Cents & Sensitivity

The consumer press these days is a hotbed for health information, from pharmaceutical advertising to the latest medical trends and technology. As a result, Americans are increasingly well informed about symptoms, diseases and treatments, and they are seeking solutions that will provide independence, comfort and an improved quality of life.

Three of the diseases receiving increasing attention are Alzheimer’s, chronic obstructive pulmonary disease (COPD) and obesity, in part because these patient populations are rapidly expanding. Although they seem unrelated, these diseases have another common factor: They all result in a myriad of complications that require multiple products and services over extended timeframes.

From a business perspective, this means there are a growing number of opportunities for home medical equipment providers to reach out and meet the need for help with patient and caregiver education, information for physicians, and specialized equipment, keeping in mind that the key to these markets — and all home health care — is service. Caring for Patients and Caregivers Alzheimer’s disease, which is initially diagnosed by the inability to remember recent experiences, is a devastating condition that currently affects an estimated 4.5 million Americans, according to the Alzheimer’s Association. Because of Alzheimer’s progressive nature, patients lose both memory and the ability to record new information, says Cathy Cress, MSW, president of Cresscare, a private case management agency in Santa Clara and Monterey, Calif., and author of the Handbook of Geriatric Care Management (Aspen Publishers Inc.).

“Where there used to be [brain] tissue there is just white plaque, and that affects all parts of the brain, including the parts that affect the ability to ambulate,” Cress describes. “As the disease progresses and more plaque appears, ambulation becomes more difficult, and at the very end of the disease, a lot of Alzheimer’s patients are completely bed-bound.”

Once diagnosed, an Alzheimer’s patient is expected to live an average of eight years, although some may survive for up to 20. At present, Cress says, 70 percent of Alzheimer’s patients are cared for at home, and they require a variety of home medical equipment products to remain functional for as long as possible, and to remain safe.

The first step is an in-home assessment, says Anne Llewellyn, RN.C, BHSA, CRRN, CEAC, co-founder and vice president of Professional Resources In Management Education Inc. (PRIME), a national health care education company in Tamarac, Fla. Llewellyn, who has more than 15 years of experience as an independent case manager, says a good assessment includes an evaluation of the patient’s safety and functional status to determine what adjustments are needed in the home, from lighting the hallways to installing grab bars in the bathrooms.

Because some Alzheimer’s patients “wander,” the home assessment should also include appropriate placement of locks, barriers and alarms, stresses Cress. Patients in late stages of the disease, on the other hand, may be chair- or bed-bound and require transfer devices or pressure-alleviating products such as cushions, pads or other support surfaces.

Since the disease follows a unique path with each individual, a wide range of complications can increase the necessity for an assortment of products and services — and there is no way to predict what a caregiver’s role might involve. While the need for assistance increases as time goes on, feeding, grooming and bath safety products, for example, can enable patients to delay complete dependence on caregivers and make feeding and bathing times less stressful.

A home assessment will highlight the need for specific supportive measures, says Cress, who notes that HME providers should work with geriatric care managers to educate them about available products.

“The first step HME providers need to take is to understand what geriatric care managers do,” she explains. “The second step would be to actually market to them, because a case manager focuses on the continuum care — including home care products — and then becomes a conduit from the various parts of the continuum to the family.” Educating Patients, Informing Doctors COPD is another costly disease — in terms of dollars and quality of life. An estimated 30 million Americans have the disease, which is characterized by obstruction of airflow and gradual loss of lung function, although only 16 million adults have been diagnosed.

Since there is no cure, the goal is to provide treatment that will improve lung function, reduce symptoms and enhance the quality of life of those affected, according to Rand Sutherland, MD, MPH, a physician at National Jewish Medical and Research Center in Denver. “Optimal treatment involves a combination of health care maintenance, drug therapy and non-drug therapy,” he says.

