At Sunset we always strive to go above and beyond to meet our customers’ needs. We set out to improve the new Deluxe Masks to include additional features to add comfort at a price that will make your next competitive bid a little easier. Look around at the new masks’ features and give us a call if you want to see one for yourself.
We’ve been long-time fans of the SleepWeaver masks here at Sunset Healthcare Solutions. In fact, the Advance is one of our top-selling CPAP masks and the newer Élan is not far behind. If you haven’t tried them yet, here’s a list of our Top 10 reasons to consider them.
Here at Sunset we pride ourselves on bringing quality CPAP and respiratory products to market. We follow rigid quality standards to ensure each of our products will meet the needs of our customers. The following article explains how we select the products that we add to our line and gives details on one of our most important quality assurance processes, the First Article Inspection.
When Sunset is looking to bring on a new product from a new or existing supplier, they must first be approved by Quality. The approval process for a new supplier consists of three main steps:
Once the supplier approval process is complete, and we are ready to place an order, the Purchasing department will alert the Quality team to inspect the product once it arrives. At this time we perform what is called a First Article Inspection. First Articles are intended to confirm the physical configuration of a device and its components to ensure the specifications meet those agreed upon by Sunset and the supplier.
During each First Article Inspection, we compare the product we receive to the Device Master Record (DMR) to ensure they match our quality standards. The DMR consists of detailed drawings, dimensions, material specifications and any other details about the product and packaging that we have determined and passed along to the supplier prior to bringing on the product. We thoroughly compare every component to ensure the product has met our predetermined specifications. In some instances, we also perform additional tests to verify product performance.
The details of the inspection are recorded on a First Article Inspection Form. If anything needs to change, we send the product back to the supplier and repeat the process over again. Once everything looks ok, we fill out another form called an Engineering Change Order which we use to formally release the product into inventory.
By performing First Articles we are ensuring our products are held to the standards we have in place and those that are set by regulated bodies. These product inspections are one of the many ways we ensure we are continuously bringing the highest quality CPAP and respiratory products to market. First Article Inspections ultimately provide peace of mind for both Sunset and our valued customers.
Round 2 reimbursement amounts from Medicare were recently announced. This new competitive bidding legislation means there will be a lot of change in our industry in the next couple of years, especially for smaller stores who may not have the scale to remain competitive due to these new Medicare cuts. Many HME registered for this process as of March of 2012 and are probably anxiously awaiting their fate.
This new legislation does not affect reimbursement amounts for private insurance; it only affects Medicare reimbursements at this time. There are pros and cons to accepting a round 2 contract. As Elizabeth Deprey of HME News blogged earlier this week, some HMEs were relieved to be out of a Medicare contract. The high administrative costs of billing Medicare and time consuming government audits are draining and in the end, just not worth it for many smaller companies. The National Association of Independent Medical Equipment Suppliers (NAIMES) has put together an anonymous survey to gauge the end result of round 2 contracts.
The whole logic behind this legislation change is to protect consumer rights; ensuring companies are delivering the highest quality products to their patients at the lowest possible cost. The bill is also a means for cutting the allocation of Medicare spending on these products by dramatically decreasing reimbursement rates. To give you a little more insight to specifics on how this might affect you, check out the new HCPCS Reimbursement by State. We also put together the chart below so you could better see an example of how HCPCS rates have changed across CPAP supplies specifically.
| Product | Reimbursement 2012* |
Reimbursement 2013** |
Difference | Difference % |
| CPAP Tube | 36.00 | 15.30 | 20.70 | 58% |
| Replacement Full Face Cushion | 65.00 | 20.40 | 44.60 | 69% |
| Full Face CPAP Mask | 170.55 | 99.00 | 71.55 | 42% |
| Nasal CPAP Mask | 106.35 | 59.00 | 47.35 | 44% |
| Replacement Foam Filters | 11.78 | 6.81 | 4.97 | 42% |
| Replacement Filters | 4.88 | 2.38 | 2.50 | 51% |
| Headgear | 32.00 | 20.40 | 11.60 | 36% |
| Chinstrap | 14.50 | 11.01 | 3.49 | 24% |
*reimbursement average 2012
**reimbursement Ohio 2013
As you can see, the average 45% decrease in reimbursement rates was no media exaggeration. Some products are affected more than others, for example, replacement cushions’ reimbursement rate decreased 69% while chinstrap reimbursement rates decreased by only 24%, with additional variances by state and region.
