Oxygen Delivery

Speedy Delivery

While providers transition to low-delivery models, they must drive efficiency in their existing operations.

• By Joseph Duffy
• Aug 01, 2013

Portable oxygen concentrators (POCs) are getting significant attention these days, as oxygen providers seek the most efficient ways to run their oxygen business. But, transitioning to a low-delivery model does not mean a providers shouldn’t be exploring other avenues for reducing their existing delivery costs.

The latest Medicare data shows that patients receiving POCs billed to Medicare rose from 1,500 in 2007 to 20,000 patients in 2011, the year of the latest available data. But as oxygen providers trend toward no-/low-delivery, POCs remain in their infancy with oxygen delivery methods varying across the United States. Providers continue to search for oxygen delivery strategies that make their business more efficient and still meet the needs of this growing patient population.

“For many providers this is but one of a spectrum of challenges the industry is throwing at them — changing business models, reduced reimbursements, audit challenges, and more,” says Chris Watson, chief marketing officer at HME software firm Brightree. “Many providers are struggling with these changes, but those that will come through this with winning business models are able to adapt quickly with the use of technology. The key is achieving breakthroughs in efficiency that help them adapt, find profitable lines of business, and squeeze out margins in the new HME market.”

Technology remains a significant driving force for cutting costs across oxygen provider businesses, especially in delivery. Efficiency, especially in trying times, is survival, and it’s a tireless, never-ending goal. So regardless of your oxygen delivery method, there seems to always be something else you can do or information you can mine or measure that helps you slice off another ounce of fat. Here are some approaches that oxygen providers are using today to find a deeper level of delivery operations efficiency.

Management Technology

Watson’s company, Brightree (www.brightree.com), provides a cloud-based platform that delivers comprehensive HME billing and business management capabilities, including intake, purchasing, delivery, billing and A/R management. Watson calls their mobile delivery solution, which manages the delivery process through hand-held devices that sync with their web-based platform, “a key to efficiency in oxygen delivery.” In addition, Brightree helps providers remain effective on tight delivery schedules through trending and tracking patients to know when they are ready for refills.

“Brightree’s Mobile Delivery solution helps providers effectively manage drivers and delivery trucks to dramatically reduce DSO [days sales outstanding] by ensuring that each phase of the delivery workflow is efficient, and completely documented,” Watson says. “Brightree Mobile Delivery is integrated within the Brightree platform and supports a variety of mobile handheld devices.”

Managers can monitor delivery activity in real-time via GPS-based vehicle tracking capability. Providers can see where drivers are currently located and where they have been — and for how long.

“Productivity is dramatically increased with this level of visibility to the fleet,” Watson says.

Drivers use handheld devices to perform the following functions:

• Collect the patient’s signature, and acknowledging receipt of product and safety information.
• Electronically scan the product for a serial or lot number, eliminating human error.
• Enter a user-defined reason code if patient is not at home or refuses delivery.
• Rush orders.
• Expedite delivery by identifying which truck has the correct inventory and is nearest to the patient.

Regarding CSR support, Watson says that inquiries from patients and family members can be quickly answered with real-time delivery status. And for reconciliation and billing, drivers will wirelessly transmit order tracking into the Brightree system to expedite billing.

“Mobile handhelds can eliminate lost paperwork and missing signatures and serial numbers,” Watson says. “And Brightree’s document management solution stores all of the necessary paperwork directly on the patient’s record and is readily accessible in case of an audit.”

According to Watson, using Brightree takes some instruction to orient the drivers away from paper to an electronic system. But once implemented, she says that providers can cut delivery times, increase efficiency, reduce fuel costs, and more. She calls the handheld devices “intelligent” in that they can “walk” the driver through the delivery process using simple screen prompts to ensure that all information is delivered and signatures are received.

“Providers will see immediate results from the Brightree Mobile Delivery solution in the form of efficiency as the patient signatures are being captured electronically and transmitted immediately back to the billing department to allow claims to be sent faster,” Watson says. “Providers on the Brightree Mobile Delivery solution have experienced results, such as a 100 percent increase in revenue, 88 percent improvement in DSO, and more than 100 percent increase in the number of daily stops.”

