Choosing the Right Durable Medical Equipment (DME) Supplier

By Cheryl Switzer

At some point in the course of your PH treatment, you might be prescribed supplemental oxygen. While this may be an emotional blow, oxygen is a powerful vasodilator that can ease your symptoms and improve your sense of well-being.

Often, your doctor or clinic will choose your supplier for you, which is often one of the larger national firms with a network of facilities throughout the United States. While this may be a reasonable choice - one less decision for you to make personally - you need to know that you may have a number of vendor options depending on where you live.

Besides a few large national companies that supply durable medical equipment (DME), there are hundreds of smaller, regional suppliers across the country that would love to have your business. If you have the opportunity to choose your supplier or are in the process of trying to find a new supplier, you'll want to consider the following:

  • Responsiveness. When you call for information, is your call routed quickly to someone who is helpful?

  • Equipment. Does the supplier carry the oxygen equipment you need?

  • Insurance. Do they accept your health insurance for payment?

  • Service. What is the service schedule and what are the criteria for a fill or delivery?

  • Emergencies. Who will you call in emergencies?

  • Staffing. Is there a staff of respiratory therapists and will they come to your home?

  • Travel. If you plan on traveling, are they set-up to help you obtain supplies across the country / world?

When you call to evaluate the services and personality of a particular vendor does a person answer or do you have to navigate a complicated voice system? When you reach someone, are they helpful? Did you get the call back you were promised? If you get the run-around or people act like they are too busy or just are not particularly helpful, this will tell you a great deal about the service you might expect.

Three broad categories of supplemental oxygen equipment are available: the oxygen concentrator, liquid systems and gas systems. Below you will find a very brief description of the three types and the pros and cons of each. This, in no way, is meant to be a comprehensive view or endorsement of any system. Your particular needs should be discussed with your doctor and perhaps a respiratory therapist.  

Oxygen Concentrators
The oxygen concentrators carried by most suppliers are typically bulky and stationary (40-50 lbs). Some are noisy, and all radiate a fair amount of heat. These units run on electricity so you have to expect your electric bill to increase. You may get a break from your utility company if you can prove medical necessity. Many who require oxygen only at night opt for an oxygen concentrator. They are workhorses and are very dependable as long as you have power. They also require minimal servicing. The stationary concentrator - which can be set to provide from 1 to 6 liters of continuous oxygen - is also a good choice for someone who also uses a cpap or bipap (noninvasive ventilator) for support during sleep.
Another type of concentrator to consider is the fairly new portable oxygen concentrator (POC). It may weigh as little as 10 pounds. These newer units are designed for the person on the go, but are not built for the kind of day in and day out use the larger, stationary units can deliver. People who may need supplemental oxygen for occasional use as in during airline flights may consider purchasing one of these units for infrequent use.
We think interest in POCs will increase, prices will come down, features and battery life will improve and more choices will be available in the years ahead. But for now, only a handful of models are available, the prices are pretty high and out of the reach of many as most insurance will not pay for this "luxury." A limited number of POC styles have been approved for airline travel; it is important to check with the FAA and individual airlines for acceptable POCs.

Gas Systems
You've all seen people wheeling little baskets around with a metal cylinder inside. Those cylinders are filled with oxygen in gas form, which is relatively stable. You can store these cylinders for months with assurance the cylinders will be useful when you need them. Smaller, more portable systems are also available, so a gas system may be a good choice depending on your needs.
If you have ample storage space and want to keep a dependable supply of oxygen on hand, a gas system can be a good choice.

Liquid Systems
If you opt for a liquid system, you will keep a reservoir of liquid oxygen at home, which is used to fill your portable liquid unit. Many of these are very small and lightweight. Your provider will refill your reservoir as needed. The contents of the reservoir will evaporate over time even if you do not fill from it, so you will probably need a fill every week or two depending on your rate of usage and type of reservoir (some units seem to be tighter than others).
If you're mobile and want to stay as active as possible, you'll definitely want either a portable liquid or gas system or one of the portable oxygen concentrators (POC). Remember that each system has its pros and cons and that not all suppliers carry all systems.
Because liquid systems require more attention in the way of visits for refills, not all suppliers offer them and you need to know that before you sign up. Some providers have been known to tell customers liquid systems are more dangerous and that is why they do not carry them, but this is a ruse. In truth, it costs more to service and handle liquid oxygen as it evaporates over time and needs regular refills. But this in no way makes it inferior or unsafe. Some users prefer the smaller liquid tanks and the overall portability and dependability of some of the liquid systems. When comparing two portable units of the same weight (size) - one gas and one liquid, - the liquid system will allow you to be away from the house for many more hours, ounce for ounce.

