In the durable medical equipment industry—as well as in life—it always pays to have a backup plan! Whether its backing up data on the cloud, having contingency plans for staffing issues, or having multiple suppliers for a particular piece of equipment, these plans have saved countless heartaches, businesses, and even lives. While all of these are important, let’s focus today on a company’s responsibility to have adequate back up equipment for their existing customer/patients.

When a DME company takes on a new patient, they are agreeing with both the patients themselves and also the payer sources (Medicare, commercial insurance, etc.) to give that patient a particular piece of medical equipment, provide training and education related to how to use and maintain the equipment, and in some cases, provide ongoing assessments to ensure the patient is using the equipment properly and is compliant with the prescribed therapy/treatment/service. That’s a lot of responsibility—sometimes for little reimbursement! Implicit in the agreement to provide said equipment is the fact that the company maintains the ultimate responsibility for the equipment’s proper function and maintaining the equipment. In our industry, its common to train the end user (the patient) how to do equipment maintenance, but as long as the equipment is “rental”, the company bears final responsibility.

Looking at the oxygen concentrator as an example, we have a piece of medical equipment that requires regular service. Filter changes, concentration checks, even sieve bed rebuilds/replacement are all part of the usual maintenance for a concentrator. A DME company sets up procedures to ensure that this maintenance is actually performed. Filter changes are sometimes tasked to the patient or caregiver. Concentration checks used to be done by technicians during monthly or quarterly visits, but technology has changed and the machine self-monitors now—with built in alarms to notify users when issues arise. The sieve bed replacement is still typically done by technicians at frequencies determined by manufacturer recommendations and/or when machines fail.

In the case of an oxygen concentrator, it is typical for a DME company to place back up high-pressure cylinders in the home. These back-up cylinders are to use when the power goes out, but also in place in case the oxygen concentrator fails. The DME company is responsible to “provide oxygen” (not just rent a single piece of equipment) and the expectation is that there’s a system in place in case the primary system fails.

So, a typical procedure for the provision of oxygen would be that a DME company gets the order/prescription, delivers the equipment which includes a primary system (the concentrator) and a back-up system (the cylinders), and sets up a follow up protocol to check in with the patient to ensure the equipment is properly functioning. Follow up might be more intense in the beginning of therapy when the patient is new to treatment. Gradually, the patient may become proficient at doing more of the checking and maintaining of the equipment. But the DME company always has the responsibility no matter how long the patient has the equipment.

In addition to back up in the home for use if the equipment fails, the DME has responsibility to have “adequate back up equipment and supplies” on hand or readily available at the organization. With oxygen, a prudent and responsible DME organization will set a mathematical back up formula. If you have fifty oxygen patients in the field, four or five back up concentrators might be enough, but if you have five hundred, you probably need more. What your formula for back up is depends on many factors including:

• How new (and reliable) is your rental fleet? A fleet of brand-new concentrators theoretically needs a bit less back up than a fleet of aged, “seasoned” concentrators which tend to break down or fail more frequently.
• How far are your customers from your organization’s branch? If your patients are all within thirty miles, you might factor less back up compared to an organization with far flung patients hundreds of miles away.
• Labor costs of after-hours delivery vs. asset acquisition cost to own more equipment. Some organizations might provide a backup concentrator in the home. They won’t get any additional payment for the backup, but in the event of a break down, the cost of the extra equipment might be “worth it” in terms of saved labor costs associated with after-hours delivery/equipment replacement.
• Your patients’ oxygen needs in terms of continuous as opposed to PRN or nocturnal oxygen usage. If your company provides a lot of PRN oxygen or nocturnal oxygen, you can expect your back up needs to be a little less than if you provide it for continuous use patients.

Now, take the information and the philosophy we’ve discussed and translate it to other equipment.

Oxygen is potentially life-supportive. A prescription for continuous oxygen is something to take pretty seriously and there is liability associated with failing to provide an adequate system. Invasive ventilators should also be taken very seriously. In many cases, invasive ventilators are supporting and sustaining life for the user. If the ventilator fails, the patient might not be able to breath at all and could die. Thus, back up ventilator equipment and protocols are a big deal! The American Association for Respiratory Care (AARC) has issued guidance in the form of clinical practice guidelines (CPG’s). These CPG’s dictate that an organization establish an appropriate mathematical formula for backups. With ventilators, there is sometimes reimbursement for a backup unit in the home. Regardless of whether there is reimbursement, the AARC CPG’s call for backups in certain cases, such as when the ventilator patient is has a motorized wheelchair, or when they live farther than a given response time from the provider’s location.

Apply this logic to any and all equipment your organization provides. With wheelchairs, it might be acceptable to plan on ordering a replacement chair if one breaks. But with oxygen, ventilators, and other respiratory equipment that is potentially life supportive or sustaining, you need backup readily available.

Your company should have a plan for how they will obtain replacement units in the event of equipment breakdown. They should have back up on hand for certain types of equipment. Your back up and replacement plan should be written in policy. For backup equipment that is battery operated and requires charging, the equipment should be not only available, but also charged and ready to go. Coordinate the plan with your emergency preparedness plan. If there was a natural disaster that caused widespread power outages, your company’s plan would be put to the test. Test the plan yourself prior to an actual disaster to ensure you’re ready.

HQAA accreditation standards that you’ll need to keep in mind include:

• ORG 2—Law & Regulation. Some state licensure requirements have specific standards about back up plans and levels (Florida organizations, pay special attention here!).
• ICS 7, 8—Disaster Plan, Emergency Preparedness. Talks about written plans and protocols and how you test them.
• MM 5—Back Up Systems. A standard that describes the general and specific processes and procedures your organization should have in place regarding back up equipment.
• IMV 4—Ventilator Back Up Protocol. The standard specifically for invasive ventilator providers. It delineates and emphasizes the AARC CPG regarding back up ventilator equipment ratios.

Surveyors will ask you about your back up plans and processes. They will tour the warehouse and expect to see actual inventory in place. They will ask about your plan to find additional replacement in the event of an emergency. Finally, they will look for evidence that your system works through patient chart review and patient complaints (or lack thereof). Be able to explain to them how your system works as well as how you’ve tested it.

When your company is put to the test by a disaster, a power outage, or an after-hours equipment failure incident, you’ll be glad you have a safe, efficient, reliable process in place and so will your customer/patients.