What is the Best Oxygen Model?

Posted on in Growth Strategies, Service Solutions

By Bob Hoffman, RRT, Vice President, Nationwide Respiratory

All HMEs in the oxygen business have had numerous internal conversations in an effort to determine the most cost-effective way to meet the patient’s oxygen needs while maintaining a profit. We all know that limiting the number of deliveries is the biggest part of the solution. Every time your van is headed to an existing oxygen patient’s home, money is being spent with no additional return. So, what are the best options to significantly reduce trips to the patient’s home?

Assessing the patient’s ambulatory needs at setup is of utmost importance. A vital part of every initial assessment is a set of questions about the patient’s portable usage. This will inform the most efficient and cost-effective method of providing portable oxygen.

Assessment questions to determine ambulatory activity should include:

  • Is the patient homebound?
  • Is the patient’s activity level low, moderate, or high?
  • Does the patient work outside the home?
  • Does the patient travel? If so, how often?
  • Where does the patient live in relation to your nearest location?

Take Time to Educate the Patient

In addition to general patient education and a physical assessment, take the necessary time to thoroughly explain how reimbursement works and set expectations for both patient and company responsibilities. Be clear as to when your company will be doing follow-ups and how those will be done: by telephone or physical visit. Encourage the patient to anticipate their needs when it comes to travel and provide your company with a reasonable lead time if additional services are required.

Portable Oxygen Options

Due to technological advances in providing portable oxygen, there are choices available—but unfortunately, not many. The three options are cylinders, transfill systems, and portable oxygen concentrators (POCs). Each has its upside, but each has its downside as well. As for liquid oxygen, the costs associated with providing it, for the most part, makes it prohibitive, except in certain high liter flow situations.


Oxygen being provided by cylinders is like penicillin in the world of pharmacy. It was the only option available for years, but it still can serve a useful purpose. Cylinders are still a viable option for patients with low utilization and who can maintain adequate oxygen saturations when using a conserving device.  Most companies already have existing inventory and depending on the geographical location, patients can often times be coached into bringing their tanks to your facility for the exchange.

Tracking and refilling cylinders is never ideal, but we have done it for years and it can be an inexpensive solution for the right patients. Unfortunately, tanks run dry and require replacement, which translates into deliveries. 

Portable Oxygen Concentrators

As stationary concentrators became smaller, quieter, and more reliable, manufacturers began investing a significant amount of R&D into the development of a true, portable oxygen concentrator. Cost, durability, and battery life continue to be the major issues that keep POCs from becoming the true standard of care. However, as with any new technology, advances continue to enhance the reliability and POCs have provided HMEs with a solution to portability that allows patients to remain active without having to make arrangements through their supplier.

Because of today’s oxygen users desire to remain active and because many have discretionary income, offering POCs as a cash revenue source is a viable option. Don’t be afraid to discuss cash alternatives with your patients and capitalize on the direct-to-consumer advertisements offering portable concentrators that are being seen on television and the internet. Let your patients know that you can provide this service.

On the downside, POCs come at a considerable cost and because of their small size, they are often times dropped, kicked, and abused, thus requiring repairs. 

Transfill Systems

Transfill systems were introduced nearly 20 years ago. The technology has proven to be reliable, and most patients have little difficulty in being able to operate the system. HME companies who were early adopters have positioned themselves well to deal with reduced payments. This system solves the delivery issue and allows for total mobility for patients’ day-to-day activities. Aside from overnight traveling, patients are able to be totally independent, and their portable oxygen needs are met without having to contact their supplier.

The upfront capital layout is the only downside, but due to the long life expectancy of the product, the long-term payoff is attractive.

So, What is the Best Model? 

It all starts with the initial assessment and knowing your patient. Provide the most cost-effective mode of portability that you have available that suits the patient’s needs. As the patient’s portability requirements change, your provision needs to change as well. If you are in the oxygen business for the long haul, it is never too late to invest in transfill systems. Find the most cost-effective way to allow your oxygen patients to leave their homes while you stay at home.