Designing products for children with chronic illnesses or
disabilities is not child's play. It can often be compared to the
game of Chutes and Ladders, in which some moves drive you to the
head of the game and others take you back to the starting point.
Fortunately, manufacturers recognize these differences and continue
to create solutions that are sized just right.
“Children and teenagers are not ‘little
adults,’ which is how pediatric patients have often been
viewed,” says Dr. Robert D. Hoover Jr., chief medical officer
for DeVilbiss Healthcare. “Manufacturers are recognizing this
fact and are developing products and programs specifically suited
to the younger age groups.”
Hide and Seek: Clinical Breakthroughs Offer Advanced Care for
Kids
A key trend occurring in the pediatric mobility market is the
need for early intervention, addressing needs sooner and
acknowledging the benefits. “Therapists are finding that the
earlier they can start taking care of these children in all aspects
means they will get better results in the long term,” says
Sue Johnson, Convaid's director of sales and marketing.
“Early intervention programs are typically home-based, so
the therapists are going into the homes and providing products that
the parents can use. They are making creative uses of non-medical
products or traditional baby products by adding additional padding
or support … providing creative solutions for the smaller
kids.”
On the respiratory side, clinical awareness of pediatric
conditions continues to escalate.
“Increasingly, the clinical community is seeing growth in
various illnesses affecting the pediatric population, including
pediatric asthma and obstructive sleep apnea,” explains
Hoover. “The pediatric asthma upsurge is primarily due to an
increase in both outdoor and indoor allergens and the pediatric OSA
driver is primarily the result of the obesity problem plaguing the
younger age group. Only recently has the clinical community started
to address these problems.”
For manufacturers of pediatric home medical equipment, the drive
to develop innovative products and solutions for everyday
challenges is based on their customers' needs — from HME
providers to referral sources and, most important, end-users.
Meeting the needs of parents has always been a concern for
pediatric mobility products, and that continues to be true.
“The parent is the one who is vocalizing for the child what
the child would like to have in the chair, but also what would make
the chair easier to operate for the parent,” notes Julie
Jackson, group product manager of custom power for Invacare
Corp.
“Since the parent is almost always going to be with the
child in some format, you have to make sure the chair is
caregiver-friendly, easy for the parent to operate, easy for the
parent to push if need be and also easily operable in a classroom
environment.”
Jackson adds that the school environment should also be
considered during product development. “We want to make sure
that the chair drives quietly when in a classroom and if it has an
operating power seating, we need to make sure the actuators are
quiet as well so it is not disrupting for the class.”
Most manufacturers pay close attention to providers when looking
for feedback and communication on products and product design.
Jackson says that parents and teachers are also driving forces, and
so are therapists. “The therapist is another driving force as
he or she is the one who ultimately takes the feedback from the
parents and schools and communicates it back to us,” she
says.
Dodge Ball: The Name of the Funding Game
Funding for pediatric products continues to be a hit-or-miss
situation. Although state Medicaid programs have the ability to
make independent decisions on coverage, they often rely on
Medicare's precedents when making a determination.
“Even though we are talking about the pediatric market,
funding really does have a trickle-down effect from what Medicare
says,” says Nancy Perlich, COTA, ATS, a reimbursement
specialist for Altimate Medical. “We all need to be concerned
with what Medicare does because it will affect both the public and
private payer markets.”
Perlich is also concerned with renewal of the state children's
health insurance plans.
“My concern is making sure there are funds available and
that we at least maintain the funds that exist as opposed to
decreasing or eliminating the funds that exist for children's
health care insurance programs,” she says. “If that
goes away, I am not quite sure what will happen with the infant to
21-year-old population funding.”
Hoover adds that price is always a consideration in these days
of shrinking reimbursements. “As with most consumer products,
patients, clinicians and payers are looking for the right mix of
features and value. Medicaid agencies are no different and are
often more likely to scrutinize newer technologies because of the
typically higher cost,” he says.
