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13.4. Guidelines for Issuing Respiratory Equipment
a. Home oxygen services will be provided as medically needed to all eligible beneficiaries accepted for care within the Department of Veterans Affairs (VA).
(1) Oxygen is provided in a large cylinder under a compressed gas system. For those who require portability, a small tank with a cart is provided. This particular system requires a regulator to adjust the flow rate, a stand to secure the large cylinder, and in some cases, a humidifier to moisten the air. This oxygen system is normally furnished to patients who do not need continuous oxygen or were prescribed a low flow rate. When this particular system is provided, preset oxygen flow regulators should be provided unless the physician indicates otherwise.
(2) The oxygen concentrator delivery system provides an economical method of therapy when patients need continuous oxygen, and are relatively housebound or have minimal portability needs. The furnishing of a separate "E" cylinder or other appropriate size of compressed gas cylinder is necessary for emergency needs or to meet temporary portability needs as they may occur.
(3) The liquid oxygen system includes a reservoir canister and a portable device which can be filled from the reservoir. This method is prescribed for ambulatory patients who can use an extensive amount of oxygen from portable sources.
(4) Home oxygen should be provided by the most cost-effective means. The cost- effectiveness of using a concentrator versus compressed gas depends on local vendor charges. Local contracts for both delivery systems should be analyzed. The contract prices together with the patient's prognosis and projected liter flow rate will be the determining factors in choosing the most economical delivery system in each case. The Chief, A&MMS, in coordination with the Chief, PSAS; Chief, Health Administration Service; and Respiratory Therapy should periodically complete a market analysis in their geographical area to determine the availability of the different types of home oxygen systems, and the contractors capable of providing the required services prior to issuing formal solicitations. The solicitations should be written in such a manner as to foster competition. In some areas it may be necessary to issue separate solicitations for each system. This is dependent upon the level of competition. The quoted prices, together with the patient's prognosis and projected usage, will be used to determine the most cost-effective method in the local area for the delivery of home oxygen systems. Contract price quotations should be documented and considered in the cost analysis of the various systems. The most economical method will be used in determining purchase versus rental of equipment.
(5) All patients placed on a home oxygen therapy program should be reevaluated and the need for oxygen therapy documented every 6 months for the first year. Thereafter, the need for continuing oxygen must be documented at least annually.