HME Business Handbook: Oxygen

How to Educate Your Oxygen Patients on POC Usage

How do providers educate both patients that aren't using their POCs as much as they should be, as well as help 'super users' understand device limitations?

Portable oxygen concentrator (POC) use in the United States has exploded over the years. As an example, according to Medicare HCPCS claims data, the portable oxygen concentrator code E1392 has been in use since 2007. In 2007, there were an estimated 1,500 patients receiving a POC billed to Medicare, and in 2016 approximately 114,400 beneficiaries received POCs in 2016.

That’s not surprising what POC’s mean for patients. The core value of the POC for patients has been that it is a self-generating oxygen system they can take with them. Like a stationary concentrator, a POC takes room air and through an electro-chemical process strips away the nitrogen that is part of that air to deliver concentrated oxygen. However, instead of being tethered to a stationary device, patients can go where they want and carry out daily activities. Now patients can get outside, and lead a fuller, more active lifestyle than they could without the portable oxygen concentrator. They can much more easily spend longer periods away from home and can even travel.

And of course, for providers, the upsides are also clear: With no tanks that need to be refilled, costly delivery overhead has been slashed. No longer do oxygen providers have to maintain vehicle fleet operations to continually distribute tanks. Even with the higher up-front costs of the POCs themselves, the positive impact to the bottom line is considerable.

However, a patient education challenge has arisen that oxygen providers need to address.

THE EDUCATIONAL CHALLENGE

So what’s the challenge? To start, in cases with highly ambulatory and active patients, their POC often becomes their primary means to derive their long-term oxygen therapy. Conversely, there are patients who receive POCs but don’t use them. This presents a twin educational challenge providers must address: First, how do they educate the patients who aren’t using their POCs as often as they should on how to use the devices as well as actually getting out and using them? Second, how do they get the heavy users to keep being “super users,” but also understand their device limitations?

DO YOU HAVE A FT RT?

Retaining a respiratory therapist on staff is a critical education asset. Contracting with entrepreneur RTs clearly works and is a model used regularly, but a full-time RT can bring improved accountability for the care a provider offers, and enhance its patient education and provide disease management to the patient so that they better adhere to their treatment and benefit from it.

Because of the difference between the devices, the RT will know all the different nuances between POCs and help work with the physician to ensure there is an optimum fit between the device and the patient’s needs. The RT can use diagnostics such as pulse oximetry to objectively determine that the device is providing adequate oxygen saturation during all activities of daily living, including sleep. Then the RT can show the patient how to manage their device accordingly. Since every patient is different, this goes a long way in individualizing the prescription for each person.

In an outcomes-driven healthcare environment, an on-staff RT can drive patient results through enhanced education and coaching, and that can improve outcomes that cement both patient and referral relationships.

INVOLVE REFERRAL PARTNERS

Patient education on POCs begins with your referral partners. As patients are being on-boarded into their long-term oxygen therapy, they need to know the available options. That means providers need to engage referrals with detail educational programs that demonstrate how the POCs they offer differ, what their capabilities are, and what their use recommendations are.

For instance, when it comes to POCs that have been approved as both stationary and portable units, many physicians don’t know that some manufacturers of these systems don’t recommend that their devices be used at night as a stationary units without first doing an oximetry test to ensure that the POC maintains saturation nocturnally for that patient. Through the right education, providers can bring issues like that to the fore and give referral sources the information they need to get the patient on the right track.

MONITOR PRODUCT CHANGES

The product offerings in the POC market are constantly changing as vendors add new innovations. Manufacturers are constantly trying to bump up battery life and increase the usability and self-management capabilities of POCs. For instance, there are now POCs coming to market that let users easily swap out their sieve beds. That is a great cost-saving innovation for providers and diminishes scheduling hassles, but it also represents an educational challenge.

All staff should be clear on the full POC line a provider offers. This is important because devices can sometimes be misleading and providers must rise to the education challenge that creates. For instance, showing patients that the settings on POCs don’t represent liters per minute, but are simply the vendor’s settings is important. A small POC on a setting of three is putting out a different flow than a larger POC on the same number setting.

REMOTE PATIENT MONITORING

Speaking of product enhancements, the development of remote monitoring for portable oxygen concentrators has been a work in progress for a few years, and now it’s reaching the point of maturity. The first forays into remote POC monitoring came with devices that were largely founded on the concept of fleet management: providers would remotely monitor POCs to ensure they were being used and that they were functioning properly. That alone is a huge boon in terms of patient education: If a provider sees that a POC is sitting idle, it can work to reengage that patient with his or her therapy and device and start coaching him or her on POC use.

And the data being reported back by POCs is starting to expand beyond that asset tracking application. Now there is a move to start monitoring patient POC usage data in the same way the sleep therapy market monitors CPAP usage. Some simple data can yield even more opportunities to help educate patients. For example, let’s say a patient has an oxygen concentrator in his home, and is prescribed to use it for X number of hours a day at X setting. Remote monitoring could show that the patient is either getting more oxygen than was prescribed, or perhaps not getting the correct duration of usage. This is a golden opportunity to reach out, find out what the patient is doing, and offer some coaching.

POINTS TO REMEMBER:

  • The ever-expanding use of portable oxygen concentrators (POCs) shows their efficacy when it comes to long-term oxygen therapy, as well as in creating a more stable business model for providers.
  • However, two patient education challenges have arisen: how to make sure “super users” are using their devices at all, and how to get patients not using their POCs to start.
  • Having an on-staff RT can help in this regard. An RT that is permanently on the team can ensure that the provider tailors its education and coaching for each patient.
  • Also, providers need to get referral partners to help with patient education. They can do that by educating physicians on the POCs in their line.
  • Staying on top of new enhancements such as remote monitoring also plays an important role.

LEARN MORE:

Oxygen is a topic that is regularly covered in the Oxygen Solutions Center.

This article originally appeared in the June 2019 issue of HME Business.

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