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."