The Holy Grail: Looking for the perfect pump
Here's the right way to conduct your search
For any home infusion provider, your pumps are your lifeblood. Settle for a second-rate, inadequate home infusion pump, and you'll likely spend more time troubleshooting than providing patient care. But if you don't do your homework, you may be unknowingly throwing money away even with the most trouble-free pump. (See related story on negotiating for the best deal on pumps, p. 40.)
It seems everyone's searching for the perfect pump, that magical mix between clinical efficiency and cost. And while one agency's saving grace is another's nightmare, there's plenty you can learn from others' shopping experiences.
Pat Berberich, a sales rep for Clinical Technology, a Broadview Heights, OH-based wholesaler, says there are two questions you need to ask yourself before you begin pump shopping:
1. Who are your clients?
"It's important to know what your patient population is," says Berberich. "Are you servicing nursing homes, or are you doing mostly home infusion?"
For instance, she notes that a provider can typically use a less expensive product in nursing homes, where pole mounted pumps are preferred over ambulatory pumps.
"They're usually less expensive than ambulatory pumps, especially a multi-therapy pole mount vs. ambulatory," she says.
2. Who's paying?
"If someone is heavily into managed care, they really have to control their costs per diem," she notes.
From there, you'll have a good idea of the caliber pump you'll need and - if you've adequately figured your costs - a budget you can work within.
From there, home infusion providers who spoke with Home Infusion Therapy Management noted that they look at four distinct areas when shopping for a pump. These are:
· Cost.
Before you look at anything else, Berberich says you should know your price range.
"I think the most important thing a company needs to do, and not all companies do it, is to stay on top of what's out there and how much it costs to make sure they are doing things cost-effectively," she says.
Knowing what new technology is available is easy with a little help.
"The relationship we have with Pat is a good example," says Ed Ciarniello, RPh, IV pharmacy manager for Mason, OH-based Skilled Care. "She has a broad line of products and calls us monthly to touch base. And because we have that relationship, she knows what our needs are."
Regarding cost, it's best to have a strict budget. For example, when Lifetek Infusion in Lexington, KY, went pump shopping, director Jeanne Strunk set her price range partly through Kentucky's Medicaid reimbursement rate.
"Kentucky Medicaid reimburses you $189 a month for a pump, so if we pay $225 to lease a pump, we're going in the hole," she says. "We wanted something that was reimbursable with managed care, Medicaid and Medicare without there being a huge difference between what it cost us and what our reimbursements were."
Don't overlook the fact that the pump's not the only cost.
"We also did price comparisons of the tubing and line sets," says Philip Nelson, executive director for Infusion Solutions, a hospital-owned infusion provider in Grayson, KY. "You'll spend more on those over the long haul than you will on the pump."
Nelson also says to consider the power source for your ambulatory pumps. For example, a SIMS Deltec CADD-Prizm VIP uses one 9-volt battery, the Sabratek uses two 9-volts, and the Abbot pump uses four AA batteries.
· Flexibility.
If you've got a high percentage of total parenteral nutrition (TPN) patients, an inexpensive pump that doesn't allow you to ramp up and ramp down the dosage is useless.
In this day and age, most providers offer a wide range of infusion therapies. This was the case for Lifetek and Strunk, whose situation was far from perfect.
Because Lifetek provides a wide variety of services to its patients, ranging from TPN and chemotherapy to pain management and antibiotics, the pump had to be diverse. But that led to a hodgepodge of pumps in patients' homes.
"At one time we were using CADDs, Verifuse, Bard, and Baxter pumps," says Strunk. "So we wanted to find one or two pumps that would do everything we needed them to do."
When that's your goal, Berberich says, you've already adequately narrowed your choices.
"There are at least five multi-therapy ambulatory pumps out there," she says. "Although that's the high end as far as what to pay, it's convenient because they have everything."
· Ease of use.
Regardless of your patient population, it's highly unlikely your staff will be the only ones programming your pumps. So it's important that the pumps operations be simple enough that teaching a nurse, patient, or other caregiver how to use the pump isn't a lesson in quantum physics.
"It's our responsibility to train caregivers, the patient, or another home health agency," says Nelson. "Nurses come in and out of the system, and we're constantly inservicing them on the use of pumps, so we looked at ease of use and programming."
Otherwise your staff may end up taking more than its fair share of troubleshooting calls from home health nurses and other caregivers. To avoid this problem, Skilled Care let caregivers provide feedback while it was searching for a pump.
"We did some simulations here with the pumps, and we also had some of our customers [nursing homes] give us feedback," notes Ciarniello.
Lifetek took similar steps to make a choice.
"We were looking at five different pumps, so we rented them and compared," says Strunk. "If we had a patient on 5FU using a Verifuse, we put a similar patient using another pump and compared how many phone calls we got for each."
Lifetek asked patients to complete a questionnaire (see p. 41), and they compared the results. This process took about three months.
But ease of use and compatibility should include much more than just programming.
"My nursing staff called it patient friendliness," says Strunk. "This included whether the pump allowed the patient to be mobile, whether it was bulky or had sharp, pointy corners."
· Reliability.
The next consideration is the pump's reliability. If it's easy to program but breaks down every week, you're still wasting time and money.
Nelson, through the help of Infusion Solutions' parent hospitals, was able to put together a 28-page packet of information that evaluated the mechanical aspect of three pumps: the CADD-Prizm, the Sabratek, and the Abbott.
"We did background checks on the pumps: recall situations, warranty information, FDA reports, programming glitches - more on the mechanical side," he says.
Because Lifetek was already using several of the pumps it was considering for consolidation, it looked at its own internal records for pump reliability.
"For quality improvement, we had looked at problems with our pumps, so we went back and looked at the survey logs about pump malfunctions," says Strunk.
And the verdict is . . .
Lifetek was able to choose two pumps from Gish Medical: the Easy Flow 80 and the Easy Flow 480.
"They're very small and cost-effective," says Strunk. "Rental for the 80 is $30 and for the 480 is $110, and it cost just $5.25 for a tubing set."
After switching to the Easy Flow pumps, Lifetek's monthly cost for pumps and supplies dropped 68%.
"That put us in a totally different bidding range for managed care," says Strunk. "In fact, we've gained some managed care contracts because of the cost-effectiveness of these pumps, and we've added quite a bit of business from oncologists because of the ease of use of these pumps and their capabilities."
Berberich notes that the Easy Flow, with its no frills design and low cost, was the perfect pump for Lifetek.
However, to show that there's no one perfect pump for everyone, both Skilled Care and Infusion Solutions went through Berberich and settled on Sabratek pumps for the added features, including the capability to purchase software that allows the pumps to be programmed over the phone.
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