Business Solutions

Oxygen Care: Getting the Whole Picture

Remote patient monitoring has taken hold in respiratory care, and there's a strong business case for oxygen providers to get in on the trend sooner, rather than later. What do they need to know?

• By David Kopf
• Mar 01, 2018

Home oxygen equipment has experienced tremendous technical advancement in recent years, and that innovation has dramatically altered how many respiratory businesses provision their services and work with referral partners. Obviously, we’re talking about portable oxygen solutions which have allowed providers to not only adapt to major reimbursement changes, such as the 36-month rental cap and competitive bidding, but have also helped them to provide more effective care.

Well hang on to your hat, because another trend is about to further revolutionize home oxygen care: remote patient monitoring. Remote patient monitoring is a capability well known and long enjoyed to providers of sleep therapy and diabetes care solutions. In a remote patient monitoring care continuum, the care devices — PAP devices and glucometers, in this case — can monitor patient performance and feed that data back to care management systems that physicians can use to see unique health events and tweak care. Those devices can also connect with personal apps that patients use to better manage their own care.

In an outcomes-oriented reimbursement environment, remote monitoring becomes indispensable because it allows those referral partners to work with HME providers and patients to optimize outcomes. This is not only good for the patient, but ensure that the physician and provider is reimbursed.

To convey the scale and ubiquity of remote patient monitoring in both global and U.S. healthcare, let’s looks at some recent market data: At the outset of 2017, sleep therapy equipment manufacturer ResMed reported that 1 billion nights of sleep data had been downloaded using its AirView remote patient monitoring platform. That’s just one vendor. Factor in all the CPAP makers, and you can quickly get an impression of the scale involved with only the sleep segment of remote monitoring.

Globally, the number of remotely monitored patients grew by 51 percent to 4.9 million during 2015, according to researchers Berg Insight. Looking ahead, Berg reports the number of remotely monitored patients will grow at a compound annual growth rate of 48.9 percent to reach 36.1 million by 2020.

Where HME is concerned, connected medical devices, such as sleep therapy equipment, accounted for a whopping 71 percent of total remote patient monitoring revenues in 2015, according to Berg. And again, that’s just 2015.

Now the trend has come to oxygen with solid investment from the oxygen equipment manufacturers. The first foray into remote POC monitoring came when O2 Concepts worked with Verizon roughly three years ago to introduce the Oxlife Independence with DNA Technology. That first step was a device that was largely founded on the concept of fleet management: providers would remotely monitor POCs to ensure they were being used and that they were functioning properly. But that soon gave way to monitoring usage, and thusly patients.

Since that first stab at remote POC monitoring, we’ve seen other products enter the market. Two recent innovations include Invacare Corp.’s Platinum Mobile Oxygen Concentrator with Connectivity, and CAIRE Inc.’s CAIREview remote monitoring system, which is currently used on its Companion 5 stationary oxygen concentrator, and will soon be integrated into its Eclipse 5 POC.

Here to Stay

“I see this trend as definitely something that has staying power,” says Dan Van Hise, vice president of marketing for the Biomedical Division at Chart Industries Inc. “… There’s a growing desire [among HMEs] to have a connected solution to network their devices back to their headquarters, so they can have some surveillance of the technology that they have, but also to share that with their referral sources.

Even the ability for the clinicians that they may have on staff to be able to remotely monitor a patient that might be having some difficulty.”

In the POC world, remote management has a clear value proposition for the “fleet management” aspect of the technology — tracking devices in the field and ensuring they are functioning properly — but now the care management aspect is gaining equal attention among providers.

“I had a conversation last week with a mid-sized HME, located in Omaha, Nebraska,” Van Hise says. “They were very keen on using the CAIREview product that we have to help to differentiate themselves from other DMEs, and to go back to their referral sources to show those referral sources that their patients, under the provider’s care, are being not just monitored, but potentially have interventions when there’s issues that happen with the equipment, or with the patient in the home.”

Van Hise offers a scenario in which a patient has an oxygen concentrator in his home, and is prescribed to use it for X number of hours a day at X setting. For some reason, the patient is either getting more oxygen than was prescribed, or not getting the correct duration of usage.

“Things like that can set off indicators to the respiratory therapist, or the HME to potentially intervene, reach out, communicate with the patient, and then follow up with the patient if they’re not feeling well and there is something going on to alert the healthcare network as quickly as possible, to try to make a change in their care before the patients ends up showing up in the emergency room,” he explains.

Those sorts of intervention scenarios offer incredible value alone, given that readmissions are a key cost driver in COPD patient care, according to Biola Okunola, global product manager for respiratory and oxygen at Invacare. However, the technology has even further to go in order to deliver its full value to providers, patients and referrals.

“The industry’s not fully there,” she says. “We’ve not yet matured to the level where we say we can show full compliance. You want to show that you are taking steps towards helping the referral source, which is the hospital, reduce potential readmission, reduce and improve outcomes.

“So we’re going to assist with remote patient monitoring, or things that help the providers show that they are partnering with the referral source to help that extension of care; that they are helping the referral source improve outcomes,” Okunola adds.

But even if full compliance management a la sleep therapy’s current remote monitoring capabilities is a few years down the line, respiratory providers are expressing interest in current remote monitoring capabilities, Van Hise says.

