The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

MANDATORY REASSESSMENT OF HOME OXYGEN PATIENTS AT THREE MONTHS ? THE ONTARIO, CANADA EXPERIENCE

Michael Pohanka, Miriam FreymondTurnbull, Professional Respiratory Home Care Service Corp., London, Ontario Canada
Karen Gansel, Ministry of Health and Long Term Care, Toronto, Ontario Canada

Background:
Pursuant to a Letter of Understanding between the Ontario Ministry of Health and Long Term Care ("MOHLTC") and Ontario's home oxygen service providers, the parties agreed to jointly develop appropriate utilization cost reduction programs to achieve annualized savings of $Cdn. 5 million to the province's Home Oxygen Program (HOP) budget. This, in conjunction with negotiated reductions in reimbursement rates, would decrease the HOP expenditures from $Cdn. 62 million (fiscal 2000) to $Cdn. 54.6 million (fiscal 2004), despite anticipated increases in numbers of patients funded.

Method: Comprehensive search of relevant respiratory journal articles was conducted. It was confirmed that HOP funding eligibility criteria were consistent with other jurisdictions, and based on the results of the landmark 1980 Nocturnal Oxygen Therapy Trial Group study. However, Ontario patients approved for funding were not being reassessed until one year following initiation of oxygen therapy. The literature disclosed support for earlier reassessment, in order to identify patients who had improved from an acute respiratory illness and no longer required oxygen. Commencing October 1, 2001, new Ontario home oxygen patients were subjected to mandatory reassessment at 3 and 15 months following initiation of home oxygen therapy, replacing the previous annual reassessment process. Reassessment consists of a renewed physician order for home oxygen, and non-invasive oximetry to demonstrate continued oxygen desaturation levels at rest which meet funding eligibility criteria. Oximetry testing is conducted by registered health professionals of the service providers, in accordance with Ministry approved protocols.

RESULTS:
According to MOHLTC data, in the first year of the new reassessment process (January - December 2002), 6,088 new home oxygen patients were initially approved for home oxygen funding. Of these, only 2,682 (44%) were approved for continued funding following their reassessment at 3 months. The remainder had either died in the initial 3 months or failed to meet eligibility criteria for continued funding based on their reassessments. It is not known how many of these patients have subsequently regained, or may regain in future, eligibility for funding under HOP, since once they are discontinued from funding they are subsequently treated as a new program admission rather than as a readmission. The implementation of the three month reassessment process has generated savings for the HOP in excess of the $Cdn. 5 million annualized target. This has permitted program expenditure targets to be met, increased numbers of patients to be serviced, and further monthly reimbursement rate cuts to be avoided. In fact, reimbursement rates were increased by 2% effective April 1, 2003 as a result of this successful joint utilization control initiative. The discontinuance of oxygen therapy for improved, post-acute home respiratory patients has been supported by physicians and by registered respiratory care practitioners. Other studies are underway to evaluate patient outcomes following discontinuance of therapy.

CONCLUSION:
Mandatory reassessment of patients at three months following initiation of home oxygen therapy has identified a very significant number who have improved oxygen saturation at the rest and no longer meet eligibility criteria for funding. This has generated substantial savings in HOP expenditures without denying therapy to patients truly in need. Registered health professionals employed by home oxygen service providers have conducted non-invasive oximetry testing, in the convenience of the patient's own domicile, and achieved results similar to those reported in the literature involving invasive arterial blood gas testing conducted at independent assessment centres.

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