Supplemental Oxygen Payments and Equipment Utilization in a Low-Income Population With Interstitial Lung Disease or COPD

Background Supplemental oxygen is often prescribed to patients with interstitial lung disease (ILD) and COPD, and oxygen services are often paid through Medicare or Medicaid benefits. The specific costs to Centers for Medicaid and Medicare Services for oxygen therapy in these diseases have not been fully described. Research Question What are the estimated payments by Medicare and Medicaid for supplemental oxygen therapy, and do differences in oxygen equipment utilization or other factors impact these payments in low-income individuals with ILD or COPD? Study Design and Methods We reviewed claims data for years 2016 to 2020 for Pennsylvania residents with ILD or COPD who were dually eligible for Medicaid and Medicare and enrolled in traditional fee-for-service Medicare. A multilevel mixed-effects generalized linear model was used to identify variables associated with annual oxygen payments made by Medicare or Medicaid. Results Compared with COPD, a greater proportion of paid claims in ILD were for oxygen services (40% vs 22%) and for high flow oxygen (4.2% vs 2.2%); however, ILD represented the minority of paid oxygen claims (5.2%). The median payment for oxygen was similar at $64.53 (interquartile range, $35.04-$94.56) for ILD and $65.84 (interquartile range, $33.63-$96.70) for COPD. Most claims (≥ 94%) were for stationary concentrators. Liquid devices and stationary gas were the least used equipment. Lower payments were associated with living in a competitive bidding area and with markers of advanced age and worse health status. Higher payments were associated with living in nonmetropolitan areas, having equipment delivering high oxygen flow, and receiving liquid oxygen or a portable oxygen concentrator in addition to a stationary concentrator. Interpretation Oxygen payments and equipment utilization were similar between patients with ILD and COPD who were dually eligible for Medicare and Medicaid services; however, liquid oxygen claims were rare even among patients requiring high flow.