but a direct result of rising labor and fuel costs and the intensive and exhaustive administrative process to file even one Medicare claim. Driving in the middle of the night to a rural location to service oxygen is the norm for our industry — and also a service that comes without payment. Many states require a respiratory therapist to set up oxygen equipment in the home, and oxygen delivery is highly regulated. These also are expenses for which there is no reimbursement.

Oxygen providers enable patients to live in their own home rather than an institution. While that's an obvious bonus for the elderly and disabled, the economical impact far outweighs the patient benefits. The cost for providing oxygen is a mere drop in the bucket compared to the cost for long-term care or a hospital stay. Home care results in a 33 percent cost savings compared to hospital care. Of the total costs expended by Medicare, all of home care and beds accounts for only 2-3 percent of Medicare expenditures.

I encourage you to garner a more balanced view of the industry by talking to providers in the industry. The fact is, oxygen providers offer patients much more than equipment. They give patients peace of mind. Please tell me the price you would put on that.

This article originally appeared in the Respiratory Management Jan/Feb 2008 issue of HME Business.