“In my experience, the state Medicaid agencies are trying
to match the appropriate technology to the patient. However, there
is often difficulty getting coverage because of lack of experience
with the new technologies or inadequate documentation describing
why a specific feature or clinical benefit is necessary for that
specific patient.”
Funding also plays a role in development, says Craig Bright,
president of MedQuip. “Ultimately, all the new
‘cooler’ types of things that we would want to do are
more expensive, and our hands are really tied by having to stick to
… a price point,” he says.
According to Convaid's Johnson, Medicaid plans are
discriminating in their approvals. “They are very closely
scrutinizing the claims and, of course, in terms of our products,
they are presently only allowing one wheelchair or one mobility
device,” she says. “In the past, they were more likely
to allow a secondary chair for some kids or a stroller or another
device that was easier to use or more family-friendly.”
Although funding is a big consideration, Invacare's Jackson says
the most important factor is designing products that meet the
child's needs. “You do always take reimbursement into
consideration and how that plays in,” she explains, but
“when it comes to pediatrics, designing the right product is
what's really most ideal” along with making the product
“distinctive, unique and something that the child is going to
want and prefer over something else.
“Funding is definitely a very important aspect, but in
this case, it's more important to develop the right product for
what the individual needs.”
Risk: Providers Must Begin Saying ‘No’
As reimbursements continue to decline, providers have
historically gone out of their way — and even out of their
budgets — to accommodate the needs of their patients. Experts
say that has to change.
“We've been hearing reports of very, very low
reimbursement rates from some of the large insurance providers. As
long as somebody will provide [the equipment], they just seem to
cut more and more and more,” says Jackson. She gives the
example of one insurance company that has been reimbursing at 40
percent off retail.
Jackson advises providers to say “no” to those
clients with inadequate coverage. Instead, she says, providers
should encourage customers to tell their insurance companies that
they don't have access to what they need.
“With the tightening down and difficulties in funding,
providers should say ‘no’ more often when they can't
provide a product,” she says. “In the past, they have
oftentimes provided equipment at no profit to them — actually
even at a cost to them — just because they were doing well,
but at a certain point they can't do that anymore.”
Perlich, who was previously a provider, agrees. “We've
always taken care of our end-users, but we've done a lot for them
instead of educating and empowering them to become their own
advocates,” she says. “They need to be more involved
and become educated on the funding sources and knowing what other
support agencies are out there to help them with the process.
“The process has to be more self-initiated and
self-directed.”
Connect Four: Product Innovation Is Lining Up
Despite funding restrictions, product development is still
gaining momentum in both the pediatric mobility and respiratory
markets. DeVilbiss' Hoover says in the area of sleep-disordered
breathing, newer products have interfaces that are specifically
tailored to smaller faces and pediatric facial features.
“Devices are being designed that are better able to match
pressures and ramp algorithms for smaller patients,” he
explains. “In the area of nebulizer compressors, you're
seeing a growth in products that feature kid-friendly characters
and color choices.”
Karen Mosholder, DeVilbiss' aerosol product manager, says the
company will soon introduce a comprehensive pediatric asthma
management program. Mosholder adds that she utilizes her
experiences as the parent of an asthmatic child and a former
educator when developing products and programs to meet the needs of
the pediatric population.
“There is a fine line between helping a child feel
comfortable with taking an asthma treatment and making aerosol
therapy too much of a game,” she says. “If the ultimate
goal of any asthma management program is to teach patients to
self-monitor and to take responsibility for their own health, we
need to plant the seeds early.
“It's never too early to teach children that their aerosol
treatment is what helps them feel better.”
Bright says MedQuip continues to develop innovative ways to
encourage pediatric respiratory patients. This fall, the company
will introduce a new MDI spacer. However, he says providers should
look beyond respiratory products when serving the pediatric
population.
“HME providers should look into products they might have
never really thought about, such as nutritional supplements for
underdeveloped kids,” he advises. “They should just do
their homework on what prescriptions come out of pediatrician
offices and make it one of [the] focal points.”
