KEE – The Kansas Equipment KEE – The Kansas Equipment Reuse ProgramReuse Program

Sara Sack, Ph.D. Sara Sack, Ph.D. University of KansasUniversity of KansasDirector, ATK & KEEDirector, ATK & KEE

Overview of KEEOverview of KEE

Refurbishment programRefurbishment program Full range of durable medical equipment (DME)Full range of durable medical equipment (DME) StatewideStatewide Five AT Access Sites serve as distribution centersFive AT Access Sites serve as distribution centers Give awayGive away All persons with disabilities and chronic health All persons with disabilities and chronic health

conditions, Medicaid beneficiaries & eligibles are conditions, Medicaid beneficiaries & eligibles are prioritizedprioritized

How did KEE get started?How did KEE get started?

Legislators were concerned about Legislators were concerned about equipment at yard salesequipment at yard sales

State budget was being reviewed during a State budget was being reviewed during a tightening economytightening economy

Intensive review of the proposed DME Intensive review of the proposed DME budget (approximately $11 million)budget (approximately $11 million)

Ongoing relationship between Health Care Ongoing relationship between Health Care Policy and State Tech Program (ATK) Policy and State Tech Program (ATK)

How did KEE get started?How did KEE get started?

Health Care Policy (Kansas Medicaid) and Health Care Policy (Kansas Medicaid) and ATK discussions resulted in a NIDRR Field ATK discussions resulted in a NIDRR Field Initiated grant applicationInitiated grant application

Received $449,478 to develop a statewide Received $449,478 to develop a statewide cost-neutral DME reutilization program cost-neutral DME reutilization program from October 2001 – September 2004from October 2001 – September 2004

How is KEE funded?How is KEE funded?

Health Care Policy, Department of Health Care Policy, Department of Administration and the University of Administration and the University of Kansas, ATK’s lead agencyKansas, ATK’s lead agency– Title XIX funds Title XIX funds – $449,264 (1:1 state to federal match)$449,264 (1:1 state to federal match)

How was KEE designed?How was KEE designed?

Numerous discussions between consumers, Numerous discussions between consumers, DME providers, ATK Advisory Council DME providers, ATK Advisory Council and staff from Health Care Policy and ATKand staff from Health Care Policy and ATK– Developed agreed upon quality indicators Developed agreed upon quality indicators

Kansas Version of Quality IndicatorsKansas Version of Quality Indicators

Redistribute quality equipmentRedistribute quality equipment– Sanitized, repaired and refurbished if Sanitized, repaired and refurbished if

neededneeded

– Qualified vendors who back their work Qualified vendors who back their work are paid to refurbishare paid to refurbish

All consumers should have equal access to All consumers should have equal access to DME regardless of geography, income, DME regardless of geography, income, disability and health conditions, and type of disability and health conditions, and type of DME neededDME needed– Regional distribution centersRegional distribution centers

Access to DME is essential to quality of life Access to DME is essential to quality of life and influences consumers’ perceptions and influences consumers’ perceptions regarding safety, home and family regarding safety, home and family relationships, and community involvementrelationships, and community involvement– Timely access but not an urgent care programTimely access but not an urgent care program– Inventory turn aroundInventory turn around within 90 dayswithin 90 days

Commitment to establishing a program that can be sustained over timeCommitment to establishing a program that can be sustained over time– Must prove that the program is cost effective, or at the least, cost Must prove that the program is cost effective, or at the least, cost

neutral for agencies to continue to participateneutral for agencies to continue to participate– DME of sufficient value to warrant tracking and refurbishmentDME of sufficient value to warrant tracking and refurbishment

» Items such as wheelchairs (manual and power), scooters, hospital Items such as wheelchairs (manual and power), scooters, hospital beds, communication devices, lifts, lift chairs, specialized beds, communication devices, lifts, lift chairs, specialized strollers, etc.)strollers, etc.)

Reduce transportation barriers that limit consumers’ access to assistive Reduce transportation barriers that limit consumers’ access to assistive technologytechnology– Use staff and volunteers from disability and nondisability Use staff and volunteers from disability and nondisability

organizations to pick up and deliver equipmentorganizations to pick up and deliver equipment– Paid DME providers to deliver equipmentPaid DME providers to deliver equipment– Hired couriers to pickup and deliver equipmentHired couriers to pickup and deliver equipment

Increase the probability that AT/DME is used by the Increase the probability that AT/DME is used by the original consumer or another consumeroriginal consumer or another consumer– High national rates of abandonment not acceptable High national rates of abandonment not acceptable – Employ specific strategies to decrease possibility of abandonmentEmploy specific strategies to decrease possibility of abandonment

» Link consumer to the DME provider for maintenance, repair, Link consumer to the DME provider for maintenance, repair, or reassessment or reassessment

» Link consumer to the Tech Act Program staff for additional Link consumer to the Tech Act Program staff for additional demonstration and trainingdemonstration and training

– If equipment is not being used, pick it up for reassignmentIf equipment is not being used, pick it up for reassignment General public readily views use of DME as a solutionGeneral public readily views use of DME as a solution

– Involve nondisability partners in volunteer regional networks Involve nondisability partners in volunteer regional networks

How does KEE work?How does KEE work?

