The Impact on Service
In an industry where service is so important, the decision for HMEs to implement non-reimbursable asthma care management plans is a difficult one. As reimbursement cuts keep coming, dealers need to decide what the best business practices are for them. Since the HME industry operates on a paid-for-product basis, each individual dealer may have to decide to cut extra services, even though they make good business sense.
HME companies that specialize in respiratory have some form of client education when it comes to asthma. In fact, many have a respiratory therapist (RT) or nurse on staff for client in-home visits or perhaps a business relationship with a physician that has an in-house nurse.
The Centers for Disease Control and Prevention (CDC) estimates that 20.3 million Americans report having asthma. As one of the fastest growing diagnosed diseases in the country, health care professionals and asthmatics are looking for ways to manage the disease and its symptoms.
Gene Andrews, B.S., R.R.T, R.C.P., and president of Hytech HomeCare and Pharmacy, Mentor, Ohio, said of his experience with treating asthma clients, "They needed to know their medications and what they were for, how they worked, and they needed to know the things that triggered their asthma."
Asthma care or asthma disease management plans can give asthmatics control over their asthma and asthma-related symptoms. A typical plan can be broken up into four
1. Education for the client and their caregivers. This can include teaching the asthmatic client how to recognize the triggers that bring on an asthma attack, questions to ask their doctor and tips for smoking cessation.
2. Self-Management. Each client needs to manage their own asthma symptoms. These tools including learning how to use a peak flow meter, learning about medication options such as daily and spacers, and how to manage indoor allergy triggers such as mold and pet dander.
3. Monitoring and Assessment. Clients also need to learn how to monitor their asthma. An asthma management plan would help determine what equipment (such as a nebulizer) is right for the client, maintaining a medication regimen and symptom assessment.
4. Physician/Provider Communication. The final step involves supporting a total plan of care for the client.
-Provided by AirLogix.
Having such a plan in place can empower clients to manage their care at home, reduce their number of hospital and doctor visits and allow for traceable data.
Private disease management companies serve various health plans across the country and contract with health plans to manage a specific population of asthma patients. The majority of disease management companies get involved at the program level, as opposed to the HME companies that get involved at the patient level, to help patients and physicians follow asthma guidelines.
"It's really an extension of a physician's office, in that it helps the patient and the physician in two ways, we help do patient education, also give physician feedback," said Pamela Fry, director of corporate development for AirLogix, a disease management company in Dallas.
Insurance companies can construct in-house management plans through private disease management companies or participating physician groups. CDC figures