Problem Solvers

The Home Filling Learning Curve

How providers can identify which patients are right for home filling and educate them on using their systems.

In light of the pending reimbursement challenges for providers, interest in non-delivery oxygen therapy systems is most certainly at an amplified level. The reason being that non-delivery oxygen systems cuts costs by helping to keep providers from having to go out to homes to deliver new tanks and take the emptytanks on a regular basis.

“With competitive bidding being front and center on every homecare providers mind right now, the non-delivery model for a homecare provider is becoming more and more of a necessity, and it’s certainly a business opportunity to keep their costs down,” says Scott Frenz, senior director of downstream marketing at Philips HomeHealthcare Solutions.

Portable oxygen concentrators have become quite well known in this regard, as they have offered a way for providers to reduce deliveries and thus cut costs, while allowing patients to enjoy more independent and ambulatory lives, which translatesto better outcomes in addition to better quality of life.

Similar to POCs are home filling oxygen systems that also allow patients to be more independent and active in walking around in their house or in their neighborhood. The UltraFill from Philips Respironics and the HomeFill from Invacare are two examples of these types of systems that providers are recommending totheir patients to help them get the most benefit out of their oxygen therapy.

The Case for Home Filling

Home filling systems offer a number of benefits to patients. Traditional oxygen therapy devices with tanks rely on the providers to deliver the oxygen to theirpatients. This has a tendency to keep patients at home waiting on their oxygen.

“When we talk to our patients one of things that we hear is that their freedom and quality of life are fairly limited if they have to wait and schedule time for oxygen deliveriesfrom their homecare providers,” says Frenz.

Since a home filling system allows patients to fill their tanks on their own time, this provides more freedom to patients in terms of their daily activities and how they schedule their time. And Philips’ UltraFill system allows patients to not just fill, buttop off their oxygen tanks at their own schedule.

“So if they want to do it for 15 minutes before they’re making dinner versus having to wait until the tank is depleted or having to go through the effort to deplete the tank or empty the tank themselves then refill, that provides them some convenience andflexibility in terms of filling their tanks,” Frenz explains.

The ability to fill a cylinder at home also means no more hoarding of cylinders,something that has historically been an issue for oxygen patients.

“We know that patients have a big fear of running out and they tend to hoard cylinders because they’re worried about when is my next delivery going to get here,” says Mike Irvine, business manager of Invacare’s HomeFill Oxygen System. “By having a system where they can refill their own cylinders, they don’t have to worry that they’regoing to run out of oxygen.”

Who Can Use Home Filling?

While every patient has unique characteristics and needs, a home filling system can be a good option for just about any patient who wants to be ambulatory andeven offers some added benefits over POCs.

“A lot of the traditional POCs are portable but can be a little heavy for certain patients. It could be a challenge for them to get that around, so with the (home filling) tanks, even the 3,000 PSI tank, it’s only about 5 lbs. and lasts 8.5 hours and then the 2,000 is even lighter than that, so it is a good alternative for a patient that may not be able to transport a more traditional portable oxygen concentrator,”says Frenz.

Still, there are a few exceptions or cases where a home filling system would notbe a good idea.

“Extremely high flow patients, 5 LPM (liters per minute) and above, are probably not going to get enough time off the cylinder to really be a viable candidate and those patients are probably better on something like liquid oxygen, but fortunatelythat’s a small minority of oxygen patients,” says Irvine.

In addition, patients who need to fly, particularly ones that would fly regularly,cannot take a tank on an airplane.

“Tanks are against FAA rules, so a portable oxygen concentrator would be abetter solution for that type of patient,” explains Frenz.

A home filling system is also a good solution for patients that have been on oxygen for a while, are comfortable with tanks and may not feel as comfortablegoing to a POC-type model.

“For them to have the ability to be more active, more ambulatory, take a greater hand in their therapy, but also still remain on the traditional tank therapy is somethingthat a lot of patients feel comfortable with,” says Frenz.

Sharing Strategies for Success

Many manufacturers offer providers various sources of education on how their patients can use home filling systems to the maximum benefit. After all, the moreeducated the provider is, the more educated the patient will be.

“Some of the manufacturer’s resources are literature, videos and websites. We’ve done quite a bit over the last couple years to have more online and digital resources available to the homecare provider, which also can be available to the patient as well through our website,” says Frenz. “We provide in-person education, CEUs, workshops. We have webinars for our homecare providers on these…to get them up to speed on all our technologies, but particularly over the last couple years thenon-delivery solutions, like UltraFill and the SimplyGo.”

Mastering the System

Just as with other types of oxygen therapy, providers still need to work with patients on how to properly use their home filling system. The same standard firesafety rules apply as with any type of oxygen therapy, but as far as operation, the systems are often designed to allow for very limited training from the homecareprovider to get the patient up and running.

“The homecare provider doesn’t have to have a whole litany of things that they necessarily have to walk through with the patient, but, that said, we do provide them with tools and with some training and programs to make them feel comfortable with communicating things to the patient,” says Frenz.

Irvine points out that there is somewhat of a one-time issue that patients sometimes have with Invacare’s HomeFill device when they set their low flow meter higher than prescribed, so providers need to be aware of it and explain it to the patient in advance.

Setting the flow meter higher can be accidental or maybe even happen because the patient was feeling tired and thought more oxygen would help, but no matter what the reason, this can cause a low-flow situation and, in the HomeFill’s case, the device will stop filling.

“Our system has a patented patient protection, where if the purity drops for any reason the HomeFill compressor will stop filling the cylinder,” says Irvine.

This can lead to a patient calling up the provider to complain or question why the cylinder isn’t filling or it’s taking too long to fill or that the system keeps turning on and off.

“The very first question to ask a patient who calls in and complains is ‘What’s the flow meter set at on your concentrator?’” says Irvine. “That generally happens one time…it’s not a major issue, but for new patients getting acclimated to the system, it’s something we tell (providers) to have their driver or whomever is doing the patient education stress.”

Fostering Increased Compliance

In addition to the increased ambulatory benefit that makes home filling devices appealing to patients, the potential for increased compliance is one benefit that’shard to deny.

“If you talk to the operations guy or customer service rep at a company that still delivers oxygen, they will tell you that its very common for them to get calls on Friday afternoon because grandma’s going to see the grandkids baseball game this weekend or some other activity and she just realized she’s only got one cylinder or no cylinders left and her next delivery isn’t until Tuesday, so can you please run out with a couple of cylinders,” says Irvine.

“The point I that make for those providers is for every patient that calls you like that, there were probably two that did not, and thus either didn’t go out that weekend or went out without their oxygen and were not compliant with their oxygen therapy.”

Thus if it’s easier for patients to use the system, they’re more likely to use it and they’re going to be more compliant and do better on their oxygen, a win-win for patients and providers, alike.

This article originally appeared in the May 2013 issue of HME Business.

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