Prognosis is Promising!

Home diagnostic equipment is a fast growing enterprise as many individuals are taking more responsibility for their health and disease management programs are expanding.

Diagnostic equipment allows patients to self monitor and record statistics or data that physicians can use to modify treatment plans if necessary, which translates into better health care for the patient.

Patients who utilize home diagnostic equipment are empowered patients who ultimately become more compliant and produce better quality of life outcomes. By using the equipment, patients also are more proactive in their treatment plans and in the overall maintenance of their health. Patients also will benefit when HME providers maintain clear channels of communication with physicians.

Despite some controversy over patient privacy issues, diagnostic equipment continues to be widely used for a variety of chronic conditions. The majority of users are patients diagnosed with diabetes, asthma and sleep apnea.



Diabetes is a disease that affects hundreds of thousands of people. One important aspect of diabetes is the monitoring of glucose, the level of sugar in the body. For many, this means testing sugar levels as often as seven or eight times a day.

One piece of diagnostic equipment available to people with diabetes is a glucometer. Patients use a lancet to prick their finger and then place a drop of blood on the glucometer. The glucometer processes the information from the drop of blood and then flashes a number indicating how high or low the glucose level is.

This is very important for diabetics because it indicates whether they need to take more insulin or other medication to bring the glucose level down, or whether they should eat to bring the glucose level up.

While this may seem like a little task, it can mean life or death for a diabetic. Many related illnesses such as blindness and diabetic foot ulcers can occur if a diabetic does not control his or her blood sugar. If sugar levels are too low, death can occur if proper measures are not taken.

"Self blood glucose monitoring is the most important thing that has happened in diabetes since the discovery of insulin," said Dr. Daniel Lorber, director of endorcrinology, New York Hospital Medical Center of Queens, Flushing, N.Y.

Glucometers are a vital piece of home diagnostic equipment if diabetics want to improve their quality of life. Patients who are able to track their sugar levels over time tend to be more compliant because they are aware and informed of what their body is doing. If a diabetic is able to control glucose levels, then the quality of life is improved and illnesses can be avoided.

"It encourages self reliance because diabetes is such a minute-to-minute, hour-to-hour, day-to-day disease," said Dr. Lorber.


When an individual has an asthma attack, the lungs expand and close off airways. This causes asthmatics to become short of breath and have difficulty breathing.

To gauge the level of air that is able to enter the lungs, patients with asthma use peak flow meters, which measure the amount of air a patient is able to actually take into the lungs.

Patients set the gauge to zero and blow into the mouthpiece of a peak flow meter. The results indicate whether or not the patient needs to take a breathing treatment.

If the level of air getting into the lungs is minimal, then patients must use a nebulizer, which takes a liquid medication and transforms it into a light mist that seeps into the lungs to make them contract so more air enters the lungs and patients can breathe.

Sleep Apnea

Patients diagnosed with obstructive sleep apnea (OSA) often cannot breathe while sleeping. Home diagnostic equipment can be used for several different protocols when dealing with sleep apnea.

Some equipment determines if a patient does indeed have OSA and if it is necessary for the patient to participate in a sleep study to further determine the need for medical equipment.

"Our device is used primarily as a screener; it records pulmonary activity to determine if a patient needs to go to a sleep lab for a study or to rule out obstructive sleeping disorders," said Gary Gaskin, marketing manager, Nidek Medical, Birmingham, Ala.

Home diagnostic equipment also benefits patients with sleep apnea by helping determine compliance and improve outcomes.

"We've got an 18-channel and 24-channel monitor that can be used in the home to tracks stats and levels of breathing so physicians can keep track of what their patients are doing," said Gaskin.

By taking advantage of the equipment available on the market, sleep apnea patients are able to track their various levels of breathing throughout the night. Physicians then use this information to determine if another form of treatment is necessary.


While home diagnostic equipment can help compliance and improve outcomes, there is a lot of controversy regarding the use of equipment for physician monitoring and tracking of patients.

Many individuals believe that this "home monitoring" can be viewed as a violation of privacy. The question of responsibility comes into play as it is necessary to determine who the responsible party really is.

If a patient's health begins to deteriorate, a physician needs statistics and relevant information to determine if another form of treatment is needed. However, it also is important to recognize that an individual's health maintenance is the sole responsibility of that individual. There are guidelines associated with the diagnosis and treatment of certain conditions. While physicians and experts can educate patients and offer these reatment guidelines, if a patient decides not to adhere to those guidelines, then the patient suffers.

"A major problem with self-monitoring is that patients are not educated and don't know how to interpret the data," said Dr. Lorber.

Although it is up to the patient to maintain treatment compliance, Medicare, Medicaid and private insurance companies often require that physicians monitor the use of home diagnostic equipment to ensure that the patient is utilizing the machine.

Reimbursement issues also can be confusing for health care providers and HME dealers. For example, according to the American Diabetes Association, glucometers are sold "over the counter" in local pharmacies, however to qualify for reimbursement, a physician must show medical necessity.

If an insurance company is going to pay for a piece of home diagnostic equipment, it wants to guarantee the machine is being used for its intended purpose. Regardless of reimbursement, HME dealers should work with physicians and payors to ensure continuity of care for the patient.


HME providers can help their business and patients by maintaining a clear line of communication with physicians. Through collaborating with other health care providers, HME dealers can streamline the process of providing patients with home diagnostic equipment.

Many home medical equipment (HME) dealers are tasked with the responsibility of tracking paperwork from the physician in helping to comply with insurance companies and regulations set forth by the Health Care Financing Administration (HCFA).

HCFA recently passed new restrictions and guidelines for BiPap S/Ts, machines used by patients for respiratory treatments. Under the new regulations, physicians and HME dealers must be aware of the specific guidelines governing the diagnosis and need for the machine.

It is important for providers to be aware of all government and private insurance guidelines when filling an order for a piece of home diagnostic equipment. It also is necessary for HME dealers to be knowledgeable about any piece of equipment they rent, sell or distribute so they are able to better serve their clients.

When selling or renting home diagnostic equipment, HME dealers should educate the patient on the equipment's many features and functions as well as its proper use.

According to Dr. Lorber, it also is important for patients to have their machines calibrated to verify the machine is precise in its calculations.

"If you took a home pregnancy test, you probably wouldn't just rely on those results; you would probably follow-up with a physician. Patients need to make sure they are receiving correct data when they use home diagnostic equipment, hence the importance of verifying a piece of equipment is working properly" he said.

Home diagnostic equipment dealers and providers can benefit both from the growing market and the knowledge that they are helping patients achieve healthier lifestyles.

As patients become more empowered in their treatment protocols and as technology offers more home health care alternatives, the home diagnostic equipment market will prosper. Although controversy will remain when dealing with patient privacy issues related to home monitoring, compliance and better outcomes continue to outweigh any negative aspects associated with the use of home diagnostic equipment.

This article appeared in Home Health Products, November/December 2000, Vol 8, #10, pg. 22-23.

This article originally appeared in the November 2000 issue of HME Business.

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