One more note about oxygen systems. Both gas and liquid systems offer "on-demand" and "continuous flow" portable devices. The on-demand units conserve oxygen by emitting oxygen only when it senses your inspiration. In other words, it sends you a little burst of oxygen every time you take a breath. A continuous flow system emits a flow of continuous oxygen. People who take very shallow breaths may do better on a continuous flow system, but many people do well on a conserving (on-demand) system. If you want more time away from the house, you might ask to be tested for an on-demand (conserving) unit.
Your geography and ease of delivery will also play a role in your doctor's choice of an oxygen system for you. People in remote areas, where deliveries are sometimes difficult, may do better with an inventory of gas cylinders, which, as stated previously, will reliably hold their contents.

Health Insurance Considerations

Medicare / Medicaid
With recent planned cuts in Medicare payments for DME oxygen rentals, Medicare recipients may have a tougher time finding a vendor of any kind. On January 1, 2006, a clock began to tick. Your supplier could count on Medicare payments for the rental from your equipment for 36 months. On January 1, 2009 or after any consecutive 36 months of rental use, the patient will own all oxygen equipment.
Nobody knows yet how anything will be handled after that and some questions should be considered. Will Medicare still pay for liquid refills? Who owns all those empty gas cylinders and how are they refilled? When your concentrator breaks down, who fixes it and who pays for the repairs? It's a mess and if this alarms you, you may want to send some letters to your elected officials on this subject. Also check the Action Central Page for more information.

Private Insurance
If you have private insurance, you'll want to read over your policy carefully. Some policies have caps for DME rentals. You'll want to make sure the supplier you are researching will accept your coverage and if you do have a cap, you'll want to discuss this with your supplier before you're committed to that company or system. Your insurer's contractual price worked out with the supplier probably won't be passed along to you once your cap has been reached. This can be a shocker if you have not worked it out ahead of time with the DME firm.

If you will be ordering one of the portable systems, you'll want to ask about refills and deliveries. Some larger suppliers may only come weekly or every two weeks while others may have fewer hard and fast rules about this. Many of us like to keep enough oxygen on hand in case of emergencies or interruptions in service. Find out what service they can give you.

Most DME suppliers do not deliver supplies on the weekend except in emergency situations. You'll want to ask about this and also find out if a respiratory therapist is on call after hours.

Respiratory Therapists
If you have questions or concerns about your equipment, you will want to direct them to a respiratory therapist. It would be helpful to know how many RTs are employed by the firm you are evaluating. Also ask how long they have been on staff, as high turnover is a red flag. If possible, ask to speak to an RT.
The relationship you forge with a good RT can be invaluable to you if and when problems arise. These are the people who are qualified to help you select equipment that meets your healthcare and lifestyle needs.

Travel Considerations
If you plan on traveling, you'll want to inquire about their network of locations and their travel policies. Do they have many branch offices across the country? Do they all carry comparable equipment? Note: liquid oxygen is not necessarily available from one location to the next. Don't assume you can get liquid delivered remotely.
The largest DME suppliers have a network of offices across the country. Smaller, regional suppliers are typically linked to a network of other smaller, regional providers to provide service to the traveler. For most travelers, there is no extra charge for supplies used while traveling. Your supplier typically absorbs these costs, but you'll want to ask about the policy of the firm you are considering.

In summary, we encourage you to be proactive in finding the best DME provider for you and the best equipment for your needs. Don't assume a national chain will give better service than a regional firm. One office of a large chain can provide excellent service while another office may be ranked very low. If you make a few calls and do some homework, you'll stand a better chance of finding a good supplier that will serve you well.

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