Investigating the COPD Patient: Technology Trends to Reimbursement Woes, What Providers Need to Know About This Dynamic Market Segment
- By Elisha Bury
- Jul 01, 2007
Bob McCoy, of Valley Inspired Products, Apple Valley, Minn., calls COPD the Rodney Dangerfield of health care — “COPD gets no respect.”
In many ways, he’s right. How many times has a patient said that he or she is embarrassed to use oxygen in public? How many times have others blamed the patient for his or her condition because of a smoking habit?
Gretchen Lawrence, BA, RRT, FAARC, program associate for the National Lung Health Education Program (NLHEP) in Irving, Texas, compares the public’s awareness of COPD to that of cardiac problems. She says most people know the signs of a heart attack and understand how to do CPR, but if someone gets short of oxygen, “people will often ignore you.”
Health organizations also have ignored COPD for some time, and McCoy says doctors often show a lack of respect for the COPD patient’s slow death.
“Low oxygen levels don’t just make you short of breath; it causes cell damage in every organ in your body — from your brain to your heart to your kidneys to digestive track,” he says.
Unlike other conditions, such as a heart attack, COPD patients don’t have an instant picture of cause and effect, and that means many organs may begin to fail before adequate treatment is administered.
Many strides have been made in the care for COPD, from emerging technologies that conserve oxygen to devices that make travel possible. Today’s COPD patient demands solutions to remain healthy and active, and manufacturers are ensuring that those technologies are in place. To survive the changing market dynamics, however, providers must strike a balance between expensive technologies and waning reimbursement.
A New Attitude: Streamlining Standards and Technology to What Today’s COPD Patients Want and NeedTechnology is spurring the oxygen market, and COPD patients have had a hand in that growth.
“The patients are more sophisticated about how to navigate the health care system than they were 20 years ago,” Gretchen Lawrence, of the NLHEP, says. “Change is happening.”
In fact, discerning COPD patients are responsible for driving some of the latest advances in portability. Still, COPD patients’ greatest challenge is getting the appropriate equipment to meet their needs.
According to Bob McCoy, of Valley Inspired Products, the provider’s goal to meet patient needs consists of one thing: keeping the patient as active and ambulatory as possible.
As technology continues to evolve and reimbursement continues to dwindle, providers must pay attention to the changing trends to successfully meet market demands:
PortabilityMcCoy calls portable oxygen “the heart of the market.” And that makes sense when you consider that a healthy lifestyle means an active lifestyle. COPD patients must have units that ease getting out of the home and exercising.
“If you keep a patient active and oxygenated, they’re going to have less complications,” McCoy says. “Therefore, they’ll spend less time in the doctor’s office or the emergency room or the hospital with exasperation due to being sedentary due to us giving them very poor ambulatory oxygen systems.”
COPD patients are starting to recognize that need. “They want the newest of everything,” Caryn Plessinger, of Hub’s Home Oxygen, Williamsport, Pa., says. “The race is on to get the smallest, the lightest, the most portable piece of equipment that they can have so that they can be active.”
FAA approval of many portable devices has brought additional mobility to oxygen users.
AccessMany patients may not be aware of the 36-month cap on rentals or impending competitive bidding, but these policies will certainly have an impact on the equipment they use and the choices they make.
Joe Lewarski, vice president of Clinical & Government Affairs at Goleta, Calif.-based Inogen, says COPD patients’ choice to switch providers or technologies will be weakened. “If a patient is unhappy with a supplier today and wants to change companies because, say, the company up the street is offering a new technology that would be more favorable for that individual patient, but it’s an expensive technology, the other company will be less likely to take on that patient because they won’t be able to recoup their cost,” he says.
Lewarski calls access the biggest challenge facing COPD patients today. He also thinks that the lack of reimbursement will impede the use of portable technologies because these devices are more expensive.
Standardized CareMcCoy is pushing for standards for oxygen care across the board. “Right now, home care dealers are doing whatever they feel is the best treatment,” he says.
