In the United States, hundreds of thousands of malnourished children and adults require life-sustaining enteral nutrition (EN) to receive necessary nutrition and hydration. EN refers to any method of feeding that uses the gastrointestinal tract to deliver the nutrition. EN is provided via tube feeding and/or oral nutrition supplements (ONS) and requires disposable supplies for administration.
Individuals requiring EN often have a variety of medical conditions and may need EN on a temporary, long-term or life-long basis.
Navigating from hospital to home with an infant or child who is at high nutrition risk can increase parents’ stress in an already overwhelming transition. Balancing the day-to-day care of a pediatric patient who has a medical condition and is at high nutrition risk can be overwhelming. Many parents and guardians are looking to resolve their child’s feeding issues, and in some cases, transition from enteral to oral intake as safely and quickly as possible while also achieving target growth and development milestones. Durable medical equipment (DME) and home medical equipment (HME) providers can be a great support system for these families, because they can potentially reduce expenses and pressure by providing insurance coverage, allowing convenient, consistent access to supplies, and providing the possibility of on-site clinical for troubleshooting and or support.
The varied coverage landscape across the United States causes barriers to nutrition access for many EN patients. Some caregivers will not be aware of access and reimbursement nuances, which can leave HME providers in a position to offer education. HME companies, like other health care entities, are immersed in their local and greater communities, making them more able to understand the intricacies of EN insurance billing. Many caregivers of EN patients become well-educated on access out of necessity and support each other within social and advocacy groups. As a result, many HME companies support and collaborate with these groups.
Building Out Healthy & Sustainable Pediatric Enteral Nutrition Business Models
As the bridge between prescribing clinicians and patients, HME providers who take on EN therapy can balance many workflows and ensure a sustainable business model.
DME/HME providers often work closely with the prescribing clinician to provide clinically appropriate EN to the patient, monitoring for tolerance, proper utilization, ongoing product availability and satisfaction. In addition to supplying EN products, DME/HME providers play a critical role in EN management and provide extensive labor-intensive services in sourcing medically appropriate products in a changing EN market. Providers also seek to educate end users on EN management, coordinating with prescribers on documentation and submitting claims on behalf of the end user in compliance with payer requirements.
HME organizations need to understand the reality of the EN market in order to build realistic expectations. Operationally, EN may have lower margins than other categories, but this creates an opportunity to serve a critically necessary therapy with fewer competitors. Given this unique landscape, the business owner can commit to offering therapy and seeking consistently high volume that, if billed efficiently, will allow for a potentially stable and successful business base.
Partnerships Are Key
Leveraging partnerships allows business owners to understand what resources are available when making this business decision for their service areas. The American Association for Homecare (AAHomecare) and your regional or state trade associations understand state enteral reimbursement rates and can provide insurance contracting support tools. If these partnerships are optimized, membership only expands a support network of colleagues.
Manufacturers serve as valuable partners not only to navigate product access but also to designate teams who provide several types of support, including individual product education and pricing discussions as requested. Additionally, enteral manufacturers offer other value-added services, such as continuing education courses conducted by independent key opinion leaders, coverage and access to consumer support services and bridge products. HME providers who frequently partner and communicate with manufacturers and trade associations can position themselves as experts and trusted partners in the industry, which leaves the door open for other potential product line service requests.
Optimizing business opportunities and determining whether EN is a service offering for your company is another way to support patients on their journey from the hospital to the comfort of their home.