Saturday, January 31, 2009

Q. To save on costs, we’d like to ask patients to pick up their own cylinders and limit the number of cylinders we give them. Is that allowed?

A. Every respiratory provider knows that in order to survive 2009 and beyond they must seek opportunities to reduce operational costs. It is not uncommon to hear stories of providers delivering 40 to 50 cylinders per month. With the cost of contents at $2 to $4 per cylinder plus the cost of delivery, it is not complicated to see that current reimbursement is inadequate.

In years past, it has been the provider who has taken the brunt of that burden. While it may be unpleasant, we have to realize it is time for patients to share some of that burden. It is only with their involvement that we have any hope for change to the current unacceptable reimbursement policies. Unfortunately, however, you can’t look to patients to pick up their own cylinders as a solution. CMS has stated clearly that this is in violation of the supplier standards. Anytime there is proof of a supplier standard violation, your provider number/status is at risk.

Instead, to gain efficiencies in this area, make sure you have efficient routing set up for deliveries.  Let patients know when you’ll be picking up cylinders. If they call in, gently remind them of the schedule.

You can get creative. If patients are ambulatory, you can encourage - but not require - them to pick up their own cylinders. Make it an event. Consider setting a scheduled time, gathering a couple of small tables and chairs, and bringing in coffee.  Watch them gather. These patients will enjoy the opportunity to network with others facing similar challenges.

As for limiting the number of cylinders you provide: CMS prohibits such a move by taking the position that, while some patients may be heavy users, there are others who are not, and it all comes out equal in the end.

Kelly Riley is director of The MED Group’s National Respiratory Network. Reach her at