2016 Respiratory Market Outlook

Oxygen Care's Next Steps

Although in its infancy, oxygen data collection shows promise for better patient outcomes and referral partner building.

• By Joseph Duffy
• Mar 01, 2016

The diabetic and sleep segments of HME and the health industry in general have demonstrated the benefits of tracking patient performance, which have included improved outcomes and stronger relationships with referral partners. With HMEs trying to better patient outcomes while strengthening its revenue strategies, focus has turned to the oxygen industry and whether data can become a business differentiator for HME oxygen providers.

Remotely monitoring oxygen patients and sharing and leveraging that data across the care continuum could have many benefits, including the potential to improve clinical outcomes and engagement for patients, and increase referrals and business efficiencies for HMEs, according to Will Ross, senior manager of product management for respiratory care at oxygen and sleep equipment manufacturer ResMed.

“Patient-monitoring technologies in sleep, for example, assist HMEs in monitoring and coaching patients by analyzing therapy data and identifying which patients require action, allowing the HME to better their bottom line by managing more patients without adding staff, while increasing therapy adherence for better clinical results.” he explains. “ResMed’s U-Sleep patient monitoring platform does this, and was found to reduce the amount of labor associated with intervening and coaching CPAP patients by 59 percent. We believe the same efficiency gains could be seen with a similar strategy in oxygen.”

(Ross bases his response on “A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacy when compared to standard of care,” by Dominic Munafo, William Hevener, Maureen Crocker, Leslee Willes, Sarah Sridasome, Ma’an Mushin, which was published in Sleep Breath; DOI 10.1007/s11325-015-1298-4.)

Arguably, just about every industry in business benefits from some level of data collection. But while only in its infancy, oxygen data collection is not without challenges.

When asked if data collection could further enhance oxygen providers’ business, Joe Lewarski, global vice president of respiratory & sleep for Drive-DeVilbiss Healthcare, says “The short answer is ‘yes,’ although like in much of homecare, there are limited objective and published data supporting this obvious logic in COPD and long-term oxygen therapy. As you examine the evidence in other chronic diseases and therapies, the ability to impact therapy adherence and improved outcomes is a relatively complex, multivariate process that starts with effective patient education and training and includes supportive tools, such as adherence data, patient feedback and coaching tools, and, most importantly, patient acceptance and buy-in.”

With that said, there are a number of providers with COPD disease management and intervention programs. Lewarski said there are a variety of measures that providers are capturing, which may include:

• Validating effective oxygenation through titration of oxygen at rest and with activities of daily living (ADL).
• Medication assessments and reconciliations.
• Helping to insure patients understand their prescriptions and have their prescriptions filled.
• Basic nutrition assessments/assurance patients have food, water, etc.
• Providing patients with an action plan for change in their condition or exacerbations.
• Helping to insure patients are aware of any medical appointments.

Lewarski says oxygen has have a way to go to expand the benefits, citing that abroughlyout 50 percent of patients readmitted in 30 days failed to keep their outpatient follow-up appointment.

Ross says he recognizes that oxygen data collection is in a very early stage in terms of using that data meaningfully by providing HMEs and other players with actionable insights.

“We see a big opportunity in oxygen for ResMed to apply its expertise in connected care devices for remote patient monitoring, but we’re remaining disciplined,” he says. “We have a deep understanding of HME workflows, but have not had experience in the oxygen business, which is why we recently announced our intent to acquire Inova Labs, a leader in the rapidly growing ultra-portable oxygen concentration space [At press time, ResMed had completed that purchase; see “News, Trends & Analysis” starting on page 8]. The expertise of the Inova management team will be very valuable as we work together to develop solutions that will best support our HME partners. It’s not about being the first one, but about the one who does it right.”

A lot of oxygen data isn’t being collected today because of the commoditization of home oxygen therapy, driven by competitive bidding and the other many legislative and regulatory actions that have drastically decreased oxygen reimbursement, Lewarski notes.

“The value-added but often unrecognized and non-reimbursed clinical services that so many providers offered for years has been squeezed out, as many providers cannot afford to provide these needed and valuable clinical services,” he explains. “This is rooted deeper in the fact that home respiratory care is not a recognized professional service under the Medicare statute. As a result, we don’t exist in the home environment in the eyes of Medicare and many other payers.”

With oxygen devices early in their development of data collection capabilities, Ross said that objective evidence of patients’ adherence to therapy is not a frequent reimbursement requirement for oxygen as it currently is for sleep apnea devices. Datareporting technologies are typically used to provide objective evidence of patients’ behaviors and may give insights to more than just therapy adherence. Also, oxygen can be delivered via multiple different systems and not all of them currently have connectivity capabilities.

First Forays into Oxygen Data

Rob Kent, CEO of oxygen equipment maker 02 Concepts says there is no field of work where real-time feedback does not improve outcomes.

“We live in a world where data drives every industry into new heights of efficiency and performance,” he argues, “The early adopters of data strategies will have an advantage.”

02 put its money on that dynamic in August 2015, when it integrated a POC onto a cellular network.

“Our Oxlife Independence is a Dual Mode POC, with a proven track record as a 24/7 non-delivery device – no stationary needed,” he says. “Having that data is a real difference maker in the first 30 days when new patients are on oxygen. With our Dynamic Network Analysis [DNA] platform, our POC can be set up to alert a provider with an email or text when it isn’t used in the first 30 days. This allows our providers to market monitoring and intervention to reduce the risk of a readmit. This is a powerful story for hospital-based referral sources who will experience stiff penalties this year on readmissions.”

(Read more about the Oxlife Independence with Dynamic Network Analysis at bit.ly/oxlifedna.)