Brad Heath, vice president of Operations and Marketing at provider Family Medical Supply, uses Brightree to manage oxygen delivery for 15 branches in the eastern United States. Their deliveries are about 75 percent to 80 percent homefill and about 20 percent to 25 percent POC. They have been using Brightree since 2007.

“With oxygen delivery, it’s two things: first, keeping good notes and tracking your patients and second, managing your inventory,” Heath says. “Brightree does a wonderful job at both. Its inventory system lets me gage based on payer and referral source what’s the average span with which patients will be with me and when it is a better option to use a POC versus waiting to see how well they are going to do. Across the board the average tenure that your patient has with you varies greatly.”

Brightree manages and delivers data on Family Medical Supply’s oxygen delivery patients. Heath enjoys not having to spend a lot of time chasing what every patient has for equipment and who is active on what equipment. He can generate reports that tell him what patients have wanted to use a POC more than others, which often helps Heath decide whether to make a POC the patient’s backup system.

“Brightree gives you the ability to be more efficient because your data is more transparent,” Heath says.

Heath says if you are doing anything with data mining, you need to give it a year to see higher-end results just because it takes you that long to gather your own data.

He also says that payers are looking more and more to physicians to decide equipment for patients. This is due to rates being cut. The amount of money providers used to have to afford a respiratory therapist to go out to a patient’s house and assess that patient has evaporated, Heath says.

“We always tried to be a service industry and we never sold ourselves real well as that and because we haven’t, now we are about to be a product industry,” he says. “So the biggest efficiency for your business is making sure you have great relationships with physicians and they are getting you as much information up front so you’re not having to invest in the most expensive thing, which is manpower.”

Also helping oxygen providers become more efficient is Definitive Homecare Solutions’ CPR+ (www.cprplus.com), a software product that offers patient management, inventory, billing and various other services. Users can:

• Assign equipment and capture signatures electronically at the patient’s site.
• Manage workflows.
• Perform point of sale transactions.
• Manage assets and inventory.

“CPR+ allows efficient tracking with all CBAs in Round One, Round Two, and Round One Re-compete with oxygen delivery,” says Tami Maine, HME implementation manager at Definitive Homecare Solutions. “We are prompting the end user when a patient resides in any CBA to prevent any unnecessary deliveries. CPR+ will also take into consideration all competitive bid rounds with associated contractual pricing and the deadlines associated to the rounds.”

When it comes to fine tuning efficiencies for oxygen delivery, Maine points out that CPR+ offers:

• Central location to track SAT levels and testing.
• Timely documentation generation, such as auto generation of CMS 484 forms.
• Enterprise tracking of CMS 484 for timely retrieval of documents.
• Enhanced revenue procurement with efficient document tracking.
• Tracking of 36-month cap of equipment — easy tracking to ensure maintenance billing with access to the maintenance log of the visit.
• Prompts for content billing once the concentrator has capped, which ensures that content billing occurs for patients that have capped the oxygen equipment and content billing may be invoiced.

Maine says that CPR+ has efficient tracking for Medicare PAP patients with a built-in order form to prompt the end user for qualification requirements for PAP therapy, tracking compliance and creating clean claims with appropriate modifiers.

“Custom assessments let providers be patient centric with compliance of all therapies,” she says. “The web portal gives clinicians the ability to evaluate and document the patient’s condition while in the home and updated in CPR+ (real time).”

Efficiency at the Wheel

GPS technology has been a driver for delivery efficiency for a while now, helping oxygen delivery providers to reduce overtime, the number of miles being traveled and idle time, which has been shown to burn a gallon of gasoline an hour in some situations. In short, measuring driver productivity and understanding how you can stretch your capabilities to use your assets to generate additional revenue are key goals for greater oxygen delivery efficiency.

HMEGPS (www.dtegps.com), which specializes in GPS solutions for the medical equipment industry, offers FleetTraks for HME delivery vehicles. The GPS device installs in the vehicle and helps management account for employee time, know where company assets are, better service customers and reduce the number of miles accumulated by tracked vehicles.

“When your drivers are productive and you are using your equipment the way you should, you have more capacity in your vehicles so now you can crank the sales effort up and drive more product through those same vehicles,” says HMEGPS owner Bob Wagner. “We’ve also seen some people downsize the fleet because they just don’t need as many assets moving now that the drivers are more productive and more efficient while in the field. We deliver accountability for employee time. Fleet management is there to make sure employees are making the same decisions that a manager would make if they were out there riding in the vehicle, as well.”

