It’s a Small World

You wouldn’t think that investing in a fleet of hybrid cars would have anything to do with children. But at Pediatric Home Service in Roseville, Minn., it has everything to do with them.

“Our vision-mission-goal is to take care of the medically fragile child in [his or her] home using cutting-edge technology,” says Susan Wingert, CEO of the company, one of only a few home health care/HME providers in Minnesota offering respiratory care and infusion therapy to children with special medical needs.

Three years ago, Wingert began thinking about how the company was delivering its oximeters, ventilators and other equipment. It seemed rather ironic that PHS, so dedicated to helping children breathe better, might be polluting the air with the vehicles it used to transport respiratory equipment. So, the company got rid of its gas hogs and invested in a fleet of what is now some 40 hybrid cars and trucks.

“We want to provide a legacy of environmental stewardship. We want to leave a legacy for our children of an earth that is as clean as possible,” says Wingert. “You’ve got to walk the talk. If we take care of kids, we have to do it in more meaningful aspects than just the home environment.”

The story of the hybrid fleet is illustrative of just how meticulous the provider is in its care of patients. At PHS, the kids always come first.

Partnering for Pediatric Care

Although trained as a respiratory therapist, Wingert had never worked in that end of home care. For years, she was involved in sales for a national home health care company. But when her company sold once, then twice, Wingert decided to start her own business.

It was an unthinkable situation that propelled her into pediatric home care. There were plenty of people caring for adults needing respiratory care in their homes. It was time, she decided, for someone to take care of the children. “We literally had children who had been in the hospital from the day they were born until they were 7 years old because there was no one to care for them,” Wingert recalls.

She was emboldened by three doctors.

“We had three pulmonologists who really believed that there wasn’t anyone who couldn’t be treated at home. They wanted someone who paid attention. And I did.”

Wingert and five others — all but one a care practitioner — were the staff when Pediatric Home Service opened in January 1990. Working out of a 3,300-square-foot building, they offered care for pediatric ventilator and respiratory patients in their homes.

From the beginning, the company worked closely not only with the patients and their families but with the rest of the care team. “One of the things that we do really well is work to ensure that we are partnering with our physicians, our hospitals and our payers,” says Wingert. “We talk with them constantly. We have standing appointments with our referral sources on a weekly basis.”

Early on, PHS started a database to collect clinical information. Now, if a physician calls and asks for, say, information on how many patients have been on ventilators for a year, PHS can accommodate them.

Such close partnerships have helped build the business. For example, says Wingert, “physicians told us their weakest part was managing the nutritional status of the patient.” So PHS added a dietitian to monitor children’s nutritional needs from the time they are in the hospital continuing through their care at home. “Now [the children] are nutritionally supported and are able to grow,” Wingert explains.

It was payers’ prompting that inspired PHS to add an infusion component to its business in 1997. And when payers approached the company to develop a program for working with high-risk asthmatic children, PHS again rose to the occasion. It developed a comprehensive, in-home asthma management program with service provided by RRTs who have also been certified as asthma educators. The program is designed, Wingert says, “to see if we can keep [children] in school and out of the hospital and their parents at work more often.”

PHS’ staff (“the best staff in the U.S.,” Wingert insists) has also played a major role in the company’s growth. “They bleed for these kids,” she says. When staff members recognized that they were being asked to do a lot of what Wingert calls “social service support,” they decided to be intentional about it. Now employees have resources to help find services for children and their families that otherwise might not be available to them.

“We really like to deliver care from our heart,” she says. “It’s that care that makes people believe that they are actually the most important thing in the world to us. A mom who calls about a nebulizer — that is not what we would call a high-tech piece of equipment. But to that mother, it is. She’s worried that it’s not delivering medication fast enough or in the correct amounts. But we make that mom think, in a 10-minute phone conversation, that she is the only customer we have.”

Sticking to the Kids

That philosophy and the company’s combination of services have helped PHS grow to a 130-person staff — including nurses, pharmacists, dieticians and respiratory care practitioners — operating out of an 80,000-square-foot facility.

“We have only one branch, and we have no plans ever to have more than one,” states Wingert.

She also has no plans to expand the company to include adult home care. There is what PHS calls “a clear and distinct difference between the adult technology-support patient and the infant, child or adolescent patient.” Wingert doesn’t want to dilute the quality of care by expanding the company’s reach.

“Because we specialize, because we have this very small population of patients, we can delve deeply into quality of care,” she reasons. “We make a significant investment in quality on a day-to-day basis throughout our organization — from the top down.

“We understand the complexities of dealing with these patients. We can ask ‘What can we do better?’ ‘How can we make our practice stronger?’ so that we can be the [company] people look to, the one our referral sources can depend on.”

Judy Giel, PHS’ senior vice president, clinical service, says that philosophy positions the provider well for the future.

“So many times there are unique situations [we have to deal with], and it seems like there are insurmountable obstacles to getting [a patient] home so [the child] can thrive in his own environment. But Susan’s approach isn’t ‘I don’t think we can do it’ but ‘How can we do it?’ And that spills over into the culture of this organization,” says Giel.

“We spend a lot of time on clinical education here,” Wingert says, adding that the goal is to “turn those kids’ potential into the most it can be. We listen to what the needs are and we say, ‘Let’s do it.’”

But what about things like national competitive bidding? How will PHS deal with that?

“We’ve had competitive bidding in Minnesota for over 20 years,” Wingert says with a laugh. “I’ll tell you how we deal with it — we don’t. We have plenty of oxygen delivery companies here that do it really efficiently and with low cost. Our philosophy is that we take care of a much more involved patient. We look at the efficiencies and ways we can support those families and still be respectful of the health care dollar.”

Wingert makes it plain she has no plans to participate in competitive bidding “because it would take away from our core business.” And anything that takes PHS away from kids will never fly, because at PHS, it’s all about the kids.

Company Snapshot

Pediatric Home Service

• 16-year-old home care company dedicated to the technology-dependent child, with emphasis on respiratory, chronic disease (asthma education) and infusion services
• One branch in Roseville, Minn.
• 130 employees
• In its 13th year of accreditation by the Joint Commission on Accreditation of Healthcare Organizations.
• Company Vision: “To make a difference in the life of every family we serve by taking care of the child.”