Sutherland explains that drug treatment primarily includes inhaled bronchodilators (short- or long acting) and, in some cases, inhaled corticosteroids. Appropriate non-drug therapies include pulmonary rehabilitation, supplemental oxygen and, in very severe cases, lung volume reduction surgery or transplantation.

For HME providers who are willing to focus on this population, there is an opportunity to use education to produce positive outcomes. Those who offer such programs say when you improve patient outcomes, you also demonstrate the validity of the services you provide.

“You actually have to be able to benchmark yourself against other providers around the nation,” explains Harold Davis, CEO of Baker Medical in Conway, Ark., and clinical consultant/respiratory specialist for Nationwide Respiratory, a division of VGM. “That type of information is going to give providers the fuel to go back to the [physicians and payers] and say, ‘Our program does pay off. It does help patients and it will help decrease overall medical expenses with the patient,’” he says.

One of the benefits of a COPD management program is the respiratory therapist’s ability to survey the patient’s living environment and make recommendations regarding equipment needs.

“The point is not to be task-oriented, but practitioners need to turn their attention to the patient, the care of the patient and the disease the patient has. We are the eyes and ears of the physician in the home,” stresses Davis. “It has been very successful to take this information back to the physician.”

For example, Davis says physicians may not know their patients are sleeping in recliners (due to their inability to breathe) or having to walk all the way across the house at night to go to the bathroom. These are patient care issues that can affect their patients’ well being and activities of daily living.

The one-on-one contact that comes from COPD management programs can be vital. “The main reason COPD education is so important is because so many patients actually reject the fact that they even have a disease, and that the longevity of their life depends on how well they treat themselves today,” says Tim Safley, RCP, RRT, MBA, director of respiratory development for Greensboro, N.C.-based Advanced Home Care.

“Part of COPD education involves informing those on oxygen that they are actually treating their heart as much as they are treating their respiratory problems,” Safley explains.

The company’s COPD management program looks at the whole person, from medication utilization to activity levels (see sidebar on page 30). Safley says providers must consider the costs of such a program, but they should also consider the rewards. “It is certainly a marketing tool that brings in more referrals,” he says. “It is supply and demand: Yes, it’s going to cost us more, but in the long run if we get more patients, then it’s going to make us more.” Expanding Opportunity The number of Americans who are considered obese continues to increase. Approximately 127 million U.S. adults are overweight; of those, 60 million are obese and 9 million are severely obese, according to the American Obesity Association.

Michael Dionne, BS, PT, founder of Choice Physical Therapy Inc. in Gainesville, Ga., says the vast majority of bariatric patients are between 350 and 500 pounds with some level of mobility, but that home care providers are beginning to get calls for patients “of very significant size” more frequently.

“Home health providers are definitely going to see more of [the bariatric] population, and that is a factor when considering what services will be available,” Dionne says. He adds the products that will most often be recommended are walkers with rated weight, walkers with seats and walkers that can accommodate oxygen tanks, since hyperventilation syndromes dominate the population of size.

And, he notes, the health effects of obesity are broad. The AOA says there are more than 30 medical conditions associated with obesity, primarily diabetes, coronary heart disease, high blood pressure, respiratory conditions including obstructive sleep apnea, and osteoarthritis.

Manufacturers also face difficult demands in addressing the market.

“It is a challenge to develop products that accommodate all the needs for a bariatric client for a specific weight capacity,” explains John Lescher, bariatrics product manager for Invacare Corp., Elyria, Ohio. “For example, you may have one client who weighs 600 pounds and may hold his or her weight in the lower extremities such as the legs or calves, and then you may have another client who weighs 600 pounds but may hold the majority of his or her weight in the upper extremities. Keeping this in mind, it’s a challenge when developing widths, depth and comfort in products for the bariatric client.”

But the fact that the government has recently recognized obesity as an illness is a step that should eventually garner the industry more reimbursement for bariatric products, says Lescher.

Product development has certainly increased over the last several years.