So what is Sunset doing to help our customers during these times of reimbursement cuts? We recently came out with a new deluxe line of CPAP masks that include a replaceable cushion and cost about 40-50% less than similar masks from leading manufacturers. We’ll continue to provide the lowest prices to our customers, whenever possible. We’re also looking to add more cash and retail items to our line in the next year so our customers can battle Medicare cuts with a boost to their cash sales.
In addition, we are backing a favorable alternative for home care providers, the Medicare DMEPOS Market Pricing Program. This act will still reduce Medicare spending but would better accommodate smaller providers and preserve their ability to compete. John Gallagher and the team with VGM government relations are making a stand for a new Market Pricing Program (MPP), if you’re interested in advocating this, check out VGM DC Link or AAHOMECARE. Many people in the HME industry are going to be talking about this at MedTrade Spring 2013. So if you’re headed out there, keep an eye out for MPP news and updates. What do you think about the Medicare cuts and MPP? We would love to hear your feedback in the comment section below.
For your patients with chronic obstructive pulmonary disease (COPD), where long-term oxygen therapy is required, a nasal cannula is used to administer oxygen flow. These devices are simple to use and install but not all are created equal.
Following are some helpful tips for selecting the best nasal cannula for each individual patient in order to achieve maximum results.
No matter which type of cannula you choose, the most important thing is that it works. Make sure the oxygen flow is uninterrupted by selecting a kink-resistant tube. Some are reinforced with multiple internal channels (3-channel, 5-channel or 6-channel tubing) to make the whole tube sturdier. Others are referred to as “smooth bore,” meaning the inside is smooth. In some cases, smooth bore tubes are sufficient if the tube is narrow and the walls are thicker; however, when the tubes are wider, as with a high-flow cannula, multiple channels are recommended for extra support.
The second important factor is patient comfort. To achieve a comfortable fit, the tube should feel soft against the skin and be memory-free. To test this, request samples from your manufacturer and lay them out on a flat surface. If the tube lays flat instead of coiling back up, it is memory-free, which will increase comfort for the patient by securely fitting against his or her face and reducing friction against the skin.
With Medicare’s cuts on oxygen reimbursement, it can be tempting to purchase your cannulas based on price. However, if your patients are not satisfied with the equipment you provide, you will incur the extra cost of either shipping them a new cannula or sending a technician to check on them. Even if you successfully replace faulty equipment, your reputation for providing quality products may suffer, making it well worth the effort to do some additional up-front research.
A qualified distributor will have a rigid set of quality control tests that their products must pass before they can sell them to you, so you can be confident that you will receive a reliable product the first time, every time. Ask your current manufacturer what quality control measures they have in place and if you are not satisfied with the results, look elsewhere.
Most cannulas come in three basic sizes: adult, pediatric or infant, which can work for the majority of patients.
The shape of the nasal prong can also vary from curved to straight and tapered to flare. This is based on patient preference and nose shape. Most patients prefer a curved shape as it matches the natural curvature of the nasal canal. When placing a cannula with a curved nasal prong on a patient, the curve should face downward. The prongs can also be trimmed slightly for added comfort.
A standard cannula can effectively deliver between 1-6 liters/minute of oxygen. Where higher rates are required (6–15 liters/minute), a high flow cannula is a good way to provide adequate saturation without using a mask. High flow cannulas have a larger bore (wider tube opening compared to standard tubing) to allow for effective delivery of oxygen flows up to 15 LPM.
