You wouldn't think that a gelato and a cobblestone would be the
gateway to a unique new business, but that's Terry Racciato's story
and she's sticking to it.
The owner of SpecialCare, a 31-year-old home medical equipment
company in San Diego, has discovered a niche market that is gaining
traction at the San Diego airport.
Through SpecialCare, travelers can rent wheelchairs, scooters,
CPAPs and portable oxygen as well as enterals, portable enteral
pumps and even hospital beds. Everything (except for the hospital
beds) can be delivered to the traveler at the airport. When they're
ready to return home, travelers can return the equipment to
SpecialCare's office or the company will pick it up at the airport
or hotel.
"We'll even meet them at the airport, transport them [to their
flight] and then take back the equipment," Racciato says.
The five-month-old business is still in its infancy, but
Racciato believes it will one day be a money-maker. Already, it's a
feel-good endeavor.
"People can come to San Diego and still be able to get around,"
she says. "This allows them to be able to travel and see things and
not be a burden. It enables that person to really be as independent
and open to the experience as possible."
And to think it all started with a fall.
First, Go Out for a Gelato
Two years ago, Racciato, a registered nurse, and her husband Joe
headed to Italy for a three-week, belated (by 38 years) honeymoon.
For years they had worked almost 24/7 on their pediatric day care
company, Together We Grow, and their HME branch, SpecialCare, which
started in their garage in 1979 and at one time did everything
— home health, infusion, HME.
Eventually, they pared their offerings down to pediatric health
care and HME and, finally, they figured they could have that
honeymoon.
"We were going to operas and castles," Racciato says.
They arrived in Milan on a Sunday in October and the first thing
Racciato wanted to do was get a smooth, cool gelato. So off they
walked down the cobblestone street, purchased gelatos and headed
back to the hotel.
"In front of the hotel, I got my foot caught between the
cobblestone and a trolley track. I broke my foot," Racciato says,
adding with a laugh that she still held on to her gelato.
Instead of operas and castles, Racciato went to the hospital
(the only one in Milan that did orthopedics on Sunday), where the
sole doctor told her she had to go home.
"There were no crutches, no wheelchairs, nothing whatsoever,"
Racciato recalls, still surprised at how unprepared the hospital
was to handle her situation. She and her husband made it back to
their hotel — where there was no elevator.
"I am totally non-weight-bearing and I have nothing," she
remembers.
There were no wheelchairs at the airport and she had to make two
transfers — including one in Detroit — before arriving
back home. The couple missed their connection, however, and the
airline put the Racciatos up at a hotel, which also had no
wheelchairs. So the staff rolled Terry to the room in an office
chair that spun her around in circles.
Racciato took her mobility into her own hands. She called her
own company and had a wheelchair and crutches delivered to her upon
arrival at the San Diego Airport.
That might have been the end of the story, and indeed, it was
until the Racciatos decided to try their trip again.
"On July 9 of the following year, I made arrangements to return
[to Italy]," Racciato says. "On July 10, I fell and broke my
leg."
Goodbye Italy, Hello New Business
Once again, Racciato needed the aid of crutches, a wheelchair or
scooter. In less than a year, she would spend 18 weeks in a
non-weight-bearing mode.
"It was really hard to get around," she says, noting that it
"got her attention" and her sympathies were again aroused for
travelers who are disabled or become so on a trip. But Racciato is
one of those when-life-gives-you-lemons-make lemonade people.
"When something bad happens, you ask 'What social wrong or
social shortcoming can we fix that makes the world a better place?'
We started talking about what we could do to work with travelers,"
she recounts.
Specifically because of her own experience, Racciato knew there
was a void when it came to temporary HME for travelers. She
contacted the San Diego airport and made an appointment to meet
with officials there.
"I'm still on the scooter, my leg up in the air," she says,
describing that first meeting. She asked how the needs of disabled
people leaving the airport were handled.
"We take them to the curb in a wheelchair, but then they are on
their own," said one gentleman.
"What do they do?" Racciato asked.
"I don't know what they do," he responded.
That provided the perfect opening for Racciato to lay out her
plan. SpecialCare could provide equipment on a temporary basis to
travelers, whether they were arriving to tour San Diego or to
connect with one of the many passenger ships that operates cruises
from that balmy southern point of California.
"SpecialCare approached us about the need for our special needs
passengers to get their medical equipment, whether that's a
wheelchair or medical oxygen. It had not been an opportunity we had
heard about before," says Nyle Marmion, manager of concession
development for San Diego International. "But it is definitely a
service that is needed."
