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As the United States faced an Arctic front this week with more than 70 percent of Americans enduring below freezing temperatures, many home medical equipment providers were again tasked with caring for patients in extreme weather conditions. Here’s a pair of updates from AAHomecare members in Wisconsin on the special challenges associated with providing HME when the thermometer readings dive below zero. 

HME Home Medical –Green Bay, Manitowoc, and Sheboygan, Wisconsin

(Temperatures in Manitowoc on January 31 were -20 degrees and in the northern part of the company’s service area there were wind chills above -50.)
Executive Director Jim Murray explained, “Since HME Home Medical is primarily a rural provider (even though CMS doesn't recognize us as such) I can tell you without question, delivering DME during the winter months adds considerable cost to our infrastructure. In no particular order, here are some of the challenges that I am sure many providers will echo:
•    Increased cost of heating our 3 locations. In Wisconsin, it was -25 last night with a daytime high temp of -7. It is warmer in Antarctica today than Wisconsin!
•    Increased risk involved in the work. Ever slip on the ice? Ever slip on the ice while carrying a 40lb. piece of home care bed frame? HME currently has 6 DME Service Techs. 1 is out with a work-related injury and 2 more are nursing strains. All of which occurred due to winter challenges.
•    Increased time to do everything we do. Whether it is due to driving slower (delivery techs) on snow covered roads, or CPAP patients showing late for their appointments, or warehouse people unloading a truck, everything we do in the winter months takes longer than spring-fall. This time is added expense.
•    Lost work time. Our 3 branch operations were essentially closed just two days ago on 1/28/19 due to a heavy snow storm. These types of storms are limited each winter season, but you could estimate 1-3 bad storms per winter. Last April, when flowers and grass were starting to grow in states just to the south of Wisconsin; in Green Bay a blizzard dropped 30” of snow… Lost revenue due to process mistakes can be corrected. Lost revenue due to weather is revenue lost forever. Right now, we are evaluating exactly how many billable days we will have in the next fiscal year so that we can accurate forecast revenue. If we lose 2-4 days to weather and potentially countless other days effected by weather, the effect to DME’s in northern climates measures into hundreds of thousands of dollars.”
Murray further added that while the winter season absolutely adds expense to their operations, it is difficult to measure.

“The Medicare DME Fee Schedule in not sustainable under the best circumstances. If HME makes very little profit delivering a bed and home oxygen concentrator in July, what possibility for sustainable profit is left in December through February? We deliver back-up tanks (1) with every O2 concentrator. We are still making deliveries in spite of the challenges with weather and safety, we just do it much slower. Further, we have approximately 500 patients with O2 in their homes, so if any of those patients call with a service issue, we have to go. So, the conversation isn’t only with new patients, because hospitals curtail patient discharge during these extreme weather events, but we still have to meet the needs of our existing patients. 
“Lastly, most staff are making it to work, but your question does bring up an additional ‘loss of revenue’ obstacle. As with all DME’s we measure patient touches/day/colleague as well as revenue dollars/day/colleague. So, to your point, if a colleague misses work due to weather it is very challenging to make up for that revenue loss.
“From purely a safety standpoint, we are asking some staff to not try to make it to work when the conditions are so hazardous.”

Oxygen One, Inc. in Waukesha, Wisconsin

(Temperatures in Waukesha have been below zero from Tuesday morning through Friday morning, with a low of -26 on Wednesday)

Rick Adamich, president of Oxygen One, shared this account with us:
“We are definitely still serving patients during the cold, but mostly on an emergency basis. We recently upgraded our phone system and it allows staff to log into their phone from home and enter into the call distribution queue. So, Monday most all staff stayed home due to heavy snow and cold, but our intake and patient care teams handled patient and referral source calls from their houses and our delivery techs were on standby. Today we had to close again due to cold and concerns about employee safety. In both cases we have reached out to all patients with scheduled or routine deliveries and asked to reschedule. They all completely understand and are made aware that should they have an equipment malfunction or power outage, they need to go on their backup oxygen tanks we provide and call us right away. We are still committed to a minimum two-hour response time for emergency calls and hospital discharges on oxygen, even in this weather. Additionally, we will be adding weekend hours to make deliveries so patients who need tanks will have them when they are ready to venture out as it gets warmer. 

“So far, we have had very few emergency calls, but have handled them all in a timely manner. On Monday we did setup some new patients on oxygen, but today we are working with the hospitals to ensure that if there is a home oxygen discharge, that it's being done safely. The two we have received so far have agreed it's unsafe to send them home. However, it is very clear on both sides that if a patient goes home, AMA or otherwise, we will meet the need. 

“I have to add that I'm very proud of how willing our staff has been to do whatever is necessary to serve our patients. While I think Oxygen One is special, I do not think this desire to serve patients is unique to our company - I've seen examples of it with my competitors locally and heard it from colleagues all over the country. We all see ourselves as healthcare providers giving vital services, even when CMS and others don't. We are far from just ‘Equipment Jockeys’!”