For most oxygen devices, a standard tube — sometimes called “single-lumen” — is used. With regard to oxygen tubing, the description single-lumen means there is one tube carrying the oxygen from the concentrator to the patient. For dual-port oxygen-conserving devices that only deliver oxygen when the patient inhales, a demand cannula should be used. A demand cannula has a split dual-lumen tube with two airways, one that delivers the oxygen and another that senses the breathing pattern of the patient to tell the device when to expel air.
Another factor to check on the device is the maximum tube length that the concentrator allows. Normally, length of oxygen tubing is determined by patient use and preference; however, some concentrators have limits for how long the tube can be before the pressure level will be affected. This information can typically be found in the device instruction guide.
The final thing to note when checking the device is the connection port. Most major manufacturers, including SeQual, Respironics, Invacare and Covidien Nellcor Puritan Bennett, use standard connectors. For non-standard or specialty connections, some manufacturers offer Fits-All connectors that are wider and can be adjusted to fit or separate adaptors that allow a standard tube to be used with a specialty connection.
There is a lot of debate about how often to change a nasal cannula. We recommend homecare companies change their patients’ cannulas once per week to avoid infection and other complications. In addition, the cannula should be changed after the patient has been sick to avoid contact with the bacteria and mucus.
With Medicare’s recent changes in reimbursement, homecare companies have a limit to the amount they receive for oxygen patients. As a result, some manufacturers have established programs to make regular replacement easier and more affordable for their HME/DME customers.
Sunset Healthcare Solutions offers the ability to kit cannulas so DMEs can purchase a 3-month supply for each patient packed in one easy-to-use kit. All of the kits are customizable, so the DME can pick the quantities they are comfortable sending, and Sunset will assemble them at no additional charge.
With this unique approach, the DME can teach their patients how to replace their own cannulas and ship all the supplies they will need at once to save on shipping costs. Some fulfillment companies like our partners PPM, VGM and Jaysec offer drop shipping, so DMEs can have their supplies shipped directly to their patients without having to house inventory.
For patients who use supplemental oxygen, portable cylinders can be a great way to allow them freedom to move around as they please. Here we’ll review the types of oxygen cylinders, how to determine the best size and key accessories.
Two sets of names are used to differentiate between oxygen cylinder sizes. The original set uses an alphabetical system, starting with A for the smallest size and E for the largest portable size. The new naming system begins with the letter “M,” for “medical,” followed by a number that signifies the amount of cubic feet of oxygen in that can be compressed into the cylinder. So the original B cylinder is now often referred to as an M-6 cylinder because it can hold 6 cubic feet of oxygen. Below, see the handy chart that matches oxygen cylinder sizes with their dimensions, capacity and accessories.
The optimal size will depend on a client’s lifestyle and prescribed flow rate. The most common size is the M6. However, if the client is confined to a wheelchair, a larger E cylinder with a wheelchair bag may be more appropriate. Or, if he or she only leaves the house for short periods of time and weight is an issue, a smaller M4 cylinder may be better.
To determine how long an oxygen cylinder will last, there are several factors to consider: The patient’s prescribed flow rate in L/minute; the tank capacity in liters and whether they are using a regulator or a conserver. A regulator will provide continuous flow at a given flow rate. A conserver will sense when the patient is breathing and only expel oxygen when the patient is breathing in. Most conservers allow the tanks to last three to five times longer, but can be up to 10 times as expensive as regulators and are not reimbursed by insurance companies so they are not always worth the extra cost.
All patients should be supplied with a cylinder wrench and a “No Smoking” sign (it is recommended that patients hang a sign on all entrances to the building as well as in the room where the oxygen is being delivered).