“They’re very interested,” he says. “At Medtrade Fall, we had many, many large providers from coast to coast wanting demonstrations of the technology, and now we’re actually doing in-house demonstrations.

Van Hise adds that the interest is driven by the cost-savings aspects of fleet management and being able to further reduce service calls. And there’s more.

“They also have a good story to tell to the referral sources that they can provide an additional benefit of watching over their patients, by making sure that patients are using the technology correctly, and if there’s any challenges with the device or the technology, then they’ll help intervene before the patient shows back up in their hospital,” he adds.

Varied Technological Approaches

There are few approaches to how POCs are reporting data back to providers. In one scenario, the device connects to a public wireless network to report its data back. This is how O2 Concepts provisions its DNA Technology. Small bits of data are send from the device via a Verizon network back to the reporting system so that the HME provider can see the devices in the field.

Another method is to leverage Bluetooth. In this arrangement, the device connects to a user’s smart phone via Bluetooth and information is collected in an app and then sent to the management platform either via WiFi or cellular data. In either case, this is paradigm with which many patients are growing increasingly familiar, given the number of wearable health devices people current connect to their phones using Bluetooth. Both Invacare and CAIRE take this approach for their remote monitoring.

“We tried to make this as easy to use for patients as possible, and people are becoming more and more accustomed to wearable medical devices and using their phone for virtually everything now, so this is just one more extension of things that they’re already doing,” says Nick Jacobs, senior director of respiratory at Invacare. Jacobs adds that it also makes financial sense:

“We understand the compression in reimbursements, and we’re trying to make this as efficient and as cost-effective for the provider as possible,” he says. “It’s one thing to know what solution you’re going to provide, the other thing is how to do it in a cost-effective way, without adding an additional cost to the providers.

“There are options out there where you could charge more, but I’d say with Bluetooth we believe that we are covering a good portion of the market, a relevant portion of the market, without adding an additional cost to the provider,” he adds.

And to the end user, the battery and network resources consumed by such an application, are minimal indeed.

“It runs in the background,” Van Hise explains. “It does not take a lot of power to run the device. The equivalent, in terms of data usage, is like sending a text message. The data packet that is sent is like sending a text message every hour, about the device. It really has no impact on the battery life of the device, and from a data standpoint, it’s very, very low data, because it’s just sending a few parameters every hour, or when there’s an alarm condition on the device. … In terms of data, it’s equivalent to what I’d normally do typically texting throughout the day.”

Solid Growth Foundation

While the real brass ring of remote monitoring is, as Okunola underscored, the ability to manage and prove outcomes for oxygen patients, the here and now “fleet management” reality of remote monitoring technology is very compelling. The ability to track, troubleshoot, and maintain or repair devices in the field (in some scenarios) shouldn’t go ignored. Any way providers can proactively drive costs and increase client satisfaction is something worth monitoring.

“First of all, it tells you the geolocation of the device, using the cell phone’s GPS technology,” Van Hise says. “It will actually report exactly where the device is. And again, from a durable medical equipment company standpoint, that’s very helpful because it’s very accurate. So, for example, if a patient is in a block apartment houses, it can actually identify within the block of apartment houses where the device may actually, physically be located.

That’s a very powerful tool by itself; just knowing where the location is,” he continues. “It sends all the machine usage data, alarm code data, and performance data every hour, or every time there’s an alarm, back to the cloud server that’s monitoring all the data. So, the DME can set up thresholds for the number of alarm violations or error codes that would come up on a device, and then the DME can send a message to a specific driver, technician, or respiratory therapist to advise them that a concentrator located at this address is having frequent error codes in something like, low purity of the oxygen, or high temperature.

“Whatever that condition may be, if the threshold is set correctly by the DME, they can actually see a violation of that, and proactively know if there’s something going on with that concentrator that they need to take a look at and intervene before the concentrator fails, and the patient has to go on their backup oxygen system,” Van Hise says.

“We want to deter as many calls as possible,” Jacobs adds. “We want to pretty much give the provider a crystal ball. We’re offering them a portal — it’s like a dashboard — where they have access or visibility to all their deployed Platinum Mobiles that are connected to the system. … The provider can see oxygen purity, battery charge and discharge cycles, and patient use.

“Patient use, is actually equipment run time,” he highlights. “That’s where you start looking into complying, to some extent. Now that’s a little further out there, as of today, where it’s just saying, ‘This is how many hours this equipment has been used this week.’ … What we’re trying to do is make a tool that allows HME providers and oxygen providers to better manage their business, and is a means of reducing cost and providing better customer service.”

Getting to a landscape where remote monitoring is used to manage outcomes is not far away. The demand is certainly there and other care markets have paved the way. It’s a matter of time at this point.

“We understand what the market is today, and we understand what the potential is and where it is likely going to be going,” Okunola says. “You can see what’s already happening in sleep.

“We know that there’s a lot of potential for this technology, to improve what we’re doing today, but also to expand functionality within the various stakeholders,” she continues. “And you have more than just the provider or payer stakeholders. You have the end users who we are already addressing; you have the DME provider; you have the clinician; you have the payer; you have the long-term care facilities. There are multiple avenues where this could branch out and where there would be a lot of value in the caregiver, so the end-user, the patients, personal care-giver, family, loved ones. There are so many opportunities for this.”

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