Home care providers specializing in respiratory services face daunting challenges in today's marketplace. Not only are they trying to cope with oxygen reimbursement cuts, they must also wrestle with the prospect of accreditation requirements and concerns about competitive bidding.
Add to these worries the daily concerns about patient care and the constant pressure of running a business. Is it any wonder that opportunities are easy to miss?
I spent several years handling purchasing for one of the country's national home care companies. As a buyer, I was responsible for selecting from a broad array of both respiratory products and durable medical equipment. It wasn't possible to focus on every single item we bought. There were too many vendors and not enough time. Triage was the order of the day.
Now I look back on my days in purchasing and wonder what I missed. Oxygen conserving devices are a case in point. These devices accounted for a small percentage of our capital expenditures. We spent millions on sleep-related products, oxygen systems, beds and wheelchairs. Relatively speaking, conservers were small potatoes.
Admittedly, I am chagrined by the fact that I should have paid closer attention to oxygen conserving devices. I never realized how much this relatively inexpensive item impacts patient care and the cost of doing business. What I have since learned in conversation with other home care providers is that many who are much closer to the day-to-day business than I ever was are in the same boat, incurring unnecessary costs and mostly for the same reason: They have bigger fish to fry.
Yet, a closer look at conservers reveals how much is at stake in three key areas :
- Cost of doing business
- Clinical efficacy
- Patient satisfaction
BUSINESS COSTS
Beyond the price of the conserver itself, the variance in the ancillary cost of using a particular conserver can be surprising. For example, if you are using conservers that require dual lumen cannulas, you could be spending anywhere from $7,000 to $10,000 more a year for every 100 oxygen patients you serve. Simply put, dual lumen cannulas cost a lot more than single lumen cannulas.
How about savings on conservation ratios? The difference between conservers offering 2:1 savings ratios and 5:1 savings ratios is another surprise. A typical patient on an lpm (liters per minute) flow setting of 2, taking 20 breaths per minute using a 2:1 conserver, will use 218 more M6 cylinders a year than a patient on a conserver that offers 5:1 savings. That's hundreds of extra dollars a year per patient just for oxygen contents, not to mention more deliveries and the need to buy more cylinders.
CLINICAL EFFICACY
The first job of any conserver is to make certain that patients achieve and maintain adequate saturation levels, preferably above 90 percent. Conservers must be sensitive enough to sense a patient's breathing whether he is at rest, eating, talking or exercising. Ask your vendor to provide documentation that supports claims about saturation levels.
The sooner the conserver senses a breath, the faster it can deliver a bolus of oxygen to the patient's lungs. Studies have shown that the earlier oxygen reaches the patient's alveoli, the less oxygen they need per breath to maintain saturation at desirable levels. A bolus delivered prior to the first 600 milliseconds of inspiration is essential. The earlier inspiration is achieved, the better. Sensitivity and speed are critical attributes of conservers. Before you buy your next conserver, make sure the brand you are using is quick.
It's also important that the patient receive the same level of oxygen with each breath, even if their breath rate increases. Check to see whether the devices you are using/considering offer a uniform pulse regardless of breath rate. Also take a close look at conservers to see how many settings they offer, and whether they have a switch so patients can alternate between pulse delivery and continuous flow.
PATIENT SATISFACTION
Oxygen patients want freedom. That's why savings ratios matter to them. A reliable 5:1 conserver can give a typical patient as much as seven hours of ambulatory time with one M6 cylinder. These patients are also concerned about the weight of their portable device. In response, the industry's conserver manufacturers continue to develop smaller and lighter products.
The key is to provide a lightweight product that delivers consistently good clinical results. Since patients have to manipulate their conserver, make sure it's easy for them to use. If the conserver is electronic, make sure battery life is generous. Three to four months of battery life is a reasonable standard.
At a time when providers are actively searching for ways to reduce operating costs and avoid sacrificing customer service, choosing a conserver that saves money yet offers patients peace of mind makes good sense.
Fortunately, there are a number of good conserver brands available. Naturally, you will also want to negotiate a better price on the products you buy. Be certain that you look beyond the item's price tag and weigh all the other costs of buying conservers.
Of course, your assessment shouldn't stop with oxygen conservers. There are meaningful savings opportunities in many medical products. You can continue to succeed in a highly competitive environment. Opportunities to save money exist in the strangest nooks and crannies, just waiting for you to discover them. Challenge conventional wisdom, and take a fresh look at the familiar. Doing so will help you conserve your cash.
A QUICK CHECKLIST CAN HELP YOU EVALUATE THE PRODUCTS YOU BUY
- What price and terms is the vendor offering?
- Does the product require you to use ancillary items, such as masks and tubing?
- If yes, are you required to use the same brand?
- Can your vendor explain and document claims of clinical efficacy?
- How long is the product warranty, and what does it cover?
- Ask your vendor what the repair rate is. If it's 2 percent or more, factor the cost of returns and replacements.
Formerly vice president of purchasing and support services for American HomePatient, Len Serafino serves as vice president, eastern division, for Chad Therapeutics, Chatsworth, Calif. He is also the author of Sales Talk, a book for sales professionals, and has contributed several past articles to HomeCare magazine. He can be reached by e-mail at lserafino@comcast.net or by phone at 615/778-0401.