“The point of a lot of these devices ties into giving [patients] a tool that allows them to be more independent,” explains Patrick Meeker, PT, MS, clinical applications manager for The ROHO Group, Belleville, Ill. “In a lot of major cities you are starting to see bariatric centers developing. If you become a provider that specializes in bariatric equipment, you are probably going to get a lot of referrals from those facilities — and you are probably going to get a lot of referrals for other things as well,” he says.

Lescher urges providers to develop an understanding of the specific needs of obese patients and the specialized equipment these customers require. And, he advises, “[Providers] should also advertise. If their facility specializes in bariatrics or sells bariatric products, then advertise that. I’ve walked into a lot of [showrooms that] sell bariatric products, but I wouldn’t have known that unless I went through and really looked.”

Meeker mentions sensitivity as another important factor in developing success in this market. “As a professional, you must leave your stereotypes in the car — you have to treat everyone the same,” he says. “You have no idea if that person has been to three specialists, just had a surgery and is really changing his life around, or if he couldn’t care less about how big he is and is coming in for equipment because someone is going to pay for [it].”

Lescher agrees. “Everyone deserves the same quality of care,” he says. “Manufacturers, providers and clinicians need to be very sensitive to the needs of bariatric clients, both physically and mentally.” Sensitivity Makes Cents Although very different diseases, Alzheimer’s, COPD and bariatrics offer opportunities for HME providers to develop new clients or expand business with existing patients. But growth in these areas will take a well-thought out plan that, along with products, includes education and customer service — and one that addresses promotion and marketing so referral sources and consumers know company capabilities.

For example, have you offered your services as a resource for local Alzheimer’s support groups, or made your company known to the area chapter of AARP? Do the consumers in your town know about the specialty products, like bariatrics equipment, that you carry? Do you offer home assessments for bariatrics patients or those with Alzheimer’s? Have you developed a COPD management program? Are you capturing the caregiver market? When customers come in for a specific product, do you listen to them to find out how other products you carry might help?

Understanding each disease, and the products and services that relate, will show referral sources and their patients that you are the expert they can rely on. For providers who are willing to work at it, developing sensitivity in these markets can make cents. PULL QUOTES:

“A [geriatric] care manager focuses on the continuum care — including home care products — and then becomes a conduit from the various parts of the continuum to the family.”
— Cathy Cress, MSW, president, Cresscare

Becoming the ‘Go-To’ Guy Are you marketing to the geriatric care managers in your area?

According to Cathy Cress, MSW, president of Cresscare, a private case management agency in Santa Clara and Monterey, Calif., that could be one of the most efficient ways to become a resource for those with Alzheimer’s disease and their caregivers. Cress says HME providers should educate geriatric care managers about home care products that are available in order to become the “go-to” source these professionals can rely on when making recommendations for their clients.

“It’s a win-win situation, because geriatric care managers need providers to keep them knowledgeable about the products, and providers need geriatric care managers to [increase their sales],” she says.

According to the National Association of Professional Geriatric Care Managers (GCM), a geriatric care manager is a professional such as a social worker, counselor, nurse or gerontologist who specializes in assisting older people and their families to attain the highest quality of life possible given their circumstances.

Geriatric care managers:

• Conduct care planning assessments to identify problems and provide solutions
• Screen, arrange and monitor in-home help or other services
• Review financial, legal or medical issues, and offer referrals to geriatric specialists to help the elderly avoid future problems while conserving financial resources
• Provide crisis intervention
• Act as a liaison to families at a distance, overseeing care and quickly alerting families to problems
• Assist with moving to or from a retirement complex, assisted-care home or nursing home
• Provide consumer education
• Offer counseling and support

The GCM’s Web site, at www.caremanager.org, offers additional information and provides a locator service.

Partnering with Physicians On Patient Outcomes At Young Medical in Maumee, Ohio, the company’s COPD, Asthma, Respiratory Education Service — or CARES program — has more than 200 patients and close to 40 physicians onboard. Its goal, says Becky Stahl, RRT, CARES coordinator, is to help keep patients out of the hospital and emergency department, teach them how to manage their disease better and, at the same time, provide them with an improved quality of life.