How does KEE obtain inventory? How does KEE obtain inventory? – Track Medicaid equipment and bring it back into the Track Medicaid equipment and bring it back into the

program when it is no longer in useprogram when it is no longer in use– Conduct public awareness campaign to obtain donated Conduct public awareness campaign to obtain donated

equipment equipment How do customers donate or request equipment?How do customers donate or request equipment?

– Call their regional AT Access Site using the toll-free Call their regional AT Access Site using the toll-free numbernumber

– AT Access Site staff enter consumer and equipment AT Access Site staff enter consumer and equipment records into databaserecords into database

– Staff arrange for pick up of donated items Staff arrange for pick up of donated items – Staff look for equipment to match consumer’s needs Staff look for equipment to match consumer’s needs

and arrange for deliveryand arrange for delivery

What happens to equipment? What happens to equipment?

Pick up Equipment

• Sanitize

• Routine maintenance

Deliver Equipment

• Consumer

• Vendor for refurbishment

DME Vendors

• Obtain prior authorization for repair from KEE Coordinator

• Deliver or return to network

What resources are needed What resources are needed to operate KEE? to operate KEE?

Overall StaffOverall Staff– Donated time of ATK Project DirectorDonated time of ATK Project Director– 1 FTE Coordinator1 FTE Coordinator– Average of 20 hours per week at each of the 5 Average of 20 hours per week at each of the 5

AT Access SitesAT Access Sites– Network team volunteers (may be reimbursed Network team volunteers (may be reimbursed

for time, mileage, etc.)for time, mileage, etc.)

Coordinator responsibilities Coordinator responsibilities

– Build equipment inventory Build equipment inventory

»Work with vendors to enter equipment Work with vendors to enter equipment into tracking systeminto tracking system

»Conduct one and seven month follow-up Conduct one and seven month follow-up callscalls

– Coordinate public awareness activities Coordinate public awareness activities

– Work with subcontractors to help them Work with subcontractors to help them solve problems they’ve identified in their solve problems they’ve identified in their regionregion

– Review all program data including Review all program data including consumer satisfaction to identify trendsconsumer satisfaction to identify trends

»Quality assuranceQuality assurance

»Timeliness Timeliness

»Cost efficacyCost efficacy

– Compile and submit reportsCompile and submit reports

Subcontractor responsibilitiesSubcontractor responsibilities– Develop and maintain diverse network teamDevelop and maintain diverse network team– Train network teamTrain network team– Match available equipment to consumers’ Match available equipment to consumers’

needsneeds– Coordinate pick up and delivery of equipmentCoordinate pick up and delivery of equipment– Promote the program in their regionPromote the program in their region

Routinely address liability concerns Routinely address liability concerns – Maintain an adequate refurbishment budget Maintain an adequate refurbishment budget – Use certified vendors to refurbishUse certified vendors to refurbish– Train staff and volunteers (sanitization, Train staff and volunteers (sanitization,

maintenance, pick up and delivery practices)maintenance, pick up and delivery practices)– Match skills to task and employ safety practicesMatch skills to task and employ safety practices– Use local consultants to match certain Use local consultants to match certain

categories of equipment (gait trainers, standers, categories of equipment (gait trainers, standers, CPAPs, Bipaps, feeding pumps) CPAPs, Bipaps, feeding pumps)

– Disclaimer on the website and on the delivery Disclaimer on the website and on the delivery formform

Consumer RequestsConsumer Requests

431 individuals requested equipment in 431 individuals requested equipment in Year 1Year 1

631 individuals requested equipment in 631 individuals requested equipment in Year 2Year 2

706 individuals requested equipment in the 706 individuals requested equipment in the first 9 months of Year 3first 9 months of Year 3

Program OutcomesProgram Outcomes

Customer RequestsTotal = 1,768

90

70

174

97

124108

134

265

211

289

206

0

50

100

150

200

250

300

350

1 2 3 4

Quarter

Year 1

Year 2

Year 3

DME ReassignmentsDME Reassignments

127 items reassigned in Year 1127 items reassigned in Year 1 269 items reassigned in Year 2269 items reassigned in Year 2 403 items reassigned in the first 9 months of 403 items reassigned in the first 9 months of

Year 3Year 3

Program OutcomesProgram OutcomesKEE DME Reassignments

Total = 798

2631 34 36

60

50

7682

134

163

106

0

20

40

60

80

100

120

140

160

180

July-Sept Oct-Dec Jan-Mar Apr-June QUARTER

Year 1

Year 2

Year 3

DonationsDonations

275 items donated in Year 1275 items donated in Year 1 338 items donated in Year 2338 items donated in Year 2 518 items donated in the first 9 months of 518 items donated in the first 9 months of

