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.
