Ask Mark …

Mark MangusMike C. is interested in endobronchial valves and asks what the differences are between them.

Mark replies, The Zephyr and Spiration endobronchial valves are designed to improve lung function, exercise capacity and quality of life for people with emphysema by bypassing the areas of the lung that are most affected by their respiratory disease. Both are approved by the FDA.

The difference between the two valves is the shape, the method of insertion and how they function. The Zephyr valve allows air behind the valve to escape, reducing the size of the lung behind the valve. It doesn’t allow any air to flow past the valve into the lung. Spiration valves do allow some air to pass, although not a significant amount.

With Spiration valves, air and secretions flow out of the lung around the valve. Zephyr valves direct fluid and secretions through their one-way valve.

Zephyr and Spiration valves each anchor differently within the bronchial tube: Spiration actually anchors into the bronchial wall while Zephyr anchors using pressure and a large surface area of friction without piercing the bronchial wall to anchor. Theoretically, the Zephyr should result in less to no bronchial wall trauma in ‘settling into place’. Zephyr may be a bit easier to displace, say with coughing, in the early post-insertion period. Spiration valves tend to involve a bit more bleeding due to irritation and inflammation from the anchoring activity and during the initial post- insertion period.

In the end, which procedure and valve a person will likely do best with is determined by the team of experts in their use and placement. In any case, candidates for both types of valves must meet the same qualification criteria. Those who do best have their emphysema localized to the upper portions of the lung and not spread throughout the entire lung. The goal is to reduce the volume of the diseased portions of the lung, which may allow healthier regions to expand and function more efficiently drawing of endobronchial valvedrawing of endobronchial valves

Many, many, many people have written to ask why their liquid oxygen is being taken away.

Mark says, Your home care company is more than likely trying to stay in business with the low rate of reimbursement they are getting from Medicare. Reimbursement for stationary oxygen is individualized by state and territory. It is further subdivided into urban and rural reimbursement rates. The Center for Medicare Services has a zip code schedule to find your zip code and determine if your oxygen is covered under urban or rural reimbursement rules and rates.

Basically, anywhere in the contiguous United States, reimbursement for urban residents for liquid oxygen (LOX) is be- tween about $67 to  $80  per month for the stationary reservoir unit and contents. Portable oxygen is between about $34 and $67. For rural residents, the stationary amount increases to about $134/month. Portable increases to about $68 to $73/month.

Once the company has been reimbursed for 36 months, companies may bill Medicare for “contents” of liquid oxygen, which is paid at between $34 to $73/month for urban and $45 to $65/month for rural residents. Between the next 37th and 60th months, no stationary equipment reimbursement is provided. So, the total reimbursement your company gets for delivering liquid oxygen to you for the next two years is as low as $45/month.

Considering that the vehicle to carry a reservoir for filling liquid oxygen stationary units at your home costs as much as $200,000, plus more than $50,000 per year for the driver, insurance and licenses/permits and adding in the gas costs to deliver oxygen on whatever schedule one is set for service, you can see how cost versus return is impossible math to make work. The costs exceed the reimbursement. Companies – even the big ones – who used to be able to cover the deficit to provide and service liquid oxygen have no cushion of profit to cover those costs today.

Ultimately, those of you who have liquid oxygen need to plead with your companies to continue to provide service and should be prepared to pay more out of pocket. You may be able to recoup at least a portion of your out-of-pocket costs on your income tax return if you qualify to itemize deductions.

You can begin to understand the issues and dilemma! Thanks to competitive bidding where the cheapest offer prevailed, we see these reimbursement rates come about.

Now, while the competitive bidding has been  suspended  and  suppliers have been given permission to “balance bill”, it is expected that oxygen users should be able to get better service and increased choice. But, it will come down to what they can afford to pay out of pocket over what Medicare will continue to pay during this moratorium period where reimbursement rates will remain the same.man with liquid oxygen tank

For those who want to know specific details, you may view the entire codes and reimbursement schedule. It is called the “Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) January 2019 Fee Schedule” and can be found at https://tinyurl.com/yxdxufpu

Click on DME 19-A to download the schedule. Readers need to look for the E0431 – E0447 codes for oxygen reimbursement amounts by state.

Jean Rommes of Iowa shares the following telephone numbers to contact if you feel that your oxygen therapy equipment is not adequate to meet your needs.

Jean advises to first call the COPD Information Help Line at 1-866-316-2673. People with COPD will answer this phone line daily and can give support and advice.

Follow this up with a call to the Medicare Beneficiary Complaint Hotline at 1-800-404- 8702. You could also call Medicare at 1-800- 633-4227 and ask for a Durable Medical Claims Representative.

You can become a Medicare pro at www.medicareinteractive.org. The site is run by the Medicare Rights Center.