Young’s therapists use a standard questionnaire in conducting face-to-face visits and telephone follow-ups to determine if a patient’s overall health status has improved or worsened, and how their equipment is working. To track status, outcomes software is used to generate reports that can be sent to each patient’s physicians on a quarterly basis.

“After our initial visit, we call [the patient] every other month just to check in and see if they have any problems or questions, or if there is anything we can do for them,” Stahl explains. “Then, in six months, we return for a visit, so patients are seen at least twice a year. If we find out during one of the follow-up calls, or if they call in to us, that a visit is warranted, we will send a therapist out at that point also.”

The CARES program is marketed to physicians in a casual yet effective way, with outcomes as the focus.

“It’s a partnership between physicians, patients, therapists and the CARES coordinator with the goal of trying to keep the patient at home, free of medical emergencies, and trying to maintain the best quality of life,” says Stahl.

Looking at Total Patient Care with ‘Teachable Moment’ The goal of the COPD program at Advanced Home Care, Greensboro, N.C., is to increase patient understanding and self-management of the disease to achieve the highest possible functional capacity to promote independence.

One key to achieving this goal is the “teachable moment” — the time that Advanced Home Care considers crucial. The program offers an in-hospital educational session, an initial patient home visit for set-up and equipment instruction, oximetry testing and a phone assessment by a respiratory therapist during the first 24 hours. During the next 72 hours, the patient receives a 1.5- to 2-hour in-home assessment and further education on COPD, the equipment and supplies conducted by the RT.

The therapist also reviews the benefits of oxygen therapy to determine the best portable system that can meet the patient’s needs outside of the home. A personalized plan of care and visit schedule are then developed.

Tim Safley RCP, RRT, MBA, the company’s director of respiratory development, emphasizes that therapists working within the COPD program focus on the whole person not only by educating patients about their disease but also by teaching them breathing techniques, reviewing their medications, inquiring about their diet and nutritional status and placing a major emphasis on activity. Basically, Safley explains, the therapists are stepping in to look at everything that is happening with the patient from an objective point of view.

“We want to make sure these patients are not homebound just because they are on oxygen. The purpose of the program is to get them to get on with their lives and be very active,” he says.

Safley adds that taking the right approach is the key to success.

“We do exactly what we say we’re going to do,” he states. “The important thing in COPD is actually providing the needed follow-up and delivering what you promise.”

Compassionate Care Shapes Bariatrics Program Knueppel HealthCare Services in Milwaukee offers a vast array of home medical equipment products to customers in each of its three locations. But after realizing a void in the market, the company has made a conscientious effort to focus on the needs of the bariatric population.

For almost seven years, Knueppel has utilized a team approach for the successful discharge of bariatric patients that involves facilitating a prompt return of the patient to the home and community in a cost-effective manner.

The program also emphasizes safety for patients and caregivers while maximizing patient independence and mobility. This is accomplished by offering home inspections for equipment viability, augmented by follow-up education for both patient and caregiver.

Kevin Robison, a DME specialist with the company, leads the bariatric program and works to instill a sense of dignity in the process. The first step, he says, is to hire compassionate people.

“You can’t train an individual to have compassion — people either have it or they don’t,” he explains. “Basically, you apply the Golden Rule.”

The attitude goes along with one of the program’s goals, which is to help prevent the possibility of patient anxiety, humiliation or isolation by providing safe, supportive and comfortable products, along with complete patient and caregiver instruction and training.

From aids to daily living to patient lifts to mobility products, Knueppel maintains an inventory of bariatric equipment in stock that will accommodate its patients and their various conditions. What the company doesn’t do is separate it from the rest of their products.

“We want to mainstream it. We don’t want it segregated,” says Robison. “I can look at the patient’s order and determine that he or she will need bariatric equipment, but I don’t necessarily want to point it out to them and say, ‘We are going to take you to the chubby department.’”