Wagner gives an example of an oxygen delivery driver, considered an excellent employee by management, who would stop at his house each day for lunch. FleetTraks showed that the driver stopped only for 30 minutes (his allotted lunch time); however, it also revealed the driver was traveling an average 22 miles each way to the house to eat lunch and then return to his route. Forty-four miles at about $.70 per mile every day is a significant loss in time and cost.

New functionality of the HMEGPS device now lets you pick an idle threshold. If a vehicle is running but idle for a predetermined amount of time, the system will alert you or the driver via email or text. You can even pinpoint where the idling event is taking place.

Wagner says about 70 percent of his customers are involved in oxygen delivery. And it is common for these customers to reduce their total miles by 10 percent to 12 percent. Airway Oxygen, a HMEGPS customer from Wyoming, claims that after installing FleetTraks, they decreased delivery van miles by 12.5 percent, decreased overtime by 29 percent, and accelerated response times for new oxygen orders.

“Many of our provider customers say that they have a one-month ROI,” Wagner says, “because the devices come activated, you install them and from day one you see accountability and a change in employee behavior.”

Lisa Ziehl is the operations director of Rice Home Medical, a full-line medical equipment and supply company with a focus on respiratory, complex rehab and women’s health. They have five locations, each with a retail presence. They have more than 30 vehicles in their fleet. After initially going live with five vehicles equipped with FleetTraks, Ziehl says they reduced overtime by $187 per driver per month.

“We saw immediate results once we installed,” she said. “Just the awareness that tracking is available and being utilized causes drivers to act differently. We also make use of Fleet Maintenance. This helps track when oil changes and tire rotations are due, as well as when vehicle tabs are due. Gone are the days of late oil changes or missed tire rotations. We get automated emails when they are due. FleetTraks also provides information about idle time, ensuring drivers do not leave their vehicle running unnecessarily.”

Cyndi Brandt is a Product Evangelist at Roadnet Technologies (www.roadnet.com), a company that makes vehicle routing and scheduling software that collects delivery information in real-time with its GPS product, MobileCast. Roadnet customers have reported achieving a reduction in miles driven, improved customer service and increased driver productivity.

“Delivery that is efficient takes good planning,” Brandt says. “Roadnet takes the day’s orders and creates a plan for delivery for tomorrow, which meets the requirements of each order — when someone will be home, a preferred delivery time — all while maximizing the capacity of the vehicle and driving the fewest miles possible. Once vehicles are on the road, MobileCast monitors the vehicles in real-time so customers can be proactively communicated with if there will be a delay. It also has powerful suggest route tools to insert stat, low, or out of oxygen.”

Brandt points out a Roadnet customer’s typical ROI is six to 12 months and customers typically experience a 10 percent to 15 percent reduction in mileage and overtime while getting one to two additional stops per vehicle.

“Oxygen delivery is time sensitive — if you get there too late and a patient may not have a critical supply they need in order to live,” she says. “Roadnet allows routes to be created that adhere very specifically to time windows — big or small. By optimizing relative to time windows, we’ll always make the commitment that was made to the patient while also creating the best routes relative to time and cost.

“Taking that a step further, we then monitor the plan in real-time,” Brandt continues. “If there’s an emergency we can quickly adapt the plan to service a patient, or if there’s a major back up and a critical time window that won’t be met, we can proactively communicate to the patient or reassign a driver to get the product there on time. Signature capture is also an important aspect so that delivery confirmation via signature can be available to both the patient and the HME provider.”

Brandt explains you can’t measure what you don’t manage (or track) and routing has become something that many companies simply cannot live without.

“Simple optimization techniques can save you hundreds if not thousands of dollars a day,” she says. “Adding a realtime tracking component to that allows you to see how your drivers are behaving in the field — are they making unplanned stops? — and put into place bonus programs relative to performance. Not to mention that you can provide a scorecard of how well you performed to the accounts that count on you for deliveries — how many time windows did you meet or miss?”

This article originally appeared in the Respiratory & Sleep Management August 2013 issue of HME Business.