Not Child’s Play

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.

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.