In pediatrics, it's all about commitment

 - 
Monday, August 28, 2017

Before jumping into the pediatric market with both feet, HME providers need to make some important considerations about what it takes to be at the top of this difficult, but ultimately rewarding field.

Aspects that providers might find alluring – no Medicare, no competitive bidding and a potentially lifelong patient base – are countered by a heavy reliance on Medicaid, across-the-product-spectrum patient needs, in-depth involvement in the pediatric support community and a need for enduring patience and diplomacy skills in dealing with family caregivers. It is not a business segment that can be entered as a sideline.

Transitioning from the challenges of Medicare competitive bidding and provider exclusion to the political games currently being played with Medicaid is merely trading off one beleaguered government program to another, market analysts say.

“Our industry has been under a constant barrage of cuts for many years now regardless of which party is in control,” said Milena Rimassa, marketing communications manager for Torrance, Calif.-based Convaid, about the political state of Medicaid. “Cuts to any payer affects the entire payer system. Cuts to one causes pressures to providers, which causes pressures to manufacturers, resulting in fewer clinical choices for the clinician and end user. There is bipartisan consensus when it comes to cutting complex rehab and increasing regulations. The only fix is a better understanding of complex rehab by members of Congress and their staff.”

Recent attempts to repeal and replace the Affordable Care Act included nearly $1 trillion in Medicaid cuts, which ultimately led to failure, due to backlash from three Republican Senators. Yet proposed Medicaid changes remain alive at the state level, with Arkansas, Kentucky, Arizona, Maine, Wisconsin and Indiana drafting plans for new Medicare eligibility requirements and other program alterations.

Richard E. Medina, national account manager for Gurnee, Ill.-based Veridian Healthcare’s medical division, says if Medicaid cuts eventually become national policy, they will definitely impact pediatric programs.

“No funding means no Medicaid programs,” he said. “We need (bipartisan cooperation on healthcare reform) to develop a comprehensive program.”

Highly nuanced market

Pediatrics is a business segment that stands apart in HME, not only because it has a starkly different patient base, but it also features different referral sources, payers and a product spectrum that covers mobility, complex rehab and respiratory. It requires that the provider delve into the deeply nuanced specifics of reimbursement coverage, highly clinical patient and product evaluations, and broad context on disabled children’s physical and emotional needs.

“The primary factor in deciding whether to ‘get into’ pediatrics is whether or not you are committed to the sector,” Rimassa said. “Pediatric patients are not ‘little adults’ – most have unique challenges that require understanding their complete environment and the goals of both clinician and parent.”

Serving children presents some unique quandaries, like constant growth, which makes it difficult to find the right-sized products. Pre-teen and teen years are especially hard for finding equipment that matches perpetually evolving body size and shape.

Pediatric providers that properly furnish their young clients with the products and services they need while demonstrating a nurturing touch and fastidious approach to solving problems can secure that patient’s business for life. Yet it’s not an automatic development, Medina said.

“No customer is dedicated to one supplier since there is competition and displacement or simply the customer is moving away from the target area,” he said. “They also experience changes in medical needs, which includes no longer needing the services. The patient may outgrow the need for services.”

Ultimately, the way to keeping a pediatric client is the same as keeping an adult client, Rimassa said.

“The way to keep a pediatric client is with proper evaluation of needs, great service, ability to get the products funded, and honest communication with the family in regards to what is achievable and fundable,” she said.

Tech needs funding

Manufacturers are utilizing advanced technologies for new pediatric products, including upgraded electronics and wireless connectivity, so patients have access to the most sophisticated equipment available. Still, without the proper funding by payers, patients may be deprived of these advancements, manufacturers say.

“Getting payers to accept new technology is always a challenge,” Rimassa sad. “Our industry is always about continuous improvement in a product’s weight, function and style. Despite reimbursement cuts, manufacturers are always looking for ways to improve the products in way that gives more independence, comfort and active lifestyle for clients and their caregivers. Continuous education of payers is the key to getting things funded.”