Striving for Balance

It’s a tightrope. Balancing patient care and staying in business. Obviously, you want to do both. But reimbursement for oxygen products has severely declined over the last decade. At the same time, technology has dramatically advanced with a wide range of products that can enhance the quality of life for patients. What they want and what you can afford to give are often at odds.

Barbara Rogers is an oxygen user and president of the National Emphysema/COPD Association, New York. She is well informed on the legislative and regulatory issues that affect oxygen providers and is a strong lobbyist for patients, and the HME industry, in Congress. Yet, she is still a customer.

After asking to change to a “newer, smaller, quieter, more energy efficient” oxygen concentrator — and being turned down by her longtime provider — Rogers took matters into her own hands. At the time, she says, the 36-month cap was coming up, as was transfer of ownership (later reversed).

“I was quite angry that I still had this old, big, noisy concentrator. And, it was not nearly as energy efficient as the newer ones,” Rogers describes. “I again requested a change, and this time, I was flat out told ‘no,’ and I was capped by then. I also had a ventilator and a respiratory assist device, which were still being paid as capped rentals. This company had been getting paid for my ventilator for 16 years at that time and pretty much was rarely asked for supplies. I was a very low-maintenance, high-profit client and yet, I still could not get the oxygen equipment I asked for.”

So, she says, “I switched my ventilator, and its ongoing reimbursement, to another provider. I left the two capped rental items there as they were nearing the end of their reimbursement period. As far as my oxygen goes, I am currently without a provider. I am capped until Dec. 31 of this year, so, really, no one will pick me up. I decided to get my own concentrator. I bought a new, small, very quiet and much more cost-efficient one. I am fortunate that my resources and my oxygen needs allow me to do this. Once my cap is lifted, I will shop around for another oxygen provider.”

It’s tough to hear about Rogers’ situation. But it points up the dilemma many respiratory patients and their providers find themselves in when wrestling with the changes in Medicare oxygen payment policies.

“Balancing what you would ‘like to do’ from a customer service standpoint versus what you can ‘afford to do,’ unfortunately, now plays a big role in the HME provider’s decisions,” says Bob Hoffman, director of Nationwide Respiratory, a division of The VGM Group, Waterloo, Iowa. “Several years back monthly checks were often commonplace, and transitioning to what are now likely six-month checks has been difficult but necessary. You certainly lose the relationships built with individual customers but, fortunately, concentrator reliability, alarm systems and back-up systems have all eased safety concerns. However, face-to-face visits where the real patient evaluations took place, out of necessity, are now limited.”

Hoffman acknowledges that the majority of patients are typically not familiar with their options when the need for home equipment arises. However, he says, “with more savvy consumers with Internet access, it is not uncommon that once the patient is set up and does some research, a request for a different modality may arise. Then it becomes a situation where reaching a common ground between supplier and patient must be realized.

“Having a discussion as to the pros and cons of alternative equipment then takes place with the customer. The result should be being able to find a balance of feasibility from the provider standpoint and satisfying the customer.”

Jason Jacobs, manager of national accounts for SeQual Technologies, San Diego, agrees that today’s customers are more informed consumers. “It is not uncommon for them to ask for the ‘small’ or ‘pretty’ piece of equipment they found on the Internet,” says Jacobs, a respiratory therapist and former provider.

“It is imperative the HME provider match the most appropriate piece of equipment that will meet the needs of the patient. The ABN is a tool that can be used when a patient is seeking an upgraded item. HME providers are providing care to a large segment of well-informed consumers — they want what they want, when they want it.”

Holly Lockwood is an oxygen user, and as publisher of Everything Respiratory, a consumer magazine for oxygen users based in Marlton, N.J., she is also an advocate for others. Equipment choice is a prominent concern for her as well.

“We want to live just like we did before,” says Lockwood of oxygen patients. “I wish [providers] understood how depressed we are to be on oxygen and how much we don’t understand the equipment. My dream has been for an owner of an HME company to use this equipment for over a week as if they had to be on oxygen for 24/7. Then they would understand what the average patient has to go through.”

The Perfect Provider

HomeCare asked Barbara Rogers what a “perfect” oxygen provider would look like. Here’s her take:

“I think it is very hard for any provider to be the ‘perfect’ provider in this reimbursement climate. With that said, I think an ‘ideal’ provider is one that truly assesses a client’s needs, including clinical and lifestyle, and then matches those needs with all offerings in the marketplace, regardless of which manufacturers they have deals with. This allows the client to have the most mobility, comfort and clinical outcomes. This ‘ideal’ provider should also provide ongoing education, support and services on a regular basis. They should have well-trained, knowledgeable and courteous personnel and make each client feel valued, well taken care of and safe.”

Satisfying Customers while Maintaining Your Bottom Line

“In order to financially survive providing respiratory care, a logistical plan must be in place to address delivery costs, equipment mix and customer service. No longer can you simply take the call and deliver, say, a concentrator and portables, and hope everything works out. Non-delivery systems, POCs, conservers and the more traditional supply of portable tanks must all be evaluated on a per-patient basis. The provider must think of not only the service costs of today but the cost of providing service during the post 36-month capped rental period as well.”

— Bob Hoffman, director of Nationwide Respiratory, a division of The VGM Group

“Home medical equipment providers should be more like a Best Buy or Radio Shack and sell all supplies for oxygen patients, not just oxygen and CPAP equipment. We all need so much more.”

— Holly Lockwood, oxygen user, publisher of Everything Respiratory magazine

“HME providers should give their patients access to qualified respiratory therapists. This includes appropriate competency testing for the therapists, training related to policy and procedures and clinical direction for the therapists. This is essential, as therapists must take a consultative posture with their patients and referral sources.”

— Jason Jacobs, manager of national accounts, SeQual Technologies

“Make sure that clients understand there are more limits as to what providers can do and still stay in business. This has to be a partnership between client and provider if we all are to survive, stay safe and maintain client lifestyles and provider bottom lines.”

— Barbara Rogers, oxygen user, president of the National Emphysema/COPD Association