How to Help Oxygen Patients Use Their POCs Properly

Sponsored by: Inova Labs

• By David Kopf
• Jul 01, 2011

Oxygen providers have been at the bleeding edge of Medicare cuts, particularly with the implementation of the 36-month rental cap, which meant they could no longer collect funding on five-year oxygen service terms beyond the third year. This radical cut to their funding (along with the 9.5 percent cut that came with the passage of the competitive bidding delay from MIPPA) meant that oxygen providers had to undergo the radical reinvention of their businesses that many providers are only now facing.

Key to that reinvention was removing as much cost from their business models as possible, and the portable oxygen concentrator (POC) made that possible. The value proposition of the POC has been that it is a self-generating oxygen system. 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.

With no tanks that need to be refilled, costly delivery overhead has been slashed. No longer do oxygen providers have to maintain large delivery operations to continually distribute tanks. Needless to say, even with the higher up-front costs of the POCs themselves, the positive impact to the bottom line is massive.

So is the therapeutic benefit. Now patients are no longer tied to their home or a portable tank. Now they can get out, 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 in some cases, the POC has taken hold as a primary as well as secondary source of oxygen for some highly ambulatory patients. And that trend perhaps best illustrates the challenge that has been created in the success of the POC in oxygen services. Patients prefer them so much that it is critical for providers to educate respiratory patients on the proper use of their devices, as well as their limitations. Let’s look at some of the factors involved in that:

Educate physicians. There are a wide variety of POCs on the market, and it is important to educate physicians on how each of them differ and what their capabilities are, says Dan Berry, a senior territory manager for oxygen, respiratory and sleep provider Homecare Concepts. “Especially when it comes to those that are pulse dose capable,” he notes.

This is especially important for POCs that have been approved as stationary and portable units. Many physicians don’t know that the manufacturers of these systems don’t recommend that those devices should be used at night as a stationary units without first doing an oximetry with it to ensure that the POC maintains saturation nocturnally for that patient.

“The reason for that is that everyone is different,” Berry explains. “And even though you might have a patient that might trigger the device, they might have some issues saturating anyway due to the fact the their breath rate is shallowed and decreased. So they are getting fewer device triggers on that conserving device.”

And in that case, the patient would be better suited to a portable device that is pulse only during the day and a stationary concentrator to use nocturnally. Or the patient could use a POC that is capable of providing both pulse dose during the day and continuous flow during the night. (Of course the downside with the all-in-one systems is that they are a little larger than the pulse-dose-only POCs.)

No two POCs are the same. It’s important to remember that the conserving technologies used in POCs differ from machine to machine, just like patients differ. “No two are a like,” Berry says. “They’re just like snowfl akes.”

For instance, some of the devices have minute volume delivery so that the device compensates if users start exerting themselves. These devices will decrease the amount of oxygen per bolus so the patient still gets the same amount of oxygen per minute. This means patients need to be educated on how their POC is delivering its oxygen and monitoring how it performs so that they can change the setting if need be.

The numbers are relative. Also, showing patients that the settings on POCs don’t represent liters per minute, but are simply the vendor’s settings is important, explains Patrick Dunne, MEd, RRT, FAARC, the president and CEO of Healthcare Productions Inc. A small POC on a setting of three is putting out a different flow than a larger POC on the same number setting.

Staff an RT. A respiratory therapist can bring improved accountability for the care a provider offers, and ensure that the patient adheres to the treatment. Those RTs can also bring value by providing disease management to the patient. 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 needs. Dunne says the RT can “titrate to saturate,” and use pulse oximetry to objectively determine that the device is providing adequate oxygen saturation during all activities of daily living, including sleep. “It all goes back to individualizing the prescription,” he says. “Every patient is different.”

Revisit with the patient. Both Dunne and Berry note that it is critical for the HME and its RT to follow up with the patient periodically to ensure the patient adheres to treatment is critical. COPD requires hands-on management, and that follow-up is demonstrated to improve outcomes.

This article originally appeared in the July 2011 issue of HME Business.