O2 Concepts’ DNA platform lets providers log-in to see how often a patient uses oxygen and how often they ambulate on oxygen when using the device as a single-solution, according to Kent. The more traditional modalities using tanks and filling machines can never offer that, he said, and not in the first 30 days when the feedback is most critical to the referral source. The device can measure breath rate but no other biometric data at this time.

“For a provider, effectively managing data can reduce your total costs and provide better outcomes. Period,” he says. “There are always near-term downsides to any change, but they pale in comparison to the long-term consequences of being behind the curve. The shift to integrated data is coming to all industries. Those who get out in front early stand the best chance to benefit.”

What Needs to be Collected

The most important and fundamental information we can collect is on basic usage, Ross says. Measuring compliance is key to impacting outcomes and improving business efficiencies. Patients not adhering to their prescribed therapy can play a role in hospital readmissions, for example.

“In sleep, a two-arm study found that its untreated sleep apnea group averaged 32 percent more hospital readmissions than the treated group, and that sleep apnea patients on PAP therapy (standard treatment) had more than 30 percent less medical costs than those not on therapy,” Ross says, citing and article by Potts KJ et al in Population Health Management 2012. “Using sleep as a case study for other chronic conditions, we’ve seen that monitoring and coaching patients for therapy adherence alone could make a huge impact. Understanding how patients interact with their devices, such as how often they use them and for what amount of time, is the first step in getting there.”

Unfortunately, not all providers perform clinical assessments and titrate patients to their particular oxygen system at rest and with ADLs, Lewarski says. This is probably more important now than ever, as oxygen-conserving devices are widely used and incorporated into nearly every ambulatory oxygen system, from basic cylinders to POCs.

“It has been well documented in the clinical literature, as well as through anecdotal data that these devices deliver oxygen differently and that all oxygen-conserving devices are not ideal for all patients,” he explains. “It is important to match the patient to the device to insure appropriate oxygenation, as that is the purpose of home oxygen therapy. Remember, longterm oxygen therapy is the only clinical intervention proven to improve life expectancy in patients with chronic lung disease and hypoxemia.”

Pulse Oximetry and Spirometers

As oxygen data collection begins to evolve, will widely used existing measurement devices such as pulse oximeters, which monitor the amount of oxygen carried in the body, and spirometers, used to measure the air capacity of the lungs, take on a bigger role in patient data collection?

“Everyone is eager to throw more data into the cloud, but it’s important to think through the reasoning and to first identify the key pieces of information that would be most actionable and impactful,” Ross says. “It comes down to discipline and taking the time to consider clinical evidence, workflows, and insights from key opinion leaders and business partners to determine the best strategy in data collection.”

But Ross adds that data can be collected on a wider basis than is being collected now and believes there is immense opportunity, with the key being taking the time to pinpoint which pieces of information, in what combination, will have the most impact.

“I believe diagnostic tools such as oximetry and spirometry can play an important role in the home-based management of patients with chronic lung disease,” Lewarski says. “Since these data are often single points in time, it is important these be collected as part of an overall care plan, so these data can be trended and compared as part of the long term management of the patient.”

The Future of Oxygen Data Collection

For more oxygen data to be collected, companies must invest in technology development, which includes everything from the device to the desktop, Ross says. And then after data collection, how it is applied for the most impactful, meaningful outcomes.

“Technologies that use data collection to automate the process of patient coaching and exception management can increase HMEs’ efficiencies by reducing the amount of work needed to coach patients, while potentially improving adherence to therapy through more timely and effective management,” Ross explains. “And if patients are granted access to that data, they have the opportunity to become more engaged and stay on therapy. In fact, a retrospective study of usage data from ResMed’s myAir patient engagement platform in sleep recently found a positive connection between use of the platform and high adherence to CPAP therapy.”

The downside to collecting more data is the potential for a mountain of data without insights on what to actually do with it, he notes. Identifying how to make collected data actionable will be key as the industry moves toward increased connectivity.

Also, to share data we need interconnected systems through which the data can flow so it can reach key stakeholders in a patient’s care journey, according to Ross This requires integration with other health record platforms, billing and management systems. If those systems aren’t already in place, or are not connected, it’s not an easy task to create them from scratch to fit every player’s needs.

In addition, “data enabling” the devices themselves is not a trivial task. Significant investments need to be made in on-board device communications technology (software and hardware) and a robust communications infrastructure to support the reliable transfer of data.

“In the perfect world, there would be recognition and appropriate payment for home respiratory services, including incorporating clinical education, diagnostics and clinical interventions as part of the benefit – above and beyond the reimbursement for the oxygen equipment,” Lewarski says. “New payment models, such a bundling and accountable care organizations, may offer some opportunity here, especially if they become full risk-based arrangements. Then maybe, health systems and payers will use the best tool for the job.”

And as with any new process, there will be some discovery.

“The upside is simple, and incorporates many of things previously discussed,” Lewarski says. “These include improved clinical care and outcomes, improved patient experience and, of course, a lower total cost of care. The downside, as with all research, you may not like the answers to the questions the data reveals. However, that is a bridge to cross when we get there.”

For those oxygen providers looking to take data collection to the next level, he says it starts with deciding on what type of program you wish to provide and what are the goals and measures.

“Collecting data for the sake of data is not a clinical program,” Lewarski explains. “These data must be part of a holistic clinical approach to the care and management of the home oxygen user. Getting with referrals to identify their pain points and needs and collaborating on the development of a meaningful program with intent to measure and validate the results is a good place to start.”

This article originally appeared in the March 2016 issue of HME Business.