Providers tell referrals: ‘No service’ from catalogs

Discharging an ostomy or urological patient from the hospital with only a product catalog is like sending them on a long trip without a map, disposables providers say. Yet they contend that referral sources are doing it on an ever-increasing basis and that patients are getting lost as a result. Whether it be in the Midwest, Southeast or West Coast, disposables patients are reportedly being introduced to catalogs at the expense of providers. And it's not until they need guidance that patients make their way to the provider's shop. “It's getting frustrating to be an independent because the [enterostomal therapy] nurses are in love with mail-order catalogs,” said Derek Lovesee, president of Medical Equipment Specialties in Scottsbluff, Neb. “They find the catalogs to be very convenient.” Each year the number of patients receiving catalogs grows, Lovesee says, because providers are leaving the market and “nurses feel the pressure to go the catalog route.” Gary Miller, director of Mt. Carmel Medical Equipment in Pittsburg, Kansas, says the same development is happening in his locale. “We know the ET nurses are being heavily marketed to by catalog companies,” Miller said. “The convenience aspect is very attractive - all they do is circle the product in the catalog. They don't have to worry about the prescription or product information.” Inevitably, many patients seek product assistance on their own and that's when they contact the provider, Lovesee said. “They get no customer service with the catalog,” he said. “If they have a problem, they bring it to us and ask us to show them how to use the product. They come to us for the expertise.” Lovesee admits that he has “conflicting feelings” about helping catalog customers because he doesn't want to legitimize use of the book. “We do it because we want them to bring the business to us,” he said. “Sometimes they don't, but that's the way it goes.” Referral sources who believe that catalogs are a less expensive source of products aren't looking at the complete picture, added Scott Johnson, president of Forsythe Medical Supply & Ostomy Medical in Winston-Salem, N. C. “Those who recommend catalogs don't have a full understanding of the costs involved,” Johnson said. “Mail order companies charge freight and the co-pay is based on what they bill you. And you don't get services.” In order to counteract the influence of catalogs, some providers are taking the issue back to the referral sources. For Valencia, Calif.-based Shield Healthcare, it means ratcheting up its proactive marketing in area hospitals. “Our sales reps cover all the hospital departments, from ET nurses to discharge planners and to a lesser degree, surgeons,” said Marketing Manager Todd Smith. “We let them know that if providers leave the market [as a result of catalog proliferation], they will be faced with a limited number of choices.” The catalog conundrum plays out a little differently in western Indiana, where Lynn Hostetler, CEO of Lynn's Pharmacy and Medical Care, says the television airwaves have been blanketed with advertising for the product guides. “It is TV ads - not hospitals - that are pushing catalogs, and it has caused the market to shrink,” said Hostetler, whose store is in Brazil, a small town near Terre Haute, Ind. “It hasn't hurt me because I'm getting business from some of my competitors that have since gone away.” Up the road and over the border in Danville, Ill., Steve Gulick says catalogs haven't made an impact in his market and expressed disdain for the concept. “I can't believe it's an issue in other places,” said Gulick president of Gulick's Illiana Home Medical. “Ostomy is such a sensitive, personal market. We have to work closely with every patient to set them up correctly. We have a 45-year pro on staff who makes sure of that.” Providers say they find it especially ironic that so many referral sources recommend catalogs when not many clinicians are well versed in product details. In some instances, it is precisely that lack of knowledge that keeps the traditional channels open, however. “We get a lot of doctors who not only don't know about the products, but they don't want to know about them,” Johnson said. “They consider us their competent source for these products. And we've built our business on it.” Likewise, Hostetler says he has found healthcare professionals to be “clueless” about disposable appliances. “They don't know what they're doing - I've had patients come out of the hospital with 12- and 14-inch bags,” he said. “We try to be a good resource to them and rely on word of mouth from the patients.” Gulick added that clinicians shouldn't be expected to keep track of the myriad products in the disposables line. “There are 400-some different items between pouches and add ons,” he said. “We have been doing this for a long time, so we're well equipped to help patients find the right products. It's our business and that's why people come to us.” The provider community has long complained about substandard insurance coverage for disposables, whether it be for Medicare or private insurance. Adding to the uneasiness over assignment consideration is the vulnerable condition of the patients, providers say. So working out payment arrangements for patients is yet another value providers bring to the equation, they say. “This is one of the rare times when nurses ask about the price first,” Miller said. “If a patient needs a closed pouch and it's not covered, we sit down and talk with them. We help them apply for assistance if they need it, and we do some charity care. We don't waive anyone - we put them on a scale and see where they stand. If we can't do anything for them, we refer them to someone who can.” Miller then added: “I don't see the catalogs doing that.” HME