Ask Mark

image037-4Deb from Pennsylvania asks if Medicare will pay anything toward the purchase of oxygen equipment or does it only pay for rental? She is nearing the end of her five years with her current supplier and wants to buy her equipment rather than deal with the company that has the contract in her area.

Mark explains, Medicare will not purchase oxygen equipment for bene- ficiaries. Several years ago, Medicare proposed purchasing equipment as your home oxygen concentrator to save money over time. The respiratory community banded together to defeat this idea for several practical rea- sons. It would have left the beneficiary with the responsibility of maintain- ing and repairing their own equipment – including finding replacement equipment while theirs was being repaired. The time without oxygen support would have been dangerous for the majority of users. Purchasing the equipment for the oxygen user would take any chance of monitoring away, again, injecting another factor of danger into the process.

Medicare proposed requiring companies to cover the emergency equipment oxygen users need without adequate or even any payment for their services. Medicare also wanted to require any company – even if the beneficiary hadn’t originally dealt with the company – to service oxygen users with little money to cover their costs. This was rejected by the industry. The government telling business how they must operate was another snag in the plan.

Medicare then reduced oxygen reimbursement to new lows. Medicare pays your provider for 36 consecutive months and requires the next 24 months of service be without payment. The company still must provide cannulas, humidifiers, etc. They must also be available for emergency service, especially if your concentrator breaks down and needs to be replaced. Folks are “eligible” to enter a new 60 month cycle at the end of each 60 month or five year cycle.

If you decide to purchase your own home oxygen equipment, there will be absolutely no legal requirement for any home care company to take you on with regard to service, monitoring or emergency needs. As far as Medicare is concerned, it will not consider you as using your Medicare benefit to obtain your oxygen therapy.image039-2

Many people purchase their own portable oxy- gen concentrators to be used in addition to the equipment paid by Medicare.

Bottom line: Divorcing from Medicare to purchase your own equipment and all the responsibility that comes with it is a bad idea and one many have come to regret.

If you do initiate another five year cycle, you are supposed to receive new oxygen equipment. How do you tell if your equipment is new or old? Concentrators have time meters that tell you how many hours of service that device has provided. If you have more than a hundred hours, your equip- ment is not brand new.

Marilyn from Missouri tells Mark, a friend told her that she may benefit from using hydrogen peroxide mist. She is unfamiliar with this practice and wondered if he knew anything about it?

Mark emphatically tells us, Not a good idea in any way, shape or form – especially for those with COPD! Hydrogen peroxide is an antiseptic used on the skin to clean and prevent infection of minor cuts, scrapes and burns. It may also be used as a mouth rinse to relieve minor irritation. It works by releasing oxygen which causes foaming to remove dead skin and clean the area. It is not meant to be used internally!

Websites have claimed their hydrogen peroxide solutions cure anything from cancer to emphy- sema to AIDS. They were shut down by the FDA trying to prevent any tragic results from people ingesting hydrogen peroxide. Just say no!

Pat from Wisconsin is curious, does weight gain have any factors that would result in CO2 retention?image041-1

Mark says, The answer is it depends upon how much weight gain you are talking about and what your total body mass index (BMI) actually is. BMI is a measure of body fat based on height and weight. You may find many sites on the Internet where you can put your height and weight in and find your BMI.

BMI Categories:

Underweight = <18.5

Normal weight = 18.5 to 24.9

Overweight = 25 to 29.9 Obesity = 30 or greater

Until and unless one increases to a BMI of 40 or more, weight doesn’t play that significant a role in ventilation and breathing ability. However, if one has a very short neck and/or a lot of fatty tissue around the neck, especially under the chin, in the front area, a lower BMI (say of 32 to 40) might contribute to having restriction of the upper airway and promotion of disturbed sleep breathing. If one combines those factors with having an FEV1 less than 25 percent of predicted and poor physical conditioning, then the stage is set for CO2-retention. (FEV1 is Forced Expiratory Volume in one second, a flow rate measurement how much air you can forcibly exhale in one second after your deepest breath in).