Special Focus on Portable Oxygen

Seeing the Bigger Picture

What needs to happen for remote patient monitoring to become ubiquitous?

• By Holly J. Wagner
• Sep 01, 2018

Remote patient monitoring for portable oxygen continues to grow and develop. What factors need to happen in order for it to become a ubiquitous care technology for oxygen provider and patients?

Remote oxygen monitoring is starting to peek into HME. Use of CPAP systems has increased, and now broader application of the same monitoring innovations is bringing it out of the shadows to daytime oxygen systems.

Remote Patient Monitoring (RPM) is most common in diabetes and respiratory function management today, but experts say it has a promising future in cardiac event and function monitors such as cardiac rhythm/event monitors, EKG/ECG and fetal heart monitors; and neurological event monitors like EEGs.

Worldwide, the RPM market is expected to reach $31.326 billion by the end of 2023, increasing from $15.871 billion in 2017, growing at a compound annual growth rate (CAGR) of 12 percent during the forecast period, according to Research and Markets. The confluence of technology and financial necessity is opening a path — albeit a narrow one — for DME providers.

“Demand is the highest it has ever been. The manufacturers are at an all-time high. But they have this gap in the middle where a DME, the guys who can bridge the gap between supply and demand, will win,” says Caleb Umstead, education director at First Class Medical.

“Portable oxygen is a growing market today. Some companies are using POCs for a number of reasons to help patients,” says David Lyman RRT, vice president of respiratory at VGM & Associates. “POCs can be used for those traveling; to help discharges from hospitals; patients who are not within close proximity to the provider; for patients who are very active; and to reduce long-term overhead cost.”

Data firm Research and markets attributes part of the recent growth in RPM to “significant growth … in disposable incomes and increasing demand from an aging population. Availability of technologically advanced products, the budding prevalence of chronic diseases, government support in various countries and rising awareness regarding the benefits of remote patient monitoring are the major factors driving the demand for these systems.”

Hospitals are increasingly investing in remote monitoring for post-release care, and cost-cutters are looking to telemedicine to improve care, contain costs and extend services to underserved communities. RPM is sure to play a big role in all of those efforts.

When Does RPM Become the Norm for O2?

So while industry adoption of remote monitoring for oxygen is a best practice for now, it’s likely to become a requirement, under pressure from payment sources, patients and even Big Data. So far, monitoring compliance requirements are limited to CPAPs and some diabetes monitors. But as RPM capabilities improve and technology spreads across medical service delivery, it’s a safe bet that compliance requirements for oxygen and other service products are not far off.

Colorado is going all in for RPM and has developed a Medical Assistance Program that pays providers a flat fee to cover it, provided the patient is being treated for congestive heart failure, COPD, asthma or diabetes, and the provider is monitoring the patient at least five times per week; working with patients who’ve been hospitalized twice over a one-month period; and ensuring a patient’s home has enough room for the equipment and transmission capability. Other states are considering similar measures.

“CPAP has required compliance for some time now, driven mainly by reimbursement agencies,” says Jim Clement, general manager of North America at GCE Group. For other devices, “since compliance is not mandated at this time, the remote monitoring capability has generally focused on improved fleet management and, more recently, to monitor utilization to prevent readmissions.”

In other words, remote monitoring started from the perspective of tracking equipment, but expanding capabilities are rapidly shifting the focus to monitoring people.

“This trend is just starting to take root in the home oxygen therapy market with the introduction of connected POCs such as the Invacare Platinum Mobile Oxygen Concentrator. The ability to monitor and troubleshoot equipment remotely can help to reduce a provider’s cost-to-serve by eliminating costly truck rolls,” says Nick Jacobs, senior director, respiratory, at Invacare Corp.

Invacare’s Platinum Mobile Oxygen Concentrator with connectivity, launched at Medtrade late last year, features the Piccolo O2 app that lets users view the battery time remaining on their POC as well as get information and support from their phone screens. Providers can access a dedicated portal that shares information from an integrated system, providing usage and performance data.

“Remote monitoring allows the provider and clinician to get a clearer picture on how or if the patient is actually using their device. This gives the patient’s support network the ability to intervene if there is an issue related to non-use. … Remote monitoring also provides data to make sure that the patient has the right device for their condition and lifestyle,” says GCE Group’s Jim Clement.

