Pediatrics 'not for the faint of heart'

Friday, August 19, 2016

For HME providers excluded from Medicare or just fed up with margin-free reimbursement, pediatrics might hold some attraction as a new business category. With a payment model that falls outside the Medicare realm and a patient base that dovetails with mobility/rehab, respiratory and sleep therapy, pediatrics could look like an answer for companies in need of reinvigoration.

The potential is there, market specialists say, but pediatrics involves a tremendous amount of commitment to the patient base, investment in new equipment, technical know-how and experienced clinicians. It definitely is not a part-time, adjunct side business to be added on a whim.

“Pediatrics is not for the faint of heart,” said Larry Jackson, CEO of Lebanon, Tenn.-based Permobil. “And it’s not a big moneymaker. It goes beyond being just another market segment.”

Serving disabled children requires extraordinary patience in dealing with patients and their families; thorough due diligence in dealing with Medicaid and private payers over coverage; and technical expertise in matching products to each child, especially pre-adolescents who are in their prime growth years.

“The main challenges we face surround the topics of growth, ease of adjustment portability and aesthetics,” said Christy Clover-Nalley, associate product manager of pediatrics and strollers for Fresno, Calif.-based Sunrise Medical. “When serving the pediatric community, we must also address the needs of the parent or caregiver. To best address these challenges, it takes research above and beyond the traditional needs of the end user.”

follow the leader?

While pediatrics does not bill to Medicare, the program still carries influence on the market because some Medicaid carriers use it as a reimbursement model.

“What happens is that Medicare eventually trickles down to Medicaid and that hasn’t helped the advancement of equipment,” said Chris Braun, president of Los Angeles-based Convaid.

“Pediatric equipment is different from equipment for adults and you can’t just size down an adult product and think it will work in pediatrics,” he said. “The pediatric market is much smaller than the adult market and, as such, volumes are lower and costs are higher.”

Clover-Nalley agreed.

“All the Medicaid programs that base their reimbursement off the Medicare fee schedule put all durable medical equipment at risk of further erosion,” she said.

Not all Medicaid programs are following Medicare’s lead, however. Mississippi, for instance, has expanded its coverage, said Jodie Stogner, rehab product specialist for Exeter, Pa.-based Quantum Rehab.

“Our Medicaid system has gone from not paying for complex rehab equipment for anyone over the age of 21 to now covering CRT for both community and long-term care residents,” she said. “Mississippi Medicaid has always had safeguards in place, though, to assure Medicaid recipients receive adequately matched equipment through requiring a specialist physician, a physical or occupational therapist evaluation, and requiring credentialed equipment providers throughout the process through identification of need to equipment delivery, fitting, and repairs.”

Growing pains

Due to their constant growth and their bodies being in perpetual flux, children are difficult to match with the right product. Stogner relates one of the challenges experienced by a rehab provider customer.

“The pre-teen and teen years are particularly hard to match equipment to, due to difficulties finding equipment that can match such small hip widths, but also allows for adequate seat depth,” she said. “The struggle is equipment with seat-depth widths that max out at 16 inches to accommodate a pre-teen with dimensions of 12 inches wide by 17 inches deep. The same is true for back heights in getting a narrow width that exceeds availability in the height desired.”

Tom Whelan, product manager for pediatric products at Stevens Point, Wis.-based Ki Mobility, points out another challenge for pediatric providers: finding a consistent source for all the necessary equipment features.

“There isn’t one manufacturer that has every product feature option needed to meet the needs of an individual patient,” he said. “So providers have to know many different manufacturers’ products and how to combine them to properly serve the market. Those that are able to do so effectively are recognized for this and often distinguished themselves in the market giving them greater market share.”

changing mindsets

Advancing technology in today’s pediatric environment means thinking beyond conventional wisdom regarding a child’s physical and mental development, Jackson says. In Permobil’s case, it concerns creating power mobility for children under age five, which goes against popular opinion.

“We understand there is pushback to put a young child in a power chair, but the sooner you can get children in any independent mobility device, it helps them develop their brain function,” he said. “Many therapists who are enlightened are pressing for this. It takes a lot of education and it is a slow process to change the mindsets.”

One way Permobil is leading the crusade is by sponsoring workshops for GoBabyGo, a unique program at the University of Delaware. Founder Cole Gallaway’s desire to give toddlers “freedom and independence” led to a movement that provides small, simple little cars for youngsters to experience. Volunteers at regional chapters across the country have been building the miniature vehicles, designed to give children their first experience with motorized mobility. The price is roughly $100 per car and $100 for modifications. Gallaway says pediatric providers should see the program as an opportunity.

“The value for DME is to get involved with this—not as a business segment or product line, but as an environment for them to be seen as part of the pediatric clinical community,” he said. “They are part of the process by interfacing with the community.”