Diabetes market: It's a study in contrasts

There are few, if any HME product categories as mercurial as diabetes. On one hand, the disease remains prevalent and demand for related products is strong. On the other, difficulty in billing for products such as therapeutic shoes can cause problems for providers serving the market.

Ultimately, category specialists say success in this delicate business is possible, but that providers need to look at all dynamics to determine the best strategy for overcoming the market's challenges.

To Stephen O'Hare, president of Roswell, Ga.-based Pedors Shoes, the main pitfalls are high claims denial rates and complying with Medicare's accountable care organization model requirements.

“The high rate of reimbursement denials have led to comparatively fewer providers in diabetic footwear,” O'Hare said. “Those providers most skilled at fitting and providing therapeutic diabetic footwear, ironically, were most affected and companies have gone out of business due to the high percentage of claim denials.”

Still, the incidence of diabetes and need for therapeutic footwear remains, O'Hare said, while “access to qualified providers has been negatively impacted.”

The ACO model being adopted by Medicare is designed to improve patient outcomes while reducing costs, which O'Hare acknowledges are admirable goals.

“However, once you factor in the additional responsibilities as they relate to compliance and the process of reporting accountability, an additional layer of cost is added back in,” he said. “I'm uncertain of how the quality of care and outcomes are measured for people with diabetes, so it's difficult to know whether the products and services can be interpreted as improving their lives. Perhaps it does for those patients with access to the care, but my guess is there has been a drop in overall access. Efficiency-driven initiatives will inevitably impact service coverage, especially in rural areas, where diabetes incidence is highest.”

Bobby Kanter, CEO of Milwaukee-based Anodyne Shoes, agrees that the seismic shift from volume-based to outcomes-based care represents an increased burden for providers, but that therapeutic shoes are also part of the solution.

“In order to proactively reduce healthcare costs and treat patients, preventative types of treatments and products, such as diabetic shoes, are going to continue to become more important,” Kanter said.

Moreover, diabetes is “absolutely a strong market for HME,” he added. “What we're continuing to see as far as diabetic footwear is concerned, is that podiatrists are more and more referring their patients to HME providers because they don't have the office infrastructure to handle the burdens of the therapeutic shoe claim.”

Overlooked products

As a chronic disease with multiple comorbidities, diabetes touches a wide range of product categories that often escape notice because there isn't an apparent connection. As a result, there are devices and equipment that are being overlooked by healthcare providers, said Shannon Madden, marketing manager of therapy for Chattanooga, Tenn.-based Richmar.

“There is always room for improvement and innovation to serve patients better,” Madden said. “Feedback from caregivers on the problems their patients face is important to drive improvements and innovation. Just as important is caregivers actively seeking out what already exists in the marketplace.”

For example, he said Hivamat Deep Oscillation Therapy is a highly effective treatment for lymphedema, commonly found in diabetes patients.

“Despite clinical evidence for its efficacy and being available for 25 years, Hivamat is barely known outside of athletics,” Madden said. “It could be the bias of 'it's what we've always done' that causes caregivers to shy away from trying new treatments and technologies, the same way it does in other fields.”

Patients with diabetes are also more likely to develop infections, with significant risk for mortality from infections caused by Gram-negative bacteria, Madden said.

Electrotherapy is an effective solution for diabetes patients suffering from peripheral neuropathy.

“Improving methods of infection prevention for a patient demographic that is known for its susceptibility of infection is an obvious choice,” he said. “Integrating infection prevention measures into products that are already used in conjunction with diabetes patient care is an easy way to mitigate the risks of infection without altering the practices of the clinician.”