Supplemental Oxygen Therapy: Tailor to Your Patient's Needs
JAMA recently published a 'patient-centered' oxygen review. It's excellent reading. Table 1 summarizes studies of patient and caregiver feedback on oxygen use, and Box 1 provides an individual patient narrative. The described experience and related complaints are painfully familiar to anyone caring for a patient on oxygen. There isn't any 'news' here, and others have called for oxygen reform. The review highlights the evidence — or lack thereof — and is notable for its practical depiction of oxygen devices, durable medical equipment (DME) companies, and overall oxygen logistics.
I regularly receive emails from the American Thoracic Society (ATS) oxygen interest group asking for feedback to help support passage of the Supplemental Oxygen Access Reform Act. I can't speak to the substance of the act, but — per its proponents — it's designed to achieve what the JAMA review advocates: oxygen reimbursement and supply tailored to individual patient needs. Great.
There are things we healthcare providers can do now, though. De-implementation (or deprescribing) is critical to cost efficiency, but it's a distant second to not ordering oxygen at all. Outside of the mortality benefit for those with resting hypoxia, outcomes from oxygen prescriptions range from inconsistent to nonexistent. So, to start, if your patient does not have resting hypoxia, think twice (or perhaps three times) before walking them or doing an exercise test.
This brings us to the walk-of-life prior to hospital discharge. The resulting ambulatory oxygen prescription is meant to be 'short-term,' but it is rarely so. More often, it's a gateway drug, driving long-term prescriptions and patient dependence. This is well recognized, and both the ATS and CHEST College list deprescription as part of the their 'Choosing Wisely' campaign. Therapeutic overconfidence and time constraints, along with psychological patient dependence, conspire to prevent it. Discharge is typically handled by general medicine clinicians, house staff, or advanced practice healthcare providers, none of whom are comfortable withholding therapy from someone who desaturates with ambulation. However, to quote an old adage from The House of God , 'if you don't take a temperature, you can't find a fever.' If you don't walk your patient before discharge…
I'd take the same approach to nocturnal hypoxia. The Centers for Medicare & Medicaid Services (CMS) reimbursement for desaturation at night is a modern-day medical mystery. The data isn't there and there aren't guidelines recommending it. Past reviews have argued against screening or prescribing. Anecdotally, I see this less now; but again, if you eliminate reimbursement. I'm confident it won't be seen at all.
Lastly, there's oxygen education to improve health literacy. This is critical but it's a heavy lift. It takes time and resources, and both are in short supply. The JAMA review recommends an oxygen specialist to shepherd the anaerobe through the DME gauntlet. If only the authors could help me pay for one. Maybe I can negotiate with CMS myself. I'll stop ordering nocturnal and ambulatory oxygen supplementation. With the savings generated, CMS will pay for a respiratory therapist to do deprescription and DME navigation. Now that's choosing wisely.
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Fox News
17 hours ago
- Fox News
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Forbes
18 hours ago
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Forbes
18 hours ago
- Forbes
20 Hurdles For Healthcare Tech Startups In Scaling Solutions
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They look for proven, well-established companies and products, making it difficult for healthcare startups to get traction, even when they have clearly better solutions. Partnering and delivering real value to that first set of clients is critical in scaling early on. - John Bou, Modio Health 4. Integrating With Insurance Systems Health insurance companies amplify the interoperability challenge by adding another layer of complex, often siloed, data and systems that healthcare tech startups must integrate with. This makes the negotiation and implementation of business associate and HIPAA agreements more complicated, given the data types, security requirements and shared liabilities that arise from integrating with both providers and payers. - Ajai Paul, Affirm Inc. 5. Understanding The Complex Stakeholder Ecosystem Healthcare startups often make the mistake of viewing the U.S. healthcare system with a 'singular' point of view. It is an integrated ecosystem where each stakeholder is affected by the others, which means multiple interests must be aligned when adopting new technologies. - Raghav Ramabadran, Intelligine Technologies 6. Building Custom Integrations For Each Customer Healthcare startups' challenges include integrating with electronic health record systems, which is not a 'plug and play' process. Each hospital or system has its own highly customized version of an EHR, with unique workflows, data fields and security protocols. This lack of standardization means startups must build a new integration for nearly every customer. - Chris Ciabarra, Athena Security Inc. 7. Developing Strong Governance From The Outset Healthcare startups often wait to build full product depth until after