The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

DECREASING COSTS IN THE VA SAN DIEGO HOME OXYGEN PROGRAM

Marshelle Ramler, RRT, Andy Mosley, CRT, Angela Wang, MD-VA San Diego Healthcare System (VASDHS).

BACKGROUND: Containing costs is of increasing concern in today's Healthcare environment. In March 1998, a full-time coordinator was hired to manage the VASDHS Home O2 Program. Previously, the position had been an unstructured, minority-time assignment. There were 126 patients on the program and total monthly expenditures were $16,476. The average cost per patient was $131. Method: A procedure of monthly review was implemented to compare each patient's Rx with the monthly invoicing to determine if the quantity of tanks on hand was appropriate for the patient's Rx and level of activity. This initial review revealed an excess of supplies by many patients. The use of liquid oxygen (LOX) systems in some instances also contributed to the high cost. A database was created to track monthly compressed gas usage and determine the number of tanks the patient typically used in a one-week period. The results were discussed with each patient, and ?on-hand? limits were established. Patients were advised that empty tanks could be exchanged for full ones as needed. This reduced the monthly costs by decreasing the number of unused rental tanks. Limits were communicated to the contract vendor and an even-exchange policy was established. To assure compliance with guidelines, the coordinator now approves all changes in patient equipment. The use of oxygen conserving cannulae and pulse dose delivery systems, when appropriate, also reduced monthly oxygen consumption. Furthermore, because purchasing concentrators has proven to be more economical than renting, LOX systems were exchanged for VA owned oxygen concentrators whenever possible. Monthly expenditures and number of patients were tracked for a one-year period.

Results: From March 1998 to March 1999, the monthly average cost per patient was considerably reduced from $131 to $101 while the patient base grew from 126 to 173 veterans. Because equipment modifications are ongoing, this number is expected to decrease further. These savings offset the expense incurred by hiring a full-time coordinator. Conclusion: The attention provided by a full-time coordinator allowed for a significant decrease in monthly average cost per patient without compromising patient care. As a result, the VASDHS could redirect its resources and provide oxygen for its growing number of patients. EXPERIENCE: Presenter is an RRT with 15 years clinical experience in acute care facilities including 12 at the VASDHS.

OF-99-071

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