Standards should be established for titrating a patient on an oxygen system, monitoring a patient on a home oxygen system and for follow-up, McCoy says. He says certification on home respiratory is essential and urges the clinical community to drive that program.
McCoy says that change also should happen with regards to prescriptions for oxygen. He says oxygen users are often given a prescription that does not meet their needs.
“They need to be titrated to the appropriate oxygen level with the activities that they’ll be using the oxygen with,” he says. “We pretty much have a rubber stamp: One setting meets all the needs. A patient comes home with a prescription of 2 lpm oxygen. When they’re sitting, they might need 1 liter. When they’re walking, they might need 3 liters. When they’re sleeping, they might need 2.5. So, we have a very dynamic patient need and a very static oxygen delivery approach.”
Empathy and AccuracyIna Nechita, RRT, director of clinical services at HomeStar Medical Equipment & Infusion Services, Bethlehem, Pa., says COPD patients want providers to be understanding and strive for accurate, on-time deliveries.
“I think both COPD and OSA customers can be very difficult sometimes because they are challenged health-wise and they’re not getting a lot of sleep,” Nechita says. “They’re already a little upset, so they might be short-tempered.”
Nechita says to combat those difficulties, providers must be more vigilant. “I think if we’re consistent with doing what we say we’re going to do, they’re happy,” she says. “And if we understand them and want to help them, they’re happy.”
ProtectionMcCoy says work has begun to push through a patient Bill of Rights to ensure a standard of care.
“Patients don’t know what to ask for,” McCoy says. The Bill of Rights would help patients become involved in their care and not just trust that the doctor is doing the right thing.
“They don’t need the bum’s rush where they get the five minutes in and out, where they don’t even know what the doctor’s talking about,” McCoy says. “They don’t need to have equipment just dropped off at their home with no explanation. They need to have education on their medication, their oxygen equipment (and) their disease.”
Armed with that information, patients can then make appropriate choices about who provides those services.
EducationAsk industry experts how educated patients are about their condition and the answer is a resounding “not very.” Patients need education — not only about their condition, but about equipment as well.
“They know they need oxygen, but they don’t know why they need it,” says Dr. Brian Carlin, senior staff at Allegheny General Hospital and medical director of Lifeline Specialty Centers Pulmonary Rehab in Pittsburgh. “They don’t know what the benefits of oxygen will be, and they don’t often know how to use the oxygen.”
Fortunately, the attitude toward COPD is starting to change, and with it the amount of education that’s available. The American Lung Association has started to support COPD, and the National Institutes of Health recently launched a COPD awareness campaign.
Many patients are becoming Internet savvy, and organizations are sprouting Web sites to provide patient information.
The biggest help for COPD patients, however, is an underutilized opportunity — pulmonary rehab. Pulmonary rehab educates patients about their disease and how to live with it, including nutritional and exercise guidance and energy-conservation techniques, Carlin says.
Community“One of the things that I found the saddest was the isolation that COPD patients feel,” Lawrence says. “They feel terribly alone with their disease.”
Part of the reason for that isolation is that patients are embarrassed by their condition and using oxygen. Being involved in a community of COPD patients can improve compliance. Lawrence says pulmonary rehab and support groups are a great place to find that community. In fact, many pulmonary rehab centers extend maintenance programs to patients to encourage them to come back to the center for exercise under staff guidance.
“Coming to a maintenance program helps maintain those social contacts,” Lawrence says.
AttitudeWhen it comes to how a COPD patient will cope with his or her condition, attitude is everything.
Lawrence recalls a COPD patient, always clad in a bow-tie and vest, who came to the pulmonary rehab center at Baylor University Medical Center in Dallas. “He’d had a good attitude about life all of his life,” she says. “His lung function was terrible, but he could do just as much as people with better lung function because he had a great attitude.”
Providers and respiratory therapists can make a difference in their clients’ attitudes by the help that they lend. “COPD is not high tech,” Lawrence says. “It’s really high touch.”
This article originally appeared in the Respiratory Management July/Aug 2007 issue of HME Business.