Don't overlook the pediatrics sector. It might be a small market with small customers, but the opportunity it presents to HME providers is full-grown.
"It is a well-supported and well-positioned niche of the market," says Chris Braun, president of president of pediatric mobility manufacturer Convaid. "It's not super-high-volume business, but it is a good revenue source, and there are always new developments to offer."
Pediatrics business spans beyond mobility across the gamut of home products, and growing the business depends on working closely with parents and caregivers while engaging with the community, says Braun. "It really starts with involvement with therapists and parents. As I see it, the education process involves the dealers, the parents and the therapists."
And what about the young customers themselves?
"Children today have much higher expectations in terms of color and excitement than their predecessors," says Rick Derks, vice president of marketing for Medline Industries' DME division. "We attribute this to the Internet, video games and the proliferation of ever-exciting new TV programs and movies."
The Internet is also opening opportunities for more product exposure related to pediatric equipment, adds Braun. "What the Web has done is make the information accessible to the parent or caregiver before they go to buy the wheelchair."
Light and Bright
Product design trends include use of new materials to make products as lightweight and functional as possible. In the case of pediatric wheelchairs, that means lighter-weight aluminum and alloys, composite tires and components, plastics, various types of blended materials and lightweight, washable fabrics, says Convaid's Braun.
"These products are designed so the child will feel he or she is part of his environment. They are softer but durable, and colors are designed around a child's taste, including bright colors."
While the company offers wheelchairs, strollers and mobility support, its original product, the Convaid Cruiser, is still one of its largest-selling items. The lightweight folding pediatric wheelchair has positioning features including lateral supports, thoracic controls, a headrest and elevating footrests. "The intent is to make it easier for the caregiver to take the child with them wherever they go," says Braun. Extension kits and other mechanisms are available to accommodate growth.
Medline set out to design a pediatric wheelchair that kids would feel good about, says Derks. "Wheelchairs, especially for children, should never be black and drab. That would be depressing for many children," he believes.
With elevated leg rests and flip-back arms, Medline's Excel Kidz pediatric wheelchair is also convertible into hemi-position through the use of a dual axle. "What really distinguishes the chair is the fun, bright color and the traditional smiley face woven into the back of the seat upholstery," says Derks. "Our philosophy in designing the chair was to create a fun, happy chair that is functional, safe and provides a child with the best of mobility."
Typically, HME providers use the chair as a rental for occasions such as after surgery, but Medline also suggests selling the wheelchair into hospitals, where it can brighten up a pediatric unit. "We encourage [providers] to take the Excel Kidz chair into hospitals to show referral sources, physical therapists and the orthopedic units," says Derks, because the chair "attracts a lot of attention." Medline also encourages HMEs to do direct-mail campaigns to orthopedic surgeons and pediatricians.
Design for the Little Guys
It is important to design products specifically for the pediatric market, according to those who work in the sector.
"We develop products for the infant," says Bill Thompson, general manager of Philips Children's Medical Ventures, adding that "a lot of pediatric equipment is adult equipment that has been downsized. We design from the ground up to address the needs of the babies, the clinicians and those who care for the babies."
The company's apnea monitor tracks heart and respiration activity of infants and issues an alarm if adverse changes occur. Software captures the data for monitoring. A provider can also access the unit remotely to ensure it is working properly or to troubleshoot a loose lead or belt, thus decreasing the number of trips to the home.
Providers typically supply Philips' infant phototherapy systems for jaundice management only for several days of home treatment. "Phototherapy is easy to get into, but you have to optimize your business," points out Jim McKenzie, product manager. "You have to be able to deliver the service any day and answer the issues any time."
Ease of use for such a system is critical, says McKenzie, both for the caregiver and the HME company. "The easier it is for the parent to use, the easier it is for the home care dealer," he says.
While it can sound daunting, HME providers should not shrink from the demands of serving the pediatric market, says Thompson. "The misconception is that you have to be there 24/7, and that it's a lot of work. But it's no more work than an oxygen patient who might have an issue in the middle of the night."
In July, ResMed introduced its Mirage Micro for Kids nasal mask, which is based on the design of the company's adult Mirage Micro. The kids' version of the mask comes in a small headgear size and includes a small cushion suitable for children.
"The pediatric OSA market has often been neglected because of its low prevalence, but the consequences of untreated sleep apnea in children are just as devastating as with adults, if not worse," says Bernadette McBrearty, the company's senior director of patient interfaces. ResMed was the first company to offer an FDA-cleared pediatric CPAP system with its Mirage Kidsta, says Murphy. "We understand that children with OSA have unique needs."
A central feature of the new mask is its MicroFit dial, which allows children or their parents to make adjustments themselves to find the right fit. With 24 different positions that adjust the forehead support in small increments, the dial works in combination with the cushion to enhance the seal without having to overtighten the headgear.