landing their first client, but healthcare's high-risk, structured environment demands strong governance from day one. Change control, release management and a deep understanding of current operations, especially when replacing legacy systems, are essential before customizing. Building depth late risks delays and failure! - Trisha Swift, Mula Integrative Health & Wellness 8. Maintaining HIPAA Compliance With Digital Content One challenge healthcare startups face when scaling tech is managing digital content while staying HIPAA-compliant. Hospitals need more than stock photos and shared drives—they expect secure, role-based access to branded visuals that convey authenticity and protect patient privacy. Without a digital asset management strategy, startups risk falling short on compliance, credibility and growth. - Andrew Fingerman, PhotoShelter 9. Ensuring Consistent Performance And Compliance Across Disparate Systems Healthcare startups often struggle to scale because hospital environments vary widely in terms of infrastructure, workflows and data systems. Without a unified data architecture, real-time metrics, and built-in security and governance, it's hard to ensure consistent performance—or meet privacy requirements like HIPAA and business associate agreements governing protected health information. - Dave Albano, Diliko 10. Working Within Complex Pricing And Claims Rules One of the challenges is the integration of new tech into strict hospital billing and compliance processes. Hospitals have complex pricing and claims rules, and startups must work within these rules. They can't disrupt revenue or patient data safety. Doing this right builds trust and helps a solution scale faster. - Abhishek Sinha, Accenture 11. Processing Both Structured And Unstructured Health Data Integrating structured data (EHRs; lab results) and unstructured data (clinical notes; imaging; video) can be a major challenge. Healthcare startups must ensure their tech can process both, all while adapting to varying data and privacy standards across systems, which further complicates scaling and interoperability. Fortunately, generative AI is making this easier to do. - David Talby, John Snow Labs 12. Balancing Accuracy And Transparency With Scalability The healthcare and life sciences sector faces rigorous accuracy and transparency requirements that cannot be sacrificed and must be built into products from the start. Balancing this with scalability—which is really code for 'solving problems you don't have yet'—is a constant challenge—especially for startups, which often place a key focus on agility and speed. - Martin Snyder, Certara 13. 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Working Within Legacy Hospital Systems One major challenge healthcare startups face when scaling tech solutions is integration with legacy hospital systems. Many hospitals rely on outdated EHRs or siloed IT infrastructure, making interoperability difficult. Startups must ensure compliance, data security and seamless integration to gain trust and adoption at scale. - Srikanth Bellamkonda 16. Clearly Demonstrating ROI And Pathways To Reimbursement Healthcare startups often struggle to clearly demonstrate a return on investment and secure reimbursement pathways. Without established billing codes or tangible cost-savings data, hospitals hesitate to allocate budget. Startups must invest heavily in economic validation, health economics and outcomes research, ensuring payers and finance teams see sustainable revenue models before adoption. - Manav Kapoor, Amazon 17. Creating An Internal COE Establishing an internal center of excellence with deep industry experience in scaling healthcare systems is vital, but costly. A key challenge lies in selecting vendors that align with the company's DNA. Bridging the gap between emerging tech and the unique demands of healthcare requires thoughtful planning and a nuanced understanding of both innovation and patient-centric outcomes. - Hari Sonnenahalli, NTT Data Business Solutions 18. Overcoming Resistance To New Tech I've regularly observed the challenges clinical sites face when adopting new technologies. There is often reluctance or resistance to change; staffing shortages further exacerbate these issues. A more effective approach may be to 'mirror' site-level data. This would allow AI-driven platforms to build a harmonized system that enables forward progress without disrupting existing workflows. - Rachel Tam, Bristol Myers Squibb 19. Accounting For Integration Issues When Building Solutions The biggest hurdle to overcome when scaling tech solutions across hospitals or healthcare systems is not technical; rather, it is integration—into provider workflows, clinical practice guidelines, financial models and revenue cycle management programs. Unless the issues around integration are considered and covered when building the solution, scaling will not occur. The landscape is littered with misaligned HealthTech startups. - Mark Francis, Electronic Caregiver 20. Completing Vendor Risk Documentation Post-ransomware, hospitals demand extensive vendor risk audits with hundreds of security controls, SOC 2/HITRUST docs, and custom BAAs. Completing these lengthy questionnaires stretches sales cycles to 18 to 24 months, burning cash and pulling engineers from product work to compliance, blocking scale. - Mohit Menghnani, Twilio