For portable tanks, a carrier bag or cart is recommended. The most common bags range in sizes from M6, which can hold M6, M4 and M2 cylinders, up to E bags, which can be attached to a wheelchair or scooter. M6 bags often have straps to keep smaller cylinders in place. This can help reduce bag inventory by not having to stock separate bags for patients with small tanks. Many different styles are available with the most common being shoulder bags, backpacks and wheelchair bags. Bag type can be based on the patient’s preference; however, it is recommended that all bags are made of nonflammable materials.
The final accessory needed is a regulator or conserver. When selecting one, keep in mind that there are two main types of valves on oxygen cylinders. CGA 870 styles are used on tanks that are size E and smaller. CGA 540 style valves are used on larger, nonportable tanks. So you will want to select the type of regulator or conserver that matches the valve on your patient’s cylinder.
Controlling costs on supplies isn’t a new concept for most oxygen home care providers. Unlike the CPAP market where suppliers are reimbursed for each product provided to patients, oxygen suppliers are reimbursed a flat rate for each patient, no matter how many supplies they provide. But with the Affordable Care Act and competitive bidding, suppliers need to push those cost savings even further.
When everyone is getting reimbursed the same amount, you don’t want to be the one paying more for your supplies. The biggest tip I can give you is to shop around. If your company has been purchasing supplies from the same manufacturer for years, this might be a great time to shop for new suppliers.
Off-brand companies frequently carry the same quality supplies or even the exact same products for a lower cost, but they don’t have the name recognition. Let’s say you purchase your oxygen concentrators from Acme Manufacturing. That concentrator comes with a foam filter that needs to be replaced regularly. Acme probably does not manufacture that filter; they likely purchase it from a supply company that makes various products such as foam pillows and mattresses in addition to filters. That foam supply company probably sells the same filter to multiple manufacturers and distributors, so in many cases you can get the exact same filter from a different company for a lower price.
Additionally, there are companies that focus mainly on replacement parts for all of the different manufacturers, sort of like the “AutoZone” of the oxygen industry. You can buy an air filter for your Ford Explorer directly from Ford, or you can go to AutoZone and get one for your Explorer and your Audi in the same place for a lower price.
Original Equipment Manufacturers (OEMs) like our fictional Acme Manufacturing or real companies such as Ford make most of their money on the original device like the car or the oxygen concentrator, not the filters, so they don’t focus on offering the best value for replacement parts like some other distributors and manufacturers do.
The first step to finding better prices is to research supplier options. Industry tradeshows and publications like HomeCare and HME News are great resources to find other manufacturers and distributors who might offer the same products you are currently purchasing at a lower price. They may not be a name you recognize, but they might carry parts for many of the brands that are familiar to you or that you already carry like Invacare, Philips Respironics or DeVilbiss.
Reach out to a few of those companies and ask them what they would be willing to do to earn your business. Let them know that you are interested in potentially switching suppliers and you would like to have some samples of their products shipped to your office for testing purposes. Manufacturers are often willing to provide free samples so they can prove the quality of their products to you. Distribute samples to your patients and see how they compare to the products from your current supplier.
Additionally, check with those suppliers to see if they have any price breaks with higher quantities, sales promotions or free services they can provide to sweeten the deal. Many suppliers are able to provide services such as private labeling, kitting and free or discounted shipping, as well as product guarantees or discounts for new customers, but you won’t know until you ask. The suppliers that are willing to work hard to earn your business are probably the same ones that will offer extra service and perks to keep you happy in the future. In the end, you might decide to stay with your current supplier, but at least you have done your due diligence and know you are getting the best prices you can.
Pulse oximetry is a non-invasive method for monitoring the oxygen saturation levels (SpO2) in your patients’ blood. SpO2 is the percentage of oxygen that blood carries compared to the maximum it is capable of carrying. A normal rate is 94-99% in adults. Patients with COPD or other lung diseases generally have blood oxygen levels of 92% or lower, causing them to require supplemental oxygen treatment.
