According to the Balanced Budget Act of 1997, hospitals are required to provide information to patients on the availability of all home health services through Medicare participating providers as part of the discharge process. Many times this takes the form of a list, from which patients make a choice with little if any additional information regarding the company they have selected. Typically, durable medical equipment (DME) and home oxygen companies are offered in the same fashion. Unlike home health agencies – whose practices are generally held to some national standard – suppliers of home oxygen range from drop-ship companies to those who provide regular and consistent service, including visits from clinical staff members.
Medicare requires that patients receive a choice in who will provide their home oxygen. Many hospitals, taking this to the extreme, instruct those involved in the discharge process to merely present a list of providers with little or no input or bias presented to the patient. While this protects the hospital from liability or conflict of interest issues, who exactly is protecting the patient from inferior service? Who is assuring that the patient is choosing the company who will best serve their needs?
Knowing the equipment provided by local companies is key to helping patients make an informed choice.
Most consumers of ancillary health care services do not have all the information available to make an informed choice. Patients typically do not anticipate the need for home oxygen before their hospital admission. When presented with a list of providers, they will frequently respond to a familiar name, which they recognize from media advertising. Obviously, this is not the best way to choose a company who will be supplying their home oxygen.
It is our responsibility to ensure that patients and caregivers are selecting the company who will best serve their needs. We can do this by familiarizing ourselves with the oxygen providers in the area and by thoroughly assessing the needs and goals of our patients before discharge.
Knowing the equipment and services provided by local companies is key to helping patients make an informed choice. Oxygen is life. If the company selected has poor service it can lead to discomfort, injury or in some cases death. In addition, if they do not provide a wide range of styles and sizes of portable oxygen devices, patients may have to limit their activity leading to a decreased quality of life.
Oxygen Concentrators These are stationary devices that run on electricity. This machine pulls in room air, filters out the nitrogen, and delivers oxygen to the patient. They are best suited for low-flow prescriptions ( no greater than 4-5 LPM). They are dependable machines that are very simple to use. Concentrators do require regular maintence and it is important that the company selected provides this service with no additional charges. Maintenance is typically required every three months and includes checking the purity of the oxygen (FIO2), changing internal filters, assuring accurate flow and checking the hour meter for patient compliance.
Liquid Oxygen Systems: Liquid oxygen is contained in a thermos-like tank. Eight hundred and sixty times as much liquid oxygen can be stored in the same amount of space as a high-pressure tank. A small, lightweight portable can be filled off this tank. This system is great for active people who are away from home frequently. The drawback to this system is the oxygen will vent off as it is changed from liquid to gas, creating waste if the system is not used frequently.
High Pressure Tanks: These come in a variety of sizes. Small, lightweight units are available, which with the use of an oxygen conserving device, may last as long as 6 hours.
It is not important to know the detailed specifics of each individual system. What is important is knowing which companies carry what systems. If a patient requires oxygen only at night, a concentrator may be all they need. However, if the patient is very active it is important that they choose a company who not only provides various portable oxygen systems, but one that will take the time to assess the patients’ needs and provide a portable system which best suits their lifestyle.
In addition, a supplier should offer any equipment service or maintence at no extra charge. Clear instructions on all equipment should also be provided as well as follow-up if the patient requires additional training. While wheelchairs and hospital beds may not need much maintence or follow-up, it is critical that patients on home oxygen clearly understand not only how their equipment works but also what to do it that equipment fails.
Another issue not typically considered is the traveling needs of the patient. Small oxygen providers may not be equipped to provide for the needs of a patient who travels frequently. Customers may feel frustrated by their lack of mobility now that they are oxygen dependant. If travel is something your patient is interested in they need not be limited. Many companies have multiple or nationwide locations providing a seamless and stress-free vacation or visit with relatives. All companies are required to provide for their patients portable oxygen needs at a fixed cost under Medicare regulations, but some suppliers require that their patients pay for their oxygen equipment with another company at their travel destination and are reimbursed later. This can be very costly and may discourage or prevent people from traveling. If this is an issue for your patient, then a company who can accommodate those travel plans with little fuss and no expense may be in order.
Delivery of equipment and supplies is anther service to consider when helping patients or caregivers make an informed choice. Does the home oxygen provider require patients to come into their office to pick up supplies or oxygen tanks, or will they deliver on a regular basis? Patients that have limited mobility, are homebound or who live alone with limitations may find it difficult to get to the providers location. In these situations, assuring that the company selected provides delivery at no charge is important.
Many times the differentiating factor between oxygen providers is the service level. Most suppliers of home oxygen provide 24-hour service to their customers in the event of equipment malfunction or failure. Beyond that, there are varying degrees of service that patients and caregivers should be aware of.
Clinical Staff and Follow-Up: Patients with newly diagnosed lung disease or those with compliancy issues may be best served by an oxygen supplier with clinical staff available for education and follow-up. Many oxygen providers employ respiratory therapists or registered nurses exclusively for this purpose. Others go one step further and provide disease management programs in the home for their customers at no additional cost. Recognizing educational needs before discharge may be key to choosing the appropriate home oxygen provider.
Insurance Billing: Does the provider bill Medicare and accept assignment? Do they have policies in place to help customers in the event that their income is limited or they have no insurance coverage? Patients with limited incomes may choose to "give up" their oxygen due to their inability to pay. For these patients, it is critical to shop around in order to locate the provider who can work with the patient financially.
Incidentally, many HMOs are contracted with one provider limiting patient choice. These oxygen providers are contracted to provide certain equipment and services. If patients have complaints about a provider, they are obligated to due to insurance reasons, it is important that patients call their HMO and express their concerns. Many times service issues can be rectified in this manner. Other times the HMO will allow the customer to choose another oxygen provider if that provider will accept their pricing.
Ultimately the oxygen provider selected is the patient’s choice. Without informed choice, however, our patient’s quality of life may suffer. It is our duty to explore patients’ needs and guide them in the decision making process. Choosing the oxygen provider best suited to their goals will ultimately help us achieve ours by decreasing hospital readmissions as well as giving our oxygen dependant patients as full a life as possible.