Carlos Nunez, MD: The Burden of Treating COPD Chronic Symptom

July 4, 2019

Both symptomatically and financially, patients and clinicians struggle to manage the condition in lieu of a cure.

Chronic obstructive pulmonary disease (COPD) is highlighted by the stress of respiratory symptoms it puts upon patients. That stress, coupled with the reality that there is no cure for the condition, put an emphasis on treatment access and reliable options.

In an interview with MD Magazine®, Carlos Nunez, MD, chief medical officer of ResMed, explained how current therapy payment policies in US healthcare have burdened the individual patient with COPD.

MD Mag: How does COPD’s chronic burden affect current measures aimed to treat it?

Nunez: You know for now anyway, there are people working on trying to find more effective treatments. And maybe there's even a cure someday, but for now, it's a disease that has to be managed and it does progress and patients over time get worse and worse.

And usually it starts with things like smoking cessation and staying active. But eventually patients pretty quickly progress to having to be managed with medications. And then some patients also benefit from oxygen therapy—the use of oxygen therapy in COPD for those patients who it's appropriate for is pretty well documented. And if it's if it's offered as therapy for those eligible patients, it can reduce their risk for hospitalizations and death that are a result of their COPD.

So it's a really important finding, we believe, because when you see that reimbursement policy has changed over the years—while this disease continues to grow, while it continues to afflict patients without any hope for cure, at least for now—and having specific policies that actually decrease the ability for patients to access this care can be quite alarming.

For example: over the last several years, the payment policy has really looked at a very high-level actuarial approach to trying to decrease the spend in the category overall—which may not be a bad approach at the high level. The problem is, when you look at the individual usage of the devices and therapies and you look at the needs of the patients, there's nothing wrong with trying to become more efficient and to spend less money where it's appropriate.

But when you take a broad-brush approach without really diving deep into the particulars, what happens is you get patients who may not have access to the care that they deserve. For example, within oxygen, 1 category of therapy is a portable oxygen concentrator. It's a device that actually pulls oxygen out of the air, concentrates it, and then gives it to the patient—so you don't have to carry a tank, you don't have to be tethered to a device that is stationary. And the biggest benefit of this is when patients remain physically active, even the simple things we take for granted —walking down the street, to the park with your grandkids, walking through a mall or a grocery store—those little bits of physical activity really help patients maintain their health and help decrease the risk of complications from the COPD.

The reimbursement policy, using this broad-brush approach, has decreased reimbursement. It has put oxygen therapy into a competitive bidding program in a way that has resulted in reimbursement being at the lowest level that it's been in over a decade.

So as we have more and more patients diagnosed with COPD, more and more patients who would benefit from oxygen therapy, the artificial clamping down on reimbursement makes it harder for patients to get the therapy they deserve, especially a portable oxygen concentrator which allows them to maintain some normal semblance of a normal life and maintain that physical activity that's so important.