In general, pulse oximeters are used to provide insight into the functioning of the patient’s respiratory system. It can be used anytime these levels need to be tested or diagnosed.
In the senior care and homecare setting, a portable pulse oximeter like the one shown above is most commonly used to treat or diagnose patients with respiratory diseases that cause low levels of oxygen in their blood when they breathe air. A pulse oximeter is an easy, non-invasive way to measure oxygen levels at any time so supplemental oxygen amounts can be adjusted as needed throughout the day.
In addition, different types of pulse oximeters are also commonly used in the hospital setting, often during surgery with anesthesia or in the recovery room. They are also used in sleep labs as a part of sleep apnea diagnosis. In a non-medical setting, pilots and athletes commonly require spot checks at high altitudes or during rigorous training.
Generally, pulse oximeters work by shining two different kinds of light (red and infrared) through a thin part of a patient’s body, usually a fingertip or earlobe. Blood absorbs light differently depending on the level of oxygen it contains: oxygenated blood absorbs more infrared light than red light. So by comparing the changes in amounts of red and infrared light received, the instrument can calculate the SpO2 reading.
As a side benefit, you can also check your pulse, as the increase in the amount of blood with each heartbeat also affects the light.
It depends on the device and how it’s being used. According to the FDA, if an oximeter is accurate enough to diagnose or treat a disease, a prescription is generally required. If not, a prescription may not be needed. For example, if an athlete or rockclimber wanted to monitor their pulse and oxygen levels, they could purchase an OTC model that is not intended for diagnosis and would not require a prescription. To be sure, ask the manufacturer where you purchased the device.
There are three common types that fit a variety of needs. The most common is the portable fingertip pulse oximeter, which is often used at home. It is relatively inexpensive, lightweight and easy to use. However, it doesn’t always provide an accurate reading for those with circulatory problems. Also, it is designed for spot checks, instead of continuous monitoring so there are also several other options available.
The handheld pulse oximeter is most commonly used in hospitals and has a clip and wire attached to a handheld monitor. It can be clipped to a finger, earlobe or toe in an emergency situation and can be used for spot checks or continuous monitoring. The monitor can record the patient’s information for several hours at a time. Many models also come with a built-in alarm that sounds if the patient’s SpO2 or pulse rate goes outside a designated range. Some also include the ability to connect directly to a printer to prevent documentation errors.
The final type is a wrist pulse oximeter that has a small fingertip sensor that is attached to a wristwatch style recording system that continuously monitors the blood oxygen saturation level and pulse rate. It is ideal for monitoring daily activities or for an overnight sleep study because it allows the freedom to perform daily tasks and has a memory that can last for several days at a time.
Excerpt featuring Sunset Healthcare from an article in HomeCare Magazine by Larry Anderson.
Fully servicing existing patients enables providers to maximize profitability in PAP products, said Ashley Wood, director of operations at Sunset Healthcare Solutions. Replacing masks, tubes, cushions, chinstraps, humidifier chambers and filters as often as the patient’s insurance will allow can maximize HME reimbursements and profits. Wood noted that the reimbursement for supplies can add up to more per year than the device rental fees for a new CPAP setup.
Sunset Healthcare Solutions specializes in replaceable PAP accessories, including their own line of tubes, filters and masks as well as masks, cushions and humidifier chambers from major manufacturers.
“We also carry many hard-to-find filters or replacement parts for machines and masks that are previous-generation and might be discontinued by the original manufacturer,” Wood said.
Sunset Healthcare Solutions offers a customizable Resupply Kit that includes an entire three- or six-month supply of CPAP tubes, disposable and nondisposable filters and even a mask, cushions, chinstrap or humidifier chamber in a single easy-to-handle kit.
Wood suggested the addition of retail products such as CPAP mask wipes or accessory cleaners that provide continuous revenue in addition to reimbursements. “By adding retail products to their line, HME providers have a diverse product set to fall back on as reimbursements are being cut,” Wood said.
