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:
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Remember that there will always be patient needs for HME.
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Don't let the current known payment vehicle dictate how you run your business.
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Look for an unfulfilled need in your community and create a program to meet that need.
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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.
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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."
