Disease state management

Thursday, October 31, 2002

CANTON, Mass. - Disease state management isn't so widespread as to be a must for HME providers. But until some provider develops a purer brand of oxygen, DSM does offer a competitive advantage, say industry watchers.

In fact, a New York provider says his oxygen business jumped 18% this year after implementing a DSM program last December.

"The best some of my competitors can do is go out and provide referral sources with lavish lunches once a month," said the provider, who requested that his name not be used. "Well, I'm not going to spend $600 on lunch for 10 people.

"We bring Chinese, and also say we've got something for your patients. They like that better."

Canton-based Trusted Life Care, which just developed and began marketing a DSM program for its COPD patients, desires that same advantage and is willing to make the necessary investment to get it.

Under its six-week plan, COPD patients spend six to 10 hours one-on-one with a respiratory therapist.

The program helps educate patients about their disease and how to manage it better. It covers medication, triggers, infection control, family support, relaxation techniques and other issues, said Peter Falkson, senior vice president.

"We eat the cost of the program today," Falkson said. "But if we can help educate them and make them better, then we have created value for everyone along the way, and we know it will come back to reward us."

Unless outcomes improve in the form or reduced hospital and unscheduled doctor visits, insurers aren't going to pay for DSM. Falkson realizes this. But until insurers do start paying, DSM still provides his company with a benefit. When home respiratory patients land in the hospital, HMEs can't bill Medicare until the patient returns home.

So, by helping to keep COPD patients out of the hospital Trusted Life Care improves its bottom line.

"We want to be a quality provider, and we are convinced this is the way to do it," Falkson said. HME