Problem Solvers

Getting the Most from a Good Thing

Helping patients to maximize their portable oxygen usage.

• By Joseph Duffy
• Apr 01, 2015

The patient benefits of using portable oxygen, especially improved outcomes and freedom to travel, coupled with HME providers increasingly adopting a portable oxygen model as part of their business model, have helped catapult the popularity of portable oxygen systems.

As an example, according to Medicare HCPCS claims data, the portable oxygen concentrator (POC) code E1392 has been in use since 2007. In 2007 there were an estimated 1,500 patients receiving a POC billed to Medicare and in 2012, approximately 37,400 patients. Payments for POCs in 2007 were about $2 million and almost $23 million in 2012.

But as popular as this technology has become, there is still a learning curve. So to make sure new and even experienced portable oxygen patients are achieving the best quality of life and therapeutic outcomes possible, take a look at the following tips, which aims to help your patients take full advantage of their portable oxygen devices.

Wear your oxygen as prescribed. The improved survival benefit of oxygen therapy is the result of long-term adherence.

“The science and literature have demonstrated that patients who wear their oxygen as ordered over the long haul have the best survival,” says Joseph Lewarski, BS, RRT, FAARC, executive vice president of ExactCare Pharmacy. “This is particularly evident in home oxygen patients who need to wear their oxygen with ambulation. Additional benefits of oxygen during ambulation and activity include increased exercise tolerance, reduced shortness of breath and dyspnea, and improved recovery.”

Know your portable oxygen system. Lewarski said that nearly all modern portable oxygen systems, including small cylinders and portable oxygen concentrators, incorporate a pulse-dose oxygen delivery system. As a method to conserve oxygen, these systems deliver oxygen during inhalation only, which lets the device last much longer when operating remotely. Although many devices are similar in design and concept, there are numerous technical and operational differences that impact performance. The settings on the pulse dose devices are reference points to continuous flow and are based on the specific manufacturer’s oxygen delivery model and assumptions, often in an effort to mimic continuous flow. However, they are not exact matches to the continuous flow. In some patients the device might deliver more oxygen per setting when compared to continuous flow, but in other patients, it can be less. The only way to know is to have your oxygen level monitored during activity, typically by using a pulse oximeter. In addition, since patients are often using portable oxygen away from home, they must know how to operate and troubleshoot their system, as well as how to reach their oxygen provider.

Train and educate the patient. Patients need instruction on how to properly use, clean and care for their portable oxygen equipment. They also need to be educated on why they need oxygen, what the benefits of oxygen and ambulation are and what breathing techniques they can use to help when they encounter challenges, including stairs and hills. The benefits of educating COPD patients on their disease and how to manage it have been documented in a large number of clinical studies. Improved compliance and reduced frequency and duration of hospitalization are just some of the benefits. Also, convince the patient both of the need for activity and of the benefits of using oxygen while outside of the home. Patients need to be informed not just about how oxygen equipment works, but also why it’s important for them to regularly ambulate, or otherwise be active.

Monitor and measure patient satisfaction and outcomes. One of the negatives of portable oxygen is that it can diminish the need to continually interact with patients. As hospitals, physicians and other new care models are monitoring and measured for their performance, key metrics, such as readmission, patient satisfaction and experience, are measured elements of performance and have payment incentives and penalties. Collecting and sharing these data are more important than ever.

Understand your patient’s comfort with technology. For new patients and older patients switching to portable oxygen, operating equipment at home or on the go can be complicated. For example, ask your POC patients if they have a cell phone or similar personal device. That will give you an indication of how adept they are at managing battery life on a piece of technology. Patients who are more technically inclined often adapt better.

Understand your patient’s comfort with wearing oxygen. Like the fear of technology, patients might feel uncomfortable about wearing oxygen in public. In fact, some patients isolate themselves in their homes because of what they feel other people might think of them wearing and carrying oxygen. Even worse, some patients take the chance and go outside, leaving their device at home. Make sure patients understand that their portable oxygen gives them the opportunity to be more active and enjoy life more. Listen for things they might say that suggest they aren’t at ease with going out in public.

Teach patients to troubleshoot the portable oxygen device. Patients need to understand how their portable oxygen system should normally operate and what to do in the event that it is not working properly. They also need to be aware of what actions they should take if they feel shortness of breath, even when the system is working properly. They need to know when they should contact their HME provider and when they should contact their physician.

Educate patients about traveling with portable oxygen. Although this is one of the most popular reasons patients use portable oxygen, it’s still intimidating for first-timers to fly or travel long distances while toting portable oxygen. Consult with your patients about travel and create checklists that help them understand the process. For example, before flying, patients should make sure their device is allowed on a plane; that they consider a direct flight instead of connections; and that they understand their device’s battery life.

This article originally appeared in the April 2015 issue of HME Business.