The airport recognized the opportunity and contracted with
SpecialCare.
"They are permitted to come on to airport property to transact
business," says Marmion, noting that most of the rentals are made
through the airport website. "They come on property, meet the
passenger at curbfront and do the exchange of equipment right
there."
Marmion says SpecialCare advertises the service on the airport's
welcome boards and at the baggage claim.
"We only see it as a positive," he says, adding that he thinks
the business will build as word gets around.
"They're getting their feet planted and they're really starting
to roll," Marmion says. "They may be on to something. They may be
able to branch out from here. When I talked to my peers in the
industry, they were excited as well."
Taking the Next Step
Already, Racciato has been approached to expand the program but
decided against it.
"We said 'No, not yet. Let's get this off the ground,'" she
says. "Like all programs in its infancy, it is taking off slowly
but steadily."
She is immensely gratified by the program, which is designed for
the convenience of patients with such things as break-apart
scooters that can fit easily into a rental car trunk.
"We think we are doing a real service for people," Racciato
says. "We are making a difference in the quality of their visit and
the quality of their lives. When you have someone coming to visit
you, say, your parents are coming into town, everybody has to go to
see them. So, if they could have this support, you can transfer
them from an airport wheelchair to a rental wheelchair and then to
the hospital bed for a week. Suddenly, their quality of visit is
much more enjoyable."
The program isn't only about wheelchairs and oxygen and hospital
beds. CPAPs are also in demand, Racciato says, particularly by
those traveling to San Diego who do not want to lug their machines
around or deal with all the issues that crop up when going through
airport security.
"We are renting a battery-operated CPAP," Racciato says. "People
call and rent it, fax their prescription, and then [they] don't
have to mess with all that security stuff." Plus, she adds, if
travelers want to go out camping or sea fishing, "the
battery-operated CPAP fits right in."
In addition to enhancing people's travels, the company's rental
program has another huge benefit: It has nothing to do with
Medicare or insurance. The cost is strictly out-of-pocket for
users.
Like all HME providers, Racciato is not immune to the industry's
immense pressures, including declining reimbursement, expanding red
tape, the threat of competitive bidding, etc.
"It's nice not to have to worry about how insurance is going to
impact this. You can just ignore that and make it better [for the
patient]," Racciato says of the program. "It takes it out of the
perspective of dealing with the financial and back to being helpful
and really making a difference in someone else's life."
While the new program is accomplishing what the vast majority of
providers are looking to do — break away from Medicare as
much as possible — Racciato isn't divorcing herself from the
government-run insurance program nor is she backing away from the
HME business because of its problems. She has learned in her three
decades of business to roll with the flow.
"The health care industry is certainly in a challenging
environment," she acknowledges. "It will try our patience and our
skill."
Increased scrutiny, reduced reimbursement, competitive bidding,
new requirements for electronic medical records, a possible medical
device excise tax — they are all looming, she knows. But she
rejects a doom-and-gloom view of the industry.
"We are so used to feeling battered and bruised we are always
waiting to react to what bad thing will befall us next," Racciato
says. "Get out of that mode! We offer a needed service, and
regardless of what they throw at us, someone will have to provide
that care at 5 a.m. when that piece of equipment fails. Why not
us?
"No matter what happens to health care funding," she continues,
"there will still be patients who need medical equipment,
especially given the demographics of our aging society … If
we give good care that is efficient and reasonably priced, we will
always have a place."
Racciato is obviously not one to give up easily. Does that mean
she's going to try to go to Italy again?
"I certainly am," she says with spirit. "I'm not giving up. And
that's going to be the best gelato I've ever had when I get
there!"
Just Keep Getting Up
SpecialCare owner Terry Racciato has weathered the ups
and downs of the HME world, and they haven't dampened her
enthusiasm in the least. Here are her tips for moving
ahead:
Remember that there will always be patient needs for HME.
Don't let the current known payment vehicle dictate how you run
your business.
Look for an unfulfilled need in your community and create a
program to meet that need.
Rather than a meaningless exercise to comply with regulations,
use your accreditation and quality improvement processes to look at
areas that you want to improve.
Increase efficiencies with such things as bar coding, electronic
medical records, routing and GPS and cross-training for employees.
These are all important strategies for success. "But no strategy is
more important than the team you put together," Racciato
stresses.
"The funny thing about success is that you merely have to get up
one more time than they knock you down."
