Positive Partnerships
In business, they say relationships are everything. Have you ever wondered how you might build your business with one simple relationship? Getting to know your local wound, ostomy and continence nurse could just be the ticket. How can an affiliation between a specialized clinician like the certified wound, ostomy and continence nurse (CWOCN) and the durable medical equipment (DME) provider work to increase sales? Let's unravel this link and find out who benefits and how it is done.
The patient or customer enters into this liaison with the need for supplies and equipment, and is the reason for the association. The DME provider is a resource for the CWOCN and is essential for supplying the patient with the necessary equipment and dressings for the home upon discharge. It may sound simple, but how do you make it effortless so that business goes smoothly and everyone wins?
First, let's define a WOC nurse's role. A WOC nurse specializes in skin, wound, ostomy and continence care, arguably three-quarters of your business. She has completed coursework and graduated from an accredited school and often has passed a board certification test. These professionals can be found all over the health delivery spectrum and can offer the perfect connection to your patients and business. The CWOCN follows their patients closely and has contact with the nurses, case managers, social workers and the nursing units where the patients receive care. This gives them a fair idea of when the patient may be discharged, what type of insurance they have, and what needs they will have upon discharge. Questions such as, "Is this patient going to need ostomy pouches, dressings, advanced wound care products, compression therapy, a bed, or a pressure reduction or low air loss mattress?" need to be answered. Armed with this information, the CWOCN can contact the DME, or refer the social worker or caseworker to the DME. Planning ahead in this way assures that the products that the patient will need will be available the day they are discharged. This arrangement puts the patient at ease knowing they will not have to shop for supplies or become instant experts on medical equipment. The staff feels confident knowing the patient has what they need to continue care in the home.
Because they are acutely aware of the products available for home use, the DME may suggest an item to the CWOCN for the patient going home. This collaborative work is advantageous to the patient since DME providers work closely with home care products while the CWOCN is familiar with hospital products. In my own practice, many times it has been to the patient's advantage that the DME provider suggested a different product to me because they know home care products, reimbursement issues and have access to newer more innovative products.
The DME provider offers reimbursement knowledge and keeps up with the latest in Medicare Part B and Medicaid billing, another valuable service to the WOC Nurse. This is a complex process and usually requires that the DME employ someone to handle the billing and reimbursement process. This is something that could be advertised directly to the WOC Nurse. A group that sometimes falls between the cracks are those without insurance, the indigent, lacking public assistance. There are 45 million people in the United States without medical insurance. These people need products when they are discharged from the hospital. How on earth can we supply them? The DME provider can be very helpful here. Occasionally, the DME will provide lower cost supplies for these patients so they can afford to purchase them or they will allow them to pay over time for their supplies. In my own practice, I had a phone message the other day that actually started out, "This is so and so from such and such DME. Would it interest you if I could get free supplies for your patients?" This is a call that will tweak the interest of all CWOCNs and is sure to get a quick call back to the DME provider.
Knowledgeable DMEs also will send patients free products for trial if the WOC nurse suggests. In my own practice, I recently had a patient call me about some colostomy problems she was having. Ordinarily, I can send these patients to a medical supply company in a neighboring state, but she did not have anyone to drive her there. I was able to contact my representative for a link to their retail office that would send her several different types of pouches so she could try them and find one that she could use. A toll-free number was also given so that she could call them anytime with questions. After the patient was able to find a pouch that would work for her, she could have a local provider order them for her or she could mail the order. All this was free for the asking?a value-added service that helped the client and the WOC Nurse.
In my own practice, we have industry representatives who come into our wound clinic and also visit local DMEs. They communicate which products they will leave with us in clinic so they are stocked by the DME for our patients to purchase. One of our local DMEs calls our clinic periodically to see if we need him to handle anything specific for patients, product issues, reimbursement challenges and the like. Now, that is going the extra mile. On the other side of the coin, one of the major local providers of ostomy supplies decided to quit handling certain products and did not notify either of the WOC nurses in town. This lack of communication has proven to be quite a dilemma and could have been avoided with straightforward contact. Unfortunately, a strong relationship had not been developed prior to this incident.
Another service offered by some DMEs is to have a registered nurse on their staff. This provides a clinical liaison for the WOC Nurse. Imagine this scenario, the CWOCN tells the DME what the patient is using in the hospital and the RN then goes out and does an assessment on the patient. This way the supplies get to the patient faster because the RN knows what equipment the DME stocks and what the hospital has been using. They can then find the exact product match or cross-reference to the correct home care products, assuring they are there when the patient arrives home, saving the patient time and the stress. This service provides the WOC nurse with peace of mind knowing that the correct dressings and wound care products are in the patient's home for continued care.
Select DMEs that carry specialty beds, mattresses and cushions offer pressure mapping of these support surfaces. This can assist the WOC nurse in several ways: It can help in determining if the support surface or cushion the patient is using is giving effective pressure reduction, offer assistance in the selection of new products for the facility, and increase the patient's and staff's knowledge and compliance by demonstrating correct pressure relief. Another value-added tool that WOC nurses treasure are ongoing staff education on products they offer, like support surfaces. This additional education assists the CWOCN immensely. Staff enjoy hearing information from an outside source because it is usually presented in a novel manner. CEU programs are an added bonus.
DMEs have the potential to create good will between the hospital staff and the WOC nurse by developing rapport with both. When delivering products to the patients in institutions, they assist the staff in the application of the product, working as a team. Stopping by the WOC nurse's office just to check to see if everything is going alright also creates a camaraderie that supports a good relationship. In my own practice, I have developed close friendships with some of my best DME providers. Knowing the DME provider is available, at least by phone, is very comforting to the WOC Nurse. Sometimes questions come up about products that require a quick answer. In my own practice, I have the cellphone numbers of many of my representatives and DME providers. This fosters a relationship of trust and makes the DME provider indispensable.
The DME provider would be well advised to screen their products thoroughly, perhaps employing the skills of a WOC nurse. WOC nurses are a unique group of specialists and will ask many complex questions. One DME representative told me that he always makes sure his products are worthy of a WOC nurse's scrutiny before he makes a presentation to them because he respects them too much to waste their time. What a huge compliment. As you see, this synergistic relationship works both ways.
Sometimes all does not work perfectly. For one reason or another, the WOC nurse or the DME provider may not be fully aware of what the other has to offer or what the patient's needs are in time to help. It takes planning and relationship building to provide for the patient in time for discharge. Once in awhile the WOC nurse gets a hurried call from someone needing a piece of equipment because a patient is being discharged home unexpectedly that day and it is 4:30 p.m. on a Friday afternoon (how's that for a dismal picture?). There is no way the WOC nurse or the DME provider can do anything to solve this dilemma immediately. But, they can all work together to make due until Monday so the patient can be discharged and function in the home with some supplies. This is reality and I've seen it happen in my own practice. When the relationship and commitment are there, the team does not fail to pitch in to assist. It is so important to lay the groundwork and keep it maintained and reliable for these moments.
So, make the call, send the e-mail, ask them to lunch, and schedule appointments to get to know your local WOC nurses. Who knows, you just may see increased outcome, profits and friendships. After all, I experience it my own practice every day.
This article originally appeared in the May 2004 issue of HME Business.