In a world of reduced reimbursements, competitive bidding, and inherent reasonableness, why would any HME/supplier even consider giving out oxygen conservers? Isn’t it bad enough that it seems like Medicare and the third-party payment gang has it in for the industry to begin with? Now we are giving stuff away like expensive conservers?

As we know all too well, most payors do not cover conserving devices at all. Does this make sense to anyone? Well, selling conservers may be the smartest thing your organization has done in quite some time. A patient using a conserver properly will enjoy an increased level of freedom and mobility. This value translates to increased sales when your patients tell physicians and friends about this newfound freedom and quality from you—the smart supplier.

Variations on a Theme
An oxygen conserving device can be a specialty delivery mechanism—like a conserving liquid vessel or a pneumatic gas regulator device—or even a battery-operated unit shaped like a doughnut. Some look like calculators with nifty coiled tubing, and still more use other types of technology. They are all designed to provide one thing—a sufficient amount of oxygen to meet the patient’s needs—while preventing as much waste as possible. So the question is: Can a device do this “safely?”

Every patient is unique, so there can be no absolute answer. Prior to applying a conserver, all patients must be evaluated by a professional (physician or respiratory therapist). The determination process must include activities of daily living (ADLs) and some form of mild exertion. After all, patients who want conservers want greater mobility and less weight in their cylinders or vessels.

What makes one conserver “better” than the next? Conservers that use batteries have always bothered me because “battery operate red” has often meant someone is off to the shopping center to replace batteries for a patient whose device is not working. The additional cost and risk are not ideal.

Pneumatics use the pressure of the compressed gas cylinder as the operating force. I like this type better but am usually dissatisfied with the compensation ratio. Put another way, these work well at lower exertion. However, grandma may go to the mall having only one cylinder and no idea that switching the conserver to “continuous” means the tank won’t last all day.

Liquid vessels have long offered extended away times in a conserving mode, but liquid bears the stigma of potential liquid burns (very unlikely). Also, the beneficiary will have to tolerate a larger vessel in the home, which can be a bother. Ultimately, there are no absolutes—just different benefits and drawbacks. Involving the patient in the decision will help offset cost and lead to better outcomes.

The Spirit of Giving?
So why would a DME/supplier “give” these things out? A properly trained and qualified beneficiary will enjoy a better quality of life, and the DME/supplier should see a reduction in trips to the patient home. The cost of the conserver should ideally be offset by the savings in trips.

The problem often comes from lack of education on how to use the systems effectively. Providers need to be well educated on the different conservers available. Not unlike cars and trucks, not every conserver is for every person. Providers also have to understand the intended use. If a patient really does not intend to leave the house, it may be possible that a better understanding of the stationary system is all that is necessary.

Patients need to be taught all the features and functionality of the products the DME/supplier carries so they can participate in the selection process. Once a product is selected and the physician agrees that a conserver is applicable, it becomes important to thoroughly review all of the features and as much trouble-shooting as possible with the new device user. The more thorough the review, the fewer support calls/visits and the better the outcomes.

Help patients realize that conservers are not intended to deliver “emergency” oxygen when an acute episode is occurring or has occurred. Ensure that your patient knows how to switch to continuous flow, when switching is appropriate, and how to calculate time remaining in a cylinder (some manufacturers offer laminated cards for reference).

Conserving devices, like so many other products in home care, are usually not intuitive. These devices may seem scary and overwhelming to a new user. Your efforts can ease these fears and ensure a good understanding. Regardless of what product we discuss, education of the end user is the key to success.

Success in this case means proper and safe use, and user confidence to comply with therapy. Create-leave behind reference materials or ask the manufacturer what they have available. I strongly recommend the use of laminated usage cards (to tell a patient how long before the tank is empty).

As a rule of thumb, try to teach your patient everything you would want to know about the tank system if you were scuba diving and your next breath depended on your knowledge. Their next breath and your success definitely do.

If your goal is to reduce your home trips, look at the transfilling concentrators. Combining these products with a good conserving device and a well-trained patient can create a real benefit. Poorly trained patients are not only a nuisance to support, but are far less compliant and far more likely to end up in an emergency department. You do not want them telling their physician they “never understood that goofy thing anyway.”

They Don’t Cost Too Much
Among providers, the biggest misconception about conservers is that they cost too much and provide too little benefit. A conserver can mean a great sense of freedom to a patient who otherwise would be tethered to a stationary system in the home. It can also mean more business developed through better and stronger referral relationships. Referrals prefer providers who look out for their patients. With the specter of reimbursement cuts and competitive bidding, a great relationship with referral sources and cost reductions might be just the tickets to greater success and fewer worries.

Robert W. Rudowski, CRT, is president/CEO of Oximetry Co LLC, Birmingham, Mich.