The Mirage Micro mask also incorporates other child-friendly features that help them adjust to therapy more easily, according to the company. A dual-wall cushion maintains a stable seal but is soft enough to reduce pressure on small noses and sensitive nasal bridges. The headgear clips, which retain the child's settings, are easy for small hands to attach and detach. The air tubing can also be attached and detached easily, a convenient feature for children who need to get up frequently in the middle of the night.
Sara Lippold, marketing manager for Responsive Respiratory, which offers a line of pediatric regulators, nebulizers and cannulas for oxygen therapy, suggests that providers should raise their awareness of the choices available to a pediatric patient. "There are a number of more kid-friendly options outside of the one-size-fits-all model that can assist to provide effective, comfortable therapy for the patient," she says.
The company's pediatric bi-flow mask, for example, offers an alternative for patients who cannot tolerate a traditional nasal cannula. The bi-flow mask provides a less invasive option, resting just under the nostrils. The cup, which has a rabbit-nose design, creates a reservoir that directs the oxygen into the child's nose.
Not Just Small Adults
"Manufacturers are beginning to recognize that the pediatric population has different needs than the adult market," says Mark Hamman, senior vice president of Minnesota's Pediatric Home Service, one of only a few home health care/HME providers in Minnesota offering respiratory care and infusion therapy to children with special medical needs. "They are beginning to change the way they make certain products."
In the past, Hamman says, "sizes only went down to small adult. There were no pediatric sizes offered, so we would adapt the smallest sizes to work with the pediatric patient."
Founded in 1990, the company has since worked to build its pediatric business through close association with physicians, hospitals and payers. Today, PHS employs 140 people and provides a spectrum of specialized in-home pediatric care and support to more than a thousand medically fragile pediatric patients and their families.
There is a misconception in the pediatric market that views children as "just small adults," Hamman says. "We work with manufacturers and payers to help them recognize there is a big difference. Children have a different set of needs with their growing, changing bodies. Pediatric patients are constantly changing, growing and are often more medically fragile."
HME providers who enter the pediatric market should know their limitations, confirms Andy Hicks, eastern regional manager of Altimate Medical.
"When you get into pediatrics, you get into the big leagues in terms of prescribing equipment," says Hicks, who has a background in occupational therapy. He notes that most providers likely don't have the expertise to supply specialized complex rehab equipment for children, which can be an expensive proposition for an HME, often requiring multiple trips to the home.
A child's growth is another complicating factor, he notes. Altimate's EasyStand Bantam stander, for example, enables multiple positions so kids can play the Wii, watch TV or do their homework, etc. Options such as trays, supports and casters can be added for easier maneuverability.
While Altimate's standers serve patients from one-year-old through adulthood, about a third of its business is in pediatrics, Hicks says. Standing is beneficial during rehabilitation, and a doctor or therapist who may be more interested in getting the patient home from the rehab hospital might overlook a standing program. "They may not have thought about the long-term health in the home. A stander improves circulation and relieves pain, and it doesn't hurt to ask a customer who uses a wheelchair if they are involved in a standing program in the home," says Hicks.
There are also opportunities for providers to work with school systems, which are looking to mainstream students with disabilities and could use stander equipment as part of an individualized education plan, says Hicks. "The school market is a very good way to get into the market," he says, adding that school therapists are a great contact.
No Easy Reimbursement
According to Hamman of PHS, payers need to be educated that children can be managed in the home.
"The care is just as safe as in a clinic or hospital, but more importantly to them, it's extremely cost-effective," he says. He adds that reimbursement levels are low due to the lack of awareness and knowledge in the differences between pediatric and adult markets.
"The reimbursement side is not getting any easier," agrees Convaid's Braun, who urges providers to make sure they have covered their bases related to medical justification.
Hicks notes there are more avenues of funding for children, such as non-profits, but agrees that providing evidence of medical necessity is still paramount.
To build business, Philips' McKenzie advises providers to concentrate on the hospital discharge function. Discharge planners, nurses or social workers are involved in making sure infants and children leaving the hospital have what they need at home.
The company's Thompson also sees opportunities for HME providers that are involved in supplying pediatric-specific technologies to expand their business into additional aspects. For example, those who provide adult enteral feeding have an opportunity to move into that business on the pediatric side.
"It's a niche opportunity," he says. "The size of the market is so small, but if you are in a metropolitan area, you will find more patients than you think."
Experts Interviewed
- Chris Braun, president, Convaid, Palos Verdes, Calif.
- Rick Derks, vice president of marketing, DME Division, Medline Industries, Mundelein, Ill.
- Mark Hamman, senior vice president, Pediatric Home Service, Roseville, Minn.
- Andy Hicks, eastern regional manager, Altimate Medical, Morton, Minn.
- Sara Lippold, marketing manager, Responsive Respiratory, St. Louis
- Bernadette McBrearty, senior director of patient interfaces, ResMed, San Diego
- Jim McKenzie, product manager, jaundice management group, and Bill Thompson, general manager, Philips Children's Medical Ventures Monroeville, Pa.
