Carlos Nunez, MD: Who Prescribes COPD Care?

The process from initial diagnosis to specialty referral, and then to prescribed therapy, is no different in chronic obstructive pulmonary disease (COPD) than in any condition. What’s different is the need for all involved parties to be ready to more aggressively manage a COPD patient’s pursuit of proper care.

In an interview with MD Magazine®, Carlos Nunez, MD, chief medical officer of ResMed, explained the simplistic process of COPD referral—which can lead to the convoluted process of oxygen-based care for at-need patients.

MD Mag: Are pulmonary specialists or primary care physicians often addressing COPD treatment availability and costs?

Nunez: Like many things in medicine, the person who's going to come across the first signs and symptoms—not just of COPD, but that a patient may need to be on oxygen therapy or any other type of therapy—is often the primary care provider.

They may end up referring the patient to a specialist, but primary care providers as well as specialists need to be aware of these challenges, because the reimbursement policy has become so onerous. And it's also become quite difficult, in terms of the red tape and the bureaucracy.

Many patients go without the therapy that they probably deserve, or they end up on a type of therapy that doesn't optimize their chances of improving their health with regular physical activity, and a normal type of life as possible.

You know, it's actually created a system where it's almost like the haves and the have-nots. If you are a patient who needs oxygen therapy, and you recognize or your physician helps you recognize that staying active and being able to get out of the house, get off the couch, or out of your bed will be better for you in the long run—if you have the means, people can buy a portable oxygen concentrator on their own completely out of pocket.

But these are thousands of dollars, some of these devices in some cases. And so you've got people who can afford it, a small percentage of the population who are doing this, and they've got the care they deserve. Others, who are dependent on Medicare or other types of insurance or access to healthcare, who just can't afford it and because there's now so much red tape, so much bureaucracy, and so little reimbursement, they don't ever get the care that they deserve.

You know, the durable medical equipment providers—the DMEs that are often the ones who provision these devices—it takes them 3 or 4 years to make back the investment they make in a single portable oxygen concentrator. So many of them just stopped carrying them.

And so the DME, for a region of the country, or a city, or an area, may not even offer that to their patients. So patients are stuck with a stationary device or lugging around heavy tanks which may not be optimal for them. Not to say that those devices aren't useful in some situations, but there are so many patients who can benefit from the freedom of being able to still be out and be active, but have no access unless they've got the means to spend thousands of dollars on their own.