Mr. Fix-It

At a time when most respiratory providers are preparing to pare services to lessen the effect of the looming reimbursement cuts, Apex of St. Peter’s is an anomaly.

The Helena, Mont.-based home medical equipment provider is not cutting services to its 1,500 oxygen patients. Indeed, it is specializing in them.

For four years, Apex has had its own repair center, which has reaped a variety of rewards for the company. But more than just repairing respiratory equipment, Apex has also created individualized, regular maintenance schedules for each piece of equipment, a move that has paid off in customer satisfaction, fewer off-hour emergencies and longer-lived equipment.

It’s a system that is working so well that Wayde Snow, the company’s equipment repair technician, can’t understand why more providers aren’t doing it.

“I should think that with today’s issues with cost-cutting and [the need for] savings, this would be considered a viable option,” he says.

For four years, Apex has had its own repair center, which has reaped a variety of rewards for the company. But more than just repairing respiratory equipment, Apex has also created individualized, regular maintenance schedules for each piece of equipment, a move that has paid off in customer satisfaction, fewer off-hour emergencies and longer-lived equipment.

It’s a system that is working so well that Wayde Snow, the company’s equipment repair technician, can’t understand why more providers aren’t doing it.

“I should think that with today’s issues with cost-cutting and [the need for] savings, this would be considered a viable option,” he says.

Providers are facing the Jan. 1, 2009, implementation of a 9.5 percent reduction in 10 product categories and a 36-month cap on oxygen reimbursement — plus new oxygen rules that could mean they are responsible for equipment maintenance after the cap with virtually no payment. If providers were handling their own repairs, those cuts might not hurt as much because they would be seeing significant savings in terms of inventory, shipping and delivery, according to Snow.

“All of our data proves it works,” he says.

The Big Fix

A repair center was not always on the Apex radar screen. The HME company was purchased in 1997 by St. Peter’s Hospital. A non-profit accredited by The Joint Commission, it offered everything except oxygen and sleep therapy. That was added in 2003; the company got out of everything except oxygen and sleep therapy in 2006.

By 2004, the company was experiencing very rapid growth, Snow says. Like most HME providers, Apex was sending out all of its repairs, stockpiling inventory for the times when substitutes would be needed while equipment was in the shop and racking up significant shipping and delivery costs.

It was Lee Guay, Apex coordinator, who suggested establishing a repair center for the company’s respiratory segment.

“Apex had a fleet of 200 or so machines and no repair department,” recalls Guay, who thought the company could save money by hiring a seasoned mechanic.

“I hired Wayde, who was overqualified,” Guay says. “I gave him carte blanche to set up the department, because he knew how.”

Snow came to Apex with 25 years of repair experience in various industries. It was hard for him to believe that Apex — and numerous other providers — didn’t already have a repair center.

“I can’t think of an industry that has a whole fleet of equipment that doesn’t have its own repair department,” he says, ticking off planes, trains, trucks. Without a repair center, he says, “you just lose control.”

Even if you are only dealing with, say, new concentrators still under warranty, you can still run into problems, Snow says.

“The manufacturers we work with have excellent warranties … but sometimes the machines just don’t cooperate. Out-of-box failures happen,” he says.

And what happens then?

“You can send the equipment back to the manufacturer for warranty repairs and pay the shipping one way, and three weeks later you get it back. It’s a 10-day [repair turn],” Snow says, “but you have to allow one week there and back for shipping.”

Meanwhile, the customer must have the use of equivalent equipment, so providers historically have bought extra equipment to be used as replacements.

That, says Snow, “takes up space and ties up money.”

And, he adds, “you could end up with a lot more concentrators than you need … How do you deal with that? The answer is, do your own repairs.”

While he was well-versed in fixing all kinds of machines, Snow started out at Apex taking some training. He did an online course with a manufacturer, then some one-day schools. To meet FDA requirements, he became certified in every brand he would be repairing.

Then, he went about setting up the repair center for Apex. He quickly learned what wasn’t worth his time (nebulizers and oximeters) and what should be sent back to the manufacturers for repairs (CPAPs and bilevel devices).

He also learned about manufacturers’ warranty exchange programs, a tool he says now “we could not live without here.” Under the program, a repair technician can order extra parts that routinely wear out or break.

“If you’re a good wrench, you start seeing patterns in these machines — a valve that continues breaking down or whatever,” Snow says. You can buy extra parts, “then whenever you have another breakdown, you replace that part and you call the manufacturer and report that and they replace it for free. You can have that machine back on line the same day it breaks down if you’re part of this program.”

The other plus: “You don’t have to pay for shipping. And look at the time you save,” Snow says.