Altimate's Perlich says the company is continuing to explore the
pediatric market. “We are looking at how we can update our
existing pediatric standers and, in fact, we are looking to
hopefully take some of the technology that we have in the adult
market and bring it down to the pediatric side,” she
says.
“The cosmetic appeal has to be there, especially for the
pediatric market, because you're dealing with a young child and a
family that is just accepting a lot of changes to their lives. If
[a product] looks too medical, they are not going to be nearly as
excited to use it as if it had some sort of cosmetic
appeal.”
Convaid will introduce its CuddleBug wheelchair this fall to
address the growing interest in early intervention. According to
Johnson, the wheelchair can have a seat depth as small as 5 inches
and will also feature tilt-and-recline and high-low options in one
base.
Early next year, Invacare will offer a new pediatric power
wheelchair. However, providers can take a first glance at Medtrade.
The Spree TDX is a spin-off of the company's TDX SP platform, which
makes business simpler for providers by using many similar
components, according to Jackson.
“The TDX Spree was developed based upon years of feedback
that we have been accumulating from providers, parents, therapists
and end-users directly,” she says, adding that the chair
offers the company's Quiet Stability Lock and its SureStep feature,
“that allows you to climb obstacles and transition down from
obstacles smoothly.”
The wheelchair also offers a power seat height adjuster of 5
inches, “which will be standard, as well as transport
tie-down options that will be standard on the product.”
The tie-down option is a trend Jackson says she is seeing more
frequently.
“Originally, this used to just be an option that many
manufacturers would offer, but lately many school districts require
that, in order for the child to be able to be transported in a bus
… it must have a tie-down system,” she says. “So,
as a manufacturer responding to that, we definitely see the
necessity that on all pediatric chairs the transport tie-down
option is critical and one that we must offer to our
consumers.”
Although the pediatrics market is not child's play, there is a
lot of fun involved — especially if providers look for new
technological solutions that empower parents to be the best
advocates for their children.
Show and Tell
Providers of pediatric mobility equipment can get creative in
marketing to parents and referral sources. HOPE Inc., Moorhead,
Minn., a nonprofit organization committed to assisting families
with children who are physically and mentally challenged, offers
programs that HME providers could consider, including:
Mobility Equipment Lending Center: Families and their
therapists can check out mobility equipment from the organization's
lending center free-of-charge to try at home and school. Equipment
is typically loaned out in three- to six-week increments depending
on demand.
Mobility Clinics: At mobility clinics, physically
challenged children are given the opportunity to try
state-of-the-art mobility equipment. Vendors are invited to
showcase their equipment, allowing the children to try it in a fun,
interactive environment. The organization also invites physical and
occupational therapists to help properly assess the children in the
equipment.
Childhood Asthma Facts
Asthma is the most common chronic disorder in childhood,
currently affecting an estimated 6.2 million children under the age
of 18.
Asthma is the third leading cause of hospitalization among
children under the age of 15.
Asthma triggers include:
Respiratory infections and colds
Allergic reactions to allergens such as pollen, mold, animal
dander, feathers, dust, food and cockroaches
Exposure to cold air or sudden temperature change
Cigarette smoke
Excitement or stress
Exercise
Asthma can be a life-threatening disease if not properly
managed.
Within the last few years, mortality and hospitalizations due to
asthma have decreased and asthma prevalence has stabilized,
possibly indicating a better level of disease management such as
increased use of inhaled steroids.
Source: American Lung Association, Asthma & Children Fact
Sheet
Experts Interviewed
Craig Bright, president, MedQuip, Hilton Head, S.C.; Dr. Robert
D. Hoover Jr., chief medical officer, and Karen Mosholder, aerosol
product manager, DeVilbiss Healthcare, Somerset, Pa.; Julie
Jackson, group product manager of custom power, Invacare Corp.,
Elyria, Ohio; Sue Johnson, director of sales and marketing,
Convaid, Palos Verdes, Calif.; and Nancy Perlich, COTA, ATS,
reimbursement specialist, Altimate Medical, Morton, Minn.
