June 28, 2022 | By Zach Gantt, RRT, FAARC, CEO, Encore Healthcare
Patient outcomes are rapidly emerging as a powerful growth strategy. In fact, with large referrals and payers, they’re becoming a requirement. Collecting patient-focused measures and transforming that data into clinical metrics is the key to success in the respiratory DME model going forward. Elite DMEs combine compliance information with Nexus Clinical Respiratory Software to go “beyond the box” and become high-value strategic partners with their referral base.
Healthcare delivery in the U.S. is evolving with emerging managed care chronic disease initiatives, accountable care organizations, and other value-driven care models. Hospitals want to act like a complete system to maintain every penny of the healthcare dollar spent. Physician groups can drive quality and revenue with aligned home providers. And payers are struggling to understand how to effectively manage patients in the home, especially the 12% that drive 60% of the spending.
The intersection of these trends for chronic respiratory disease patients is in the home. Implementing Nexus Clinical Respiratory software and Encore TeleRespiratory Services transitions the DME from being known as the equipment supplier to a full home-based pulmonary service partner. Nexus creates unique opportunities for the provider to succeed in outcomes-based models by keeping patients out of the hospital, tracking symptoms and physician interventions, and demonstrating improvement in key metrics. The question comes down to: How do you “own the home” and execute before your competition beats you to the strategy?
Nexus Clinical Respiratory Management Software
Respiratory management software is the new model the industry is moving toward. The key to a successful transition to these models is adding sophisticated clinical metrics on top of excellent compliance results. These clinical metrics measure goal performance, objective data, and—sometimes most importantly—subjective data like self-management skills or symptom management.
These goals and metrics need to be translated into patient language and need to communicate progress in an overall plan of care. For respiratory therapists, asking “how do you feel” questions at the point of care isn't enough. They must collect scaled answers via software to standardize them and to understand the changes from initial visits to ongoing visits. Software also enables patient answers to be tied to actions and instructions and to prompt physician interventions. Additionally, a database can be used to analyze results and identify hidden relationships that drive better outcomes.
Oxygen TeleRespiratory Program
DME providers have an existing population of oxygen and nebulizer patients who will eventually need advanced therapies like noninvasive ventilation (NIV) and airway clearance devices. Due to reimbursement cuts over the years, these oxygen and nebulizer patients are just provided with equipment and never clinically managed.
Encore’s TeleRespiratory Services combine the support of a respiratory navigator-staffed call center that assesses patients with the integration of sophisticated Nexus outcome algorithms to manage the disease progression. The data algorithms from these brief and continual clinical calls measure patient engagement, identify gaps in care for physician follow-up, and detect increased clinical impairments that lead to advanced therapies such as NIV and high frequency chest wall oscillation (HFCWO).
The patient experience includes training instructions and educational videos, and suggests appropriate physician interventions. Advanced therapy identification is based upon:
Current or prior lab testing
Ongoing dyspnea and other symptoms
Continual respiratory infections
Airway clearance issues
These key criteria support a higher level of outcomes that are documented, trended, and compiled into objective physician reports.
DMEs now have cost-effective and standardized means to identify risk, manage symptoms in partnership with their physicians, and document the progression to advanced therapies. Data shows that up to 20% of COPD patients will become hypercapnic and need some form of ventilation and up to 30% of stage 3 or 4 COPD patients have undiagnosed bronchiectasis needing airway clearance devices like HFCWO.
Traditional expectations of DME services are focused on therapy compliance and basic equipment education—that's the starting point. Value-based models demand a provider move from product-centered care to patient-centered care.
This article was originally featured in the VGM Playbook: Growing Your Business With Data and Technology. To read more articles like this, download your copy of the playbook today!