In a recent two-month period, Snow says, he repaired 32 concentrators and fixed some liquid portables as well. He performs both warranty and out-of-warranty repairs.

“I average between five and 10 concentrator repairs a week,” he says. “And then there are miscellaneous repairs along the way that are really hard to predict.”

According to Guay, Snow can fix anything. “We don’t know how to retire our machines,” he jokes.

Keeping the machines running smoothly is a point of pride for Snow.

“Apex owns 500 concentrators in eight different brands ranging from the eight- to 10-year-old, no-longer-produced concentrators to the latest that the manufacturers have to offer,” he says. “As long as I can acquire the parts for the oldest machines, I can keep them productive in our fleet without having to constantly replace them with new machines. This in itself is a considerable cost savings.”

Staying on Track

While both Guay and Snow know the repair center has saved Apex money over the years by lessening inventory and lowering shipping and delivery costs, they are chagrinned that they don’t know exactly how much. When the repair center was implemented, the company, which now has 12 employees, was shorthanded and they — like many providers — didn’t track the numbers, Guay says. “We just started tracking them,” he reports.

But while tracking savings is new, tracking the equipment isn’t. Working with a software program, Snow has established a detailed system that allows him to identify where a specific piece of equipment is, when it was purchased, how many hours it has and when it was last serviced. The data is critical to running an efficient operation, Snow believes.

“I do a ton of tracking,” he says, adding that the repair center’s motto is: “Be proactive. Don’t wait for the thing to break down.”

The software has allowed him to be true to that motto with a sophisticated preventive maintenance system. There are six-month and 12-month checks, in addition to Apex’s switch-out program.

“I come up with a list of high-hour machines that are in the 20,000-hour range. Our drivers — who always carry a spare with them — go out and switch them out so I can go through them,” Snow explains. “We don’t wait for them to break down. We don’t want them to break down in the home — absolutely not. You can never eliminate that completely, but we do what we can.”

No one, he says wryly, wants a middle-of-the-night emergency call that sends them out into a Montana blizzard.

With the intent of ferreting out any potential problems, Snow is always checking out the equipment online, he says. The software often triggers some sort of action.

“When a concentrator runs out of warranty, your software tracking system will tell you what kind of repair history it’s had over three to five years,” Snow says. “You can then determine … a course of action. If history says you have had to replace some things like the compressor, you’re pretty much set to go at that point. Very few concentrators make it to five years without needing some work, sometimes very major work.”

If the machine has not been subject to repairs of any consequence, Snow says, that’s fair warning. “You’ve got a machine with 18,000 to 30,000 hours on it, so my philosophy is to get proactive. The purity isn’t as strong as it used to be, the compressor might be getting noise, so you’re faced with a choice: Retire the machine and buy a new one because you don’t want to risk a failure or, for less than half the cost of a new machine, you can refurbish this concentrator and make it like new.”

Such repairs cost Apex between $150 to $275 on average, parts and labor, Snow says. “These machines cost us $575 to $1,100 new. If you’ve done a good, thorough repair, you’ll get another three years out of that machine running 24/7.”

Always, there are the incidental repairs: broken casters, power cords and the like. But the question at the end of the day is always the same, Snow says: “How long can or should you keep this machine running?”

The answer, he says, is up to each individual company, though it also can be dictated by the availability of parts. At Apex, as long as they can keep the machine in top working order, they do.

“This is how we save money,” Snow says, adding that the repaired life of a concentrator is, of course, dependent on the quality of the repair.

“If you have 400 to 500 concentrators running, you’ve got a lot on your plate in terms of normal wear and tear,” he says. “You really cannot afford to keep seeing the same machines over and over again because of oversights. Strive to do it right the first time and you will be rewarded with greater patient safety and a lean, cost-effective repair department.”

Snow is quick to add that a repair department’s success depends on more than just the technician. For example, he depends on Apex’s drivers for information. “Environment has a big hand in [the life of the equipment] — dirtier homes make it wear out much faster,” Snow says.

Drivers also alert him to any other problems during their routine checks, he says.

“Without the team effort of the 12 people we have here, we couldn’t get this done,” he says. “It’s coordinated; we depend on each other. Our philosophy is patient service and satisfaction always.”

Together, Snow says, the Apex team is “simply maintaining the equipment we currently own. We purchase new equipment to meet customer growth. We don’t over buy.

“Survival in any industry can benefit from self-reliance when feasible,” he continues. “We may not be able to do it all, but we need to do all we can. We at Apex feel that our repair department can make us self-reliant. It fits our overall operation, our plans.”