Problem Solvers

Getting Back to Basics With Equipment Management.

The increased emphasis on infection control has made this fundamental HME business process all the more critical. What goes into effective, optimized equipment management?

An HME provider’s equipment is one of its biggest assets, and the provider should treat it that way, particularly now, given the Covid-19 public health emergency, supply chain issues, increased focus on infection control, and the need to demonstrate expertise and professionalism to patients, caregivers and referral partners.

Sandy Canally, RN, the founder and CEO of accrediting organization The Compliance Team (thecomplianceteam.org), sat down with HMEB to talk about how equipment management fits into standards compliance and overall business success. She explains what goes into effective equipment management practices; how the COVID-19 public health emergency impacted equipment management; and how those lessons will pay dividends well after the end of the public health emergency.

HMEB: Why is equipment management so important?

Canally: Managing equipment is what a DMEPOS provider does; it is linked to their identity. And providers are basically telling the world that they’re an equipment company, so they should have the greatest amount of expertise in managing their equipment, and what they’re known for by their patients.

The other thing is, it’s related to risk for their company; with supply and demand, whether or not they can get the appropriate accessories, and parts, and the money linked to their inventory. So, they need to manage it well.

One of the things that providers need to do is to look at their warehouse and storage areas, as well as delivery vans, comparing it to the manufacturer guidelines. Testing their equipment tracking system. And can they link each piece of equipment to a patient to show where the oxygen concentrator is at. So, it really is very involved and very necessary to operate a good business as a DMEPOS provider.

HMEB: The Compliance Team is an accrediting organization, of course. How does equipment management factor into accreditation?

Canally: The easy answer is, it’s directly related to manufacturer guidelines. So basically, what we do, as an accreditor, is verify that the provider is meeting what needs to be done for the various parts of equipment they provide. Whether it be oxygen, CPAP, or wheelchairs, each manufacturer has guidelines for how to handle and manage the equipment.

So, what we do, as an accreditor, is actually walk through. I always said, when I started an on-site evaluation, I started in the warehouse, because it really told me about the company and what to expect. If they did a good job in the warehouse in managing their equipment, then it has that trickle-down effect, impacting everything else they do.

HMEB: Regular, preventative maintenance plays a role in this. Do providers have to keep a history of equipment maintenance as part their policies and procedures?

Canally: Basically, we refer to it as the equipment history record, where they’re logging in where that piece of equipment is going, from location to location. So, this device is with Mr. Smith, then it goes to Mrs. McGillicuddy, then it goes to Mr. Jones. And what happens to that piece of equipment in between, with it being cleaned, with it being tested. Make sure that you have a record of all those things. If there was any kind of breakdown and need for repair in between. As well as documenting the preventive maintenance, certain things like filters being changed in between going from one patient to another.

And one of the things — and this story happened years ago, before everybody had their inventory computerized and was using the computer to track their equipment — a lot of the providers would have were binders of these equipment history logs. And there was one provider that had a fire in their place, in their warehouse, and they had to grab what was most important. They told me that they grabbed the binders of the equipment history records, which they had set up according to our standards.

HMEB: How has the COVID-19 public health emergency impacted equipment management? If it has changed what providers do, has that change been for the better, or for the worse?

Canally: The pandemic has influenced how the providers manage their equipment in a few different ways. I’ll go back to that preventive maintenance where, what’s the saying, “penny wise and pound foolish?” It’s the thought that, “okay, because we have less staff, it will be a little easier on our preventive maintenance to not keep up with it as much because of the pandemic.”

When the reality is that keeping up is exactly what you should be doing. Because during the pandemic, you don’t want to have to go into Mrs. Jones’s house and trade out that concentrator because you didn’t keep up with your maintenance. That’s only bringing more risk to this situation, and needing more equipment that you may not have because of supply chain shortages. I found that to be true, where the feedback is, “well, we don’t have the staff,” or “we don’t have this or that.” And you have to say, wait a minute, you need to factor this in and think about this in a smarter way.

Now, some folks did and continue to have supply chain problems. And it might not be with the actual equipment, but related to any kind of breakdown with repairs so that they had shortages of parts, or they had to wait for those parts that they needed for the repair.

The other thing that came into play was the disinfecting of the machines; making sure that they were using an approved disinfectant; and that they were doing it correctly, especially in the time of COVID. And whether or not delivery processes changed. Whether they left it on the porch, or they left it on the front step, instead of going into the house, because they knew that the patient was COVID positive and had just been released from the hospital. So it definitely, impacted.

Now, on the positive side, it also impacted the providers, getting closer to knowing what met the patient’s expectations. They spent more time on the phone doing follow up. Maybe it wasn’t seeing Mrs. McGillicuddy in person, but it was still that one-on-one. Doing more training over the phone, really reaching out, and having that level of connection with their patient, because of the pandemic.

HMEB: There’s a business aspect to equipment management, as well. Why is this a bottom-line priority?

Canally: Certainly, as an owner, you need to identify areas of risk in your business, and that task is directly related to your equipment. Whether or not the delivery vehicle that carries the equipment is well maintained. And every HME provider should be tracking breakdowns, because it can potentially cause harm to patients, which is a huge risk with regard to incident reports and legal involvement. And just making sure that you’re meeting the expectations of the referring physician that ordered the equipment. And training of personnel on the equipment, with handling patients, and what they need to do to make sure that the patient understands how to operate the equipment.

Again, getting back to inventory, it always really surprised me when a provider would say, “Well, we don’t know where all of our equipment is. We know where most of it is, but not all of it.” Well, your money is tied to your equipment, so you really need to know where it is at all times. So certainly, equipment management is directly related to the bottom line.

HMEB: Of course, equipment isn’t solely located in the warehouse. For example, there’s equipment in the delivery vans, which are often treated like inventory locations. How does that factor into their equipment management?

Canally: An HME provider might have 10 vehicles that need to be kept up with all of their oil changes and everything. I mean, you don’t want the vehicle to break down on your way to Mr. Jones’s house. How you store the equipment within the vehicle is also critical. You need to make sure to protect the equipment and that it’s secure. You don’t want oxygen tanks flying in your van, so the safety of the vehicles is important.

Also important: the infection control related to the management of your delivery item, making sure it’s bagged and tagged appropriately, and that there’s no cross-contamination. If you have dirty equipment and clean equipment in the same vehicle at the same time, do you have an infection control kit with a gown and gloves and hand sanitizer and all the things that are necessary? Sometimes a provider will pick up a piece of equipment that needs to be curbside cleaned before they even put it in the van.

So there are all these things that come into play — with managing the equipment, with managing your fleet — that relate directly to quality standards by the accreditors.

HMEB: If you had to narrow down some key bits of advice for providers that need to get their equipment maintenance into order, what would you say?

Canally: First, make sure that you have the manufacturer guidelines for all of your equipment. Verify and validate the location of all your inventory. And make sure that you have documentation of the equipment’s history: where it has been, any breakdowns, repairs, or preventive maintenance. And certainly, the tracking of the breakdown is key to a well-run DME business. And communicating that breakdown to the manufacturer is very beneficial.

This article originally appeared in the Jul/Aug 2022 issue of HME Business.

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