Year 3Year 3– Only 70 items (6%) were originally purchased Only 70 items (6%) were originally purchased

by Medicaidby Medicaid

Program OutcomesProgram Outcomes

3

93

7

28

2

87

4

51

9

56

9

52

4

93

6

109

6

192

9

191

11

109

0

20

40

60

80

100

120

140

160

180

200

1 2 3 4 1 2 3 4 1 2 3

YEAR 1 YEAR 2 Year 3

Donations by Funding SourceTotal = 1,131

Series2

Series1

Value of ReassignmentsValue of Reassignments

Items worth $183,941 were reassigned in Items worth $183,941 were reassigned in Year 1Year 1

Items worth $320,045 were reassigned in Items worth $320,045 were reassigned in Year 2Year 2

Items worth $395,073 were reassigned in Items worth $395,073 were reassigned in the first 9 months of Year 3the first 9 months of Year 3

Program OutcomesProgram OutcomesKEE Market Value of Reassignments

$899,059

43,02935,915 34,312

70,68565,563

59,124

102,709

92,649

123,941

157,894

113,238

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

1 2 3 4

July-Sept Oct-Dec Jan-Mar Apr-June QUARTER

Year 1

Year 2

Year 3

Value of DonationsValue of Donations

Items worth $325,568 were donated in Year 1Items worth $325,568 were donated in Year 1 Items worth $384,054 were donated in Year 2Items worth $384,054 were donated in Year 2 Items worth $511,015 were donated in the Items worth $511,015 were donated in the

first 9 months of Year 3first 9 months of Year 3

Program OutcomesProgram Outcomes

Market Value of Donations1,220,637

95,590

52,051

106,651

71,27656,411

70,975

133,546123,122

152,340

240463

118212

0

50,000

100,000

150,000

200,000

250,000

300,000

1 2 3 4

Quarter

Year 1

Year 2

Year 3

What roles do KEE’s partners play?What roles do KEE’s partners play?

DME providers are champions of KEEDME providers are champions of KEE– Provide valuable knowledge of the inventoryProvide valuable knowledge of the inventory– Promote the program to consumers and recruit Promote the program to consumers and recruit

other DME providersother DME providers– KEE brings business through refurbishing as well KEE brings business through refurbishing as well

as repeat business from KEE consumersas repeat business from KEE consumers– Appreciate timely payment Appreciate timely payment

Disability and nondisability network Disability and nondisability network volunteers volunteers – Increase public awareness Increase public awareness – Build inventory Build inventory – Help control program costsHelp control program costs– Increase volunteers’ knowledge and comfort Increase volunteers’ knowledge and comfort

level with use of technology level with use of technology

Kansas MedicaidKansas Medicaid– Serves as the financial partnerServes as the financial partner– Links KEE with DME providersLinks KEE with DME providers– Demonstrates support by promoting KEE and Demonstrates support by promoting KEE and

backing program decisionsbacking program decisions– Cost effective option to access DMECost effective option to access DME

What were some initial challenges?What were some initial challenges?

Changed state policy regarding equipment Changed state policy regarding equipment ownershipownership– Developed consumer stakeholder support Developed consumer stakeholder support

» Wider range of equipmentWider range of equipment

» Serves more Kansans Serves more Kansans

Establishing and adhering to high quality program Establishing and adhering to high quality program and refurbishment standards and refurbishment standards

Acquiring sufficient range and depth of equipmentAcquiring sufficient range and depth of equipment– Quickly received consumer requests, but no inventoryQuickly received consumer requests, but no inventory

What are some ongoing challenges? What are some ongoing challenges?

Recruiting and managing volunteersRecruiting and managing volunteers Refining staff skills in matching equipment Refining staff skills in matching equipment

to consumers’ needsto consumers’ needs Moving and delivering equipmentMoving and delivering equipment Fluctuating demands on staff timeFluctuating demands on staff time Establishing realistic goalsEstablishing realistic goals To expand or not to expand…To expand or not to expand…

Advice to others?Advice to others?

Develop partnerships, don’t go it alone.Develop partnerships, don’t go it alone. Trust your partners and give the program Trust your partners and give the program

time to develop before you make time to develop before you make programmatic changes. programmatic changes.

Communicate regularly with all partners.Communicate regularly with all partners. Establish quality standards and follow them. Establish quality standards and follow them. Consider liability – keep everyone safe.Consider liability – keep everyone safe. Insist on an adequate refurbishment budget.Insist on an adequate refurbishment budget.

Questions?Questions?

For more information contact: Sara Sack, For more information contact: Sara Sack, University of Kansas, 620-421-8367 or University of Kansas, 620-421-8367 or

ssack@ku.edussack@ku.edu