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.

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