GCE Healthcare’s Clarity, introduced in February, is a secure online platform that allows providers to remotely monitor GCE’s Zen-O POCs from any Internet-enabled device. The system uses the cellular network and GPS to transmit data on everything from oxygen flow and purity to device location and battery life. GCE has plans to roll out additional features that will give clinicians the ability to remotely gather clinical patient data and also enable its smaller Zen-O lite portable oxygen concentrator on the Clarity platform.

It’s About Compliance

With the new access to information, clinicians can monitor patient equipment not only for the equipment function, but for patient function and compliance.

“While the benefits of long-term oxygen therapy are well understood, compliance has been difficult to monitor. The new connected POCs give providers access to a variety of information on equipment usage and performance, including run time. Providers that have more fully embraced the capabilities of remote monitoring outside of oxygen therapy can, with the patient’s consent, share the patient’s compliance information with referral sources, who can then adjust the patient’s care plan accordingly,” Jacobs says.

The Centers for Disease Control and Prevention (CDC) estimates that non-adherence to prescriptions causes 30 to 50 percent of chronic disease treatment failures and 125,000 deaths per year in this country, across conditions.

Do the math: COPD is currently the fourth leading cause of death worldwide, with an overall prevalence rate between 4 percent and 10 percent of the population, according to the National Institutes of Health (NIH), and COPD is believed to be widely underdiagnosed. NIH says the prevalence of COPD is increasing and it is estimated that by 2020, COPD will be the third leading cause of death worldwide. COPD is one of the main patient groups using long-term oxygen therapy (LTOT). Use of 15 hours per day is widely accepted, but adherence to LTOT ranges between just 45 percent and 70 percent.

Advancements in monitoring let DMEs add a level of service for customers, but it takes careful management to make a profit, and even then it may be tight.

“Competitive bidding has minimized the profitability of oxygen. While some are able to be profitable, I would say it’s more of a retention tool to ensure referrals for other more sustainable products come to fruition,” says Elliott Campbell, senior vice president of Trace Medical.

“With reduced reimbursement, many providers have recognized that it is extremely difficult to provide exceptional service and be profitable with the traditional delivery model,” says Jacobs. “As a result, there has been a significant shift toward non-delivery methods, especially portable oxygen concentrators.”

Translation: Baby Boomers are much more comfortable with technology than previous generations of senior citizens, so they are much more likely to ask for things like access to their health data through web portals and phone apps. While nobody yet offers a true wearable monitor, some manufacturers are working to create interfaces with devices like the FitBit and iWatch.

“It’s still very early when it comes to remote monitoring and oxygen therapy. …Going forward, I’d expect the capabilities of remote monitoring to expand dramatically for everyone involved in caring for someone with COPD,” Jacobs says.

LTOT Technologies Joined at the Hip

The growth of RPM has gone hand in hand with the growth of the POC market: non-stationary patients call for non-stationary monitoring.

“In recent years POC manufacturers have adopted both cellular data downloads and more recently Bluetooth and smartphones as vehicles for the data retrieval,” Clement says. “As far as new capabilities on the horizon are concerned, there will be additional devices that can be networked into the POC. The GCE Zen-O as an example has bluetooth capability to will soon allow other devices, such as an oximeter, to be connected.”

Advances in remote patient monitoring include new peripherals; real-time audio and video for “face-to-face” interaction between clinicians and patients; wireless communication systems that sort the data collected to put it into the context of a patient’s condition; portable and ambulatory monitors; web-based access to patient records; systems that transfer data to an electronic medical record (EMR); and full-service outsourcing that includes a clinician to evaluate data and send a report to the attending physician, according to market researchers at Kalorama Information.

“With technology advancement – and as patients have become more accepting of technology – remote monitoring of equipment has evolved as a means of not only helping to reduce costs, but also helping to improve the quality of care,” Jacobs says.

Patients and physicians aren’t the only ones gathering data from the new tools. As RMP becomes more ubiquitous, the Big Data collected will help guide future refinements and even treatments.

This article originally appeared in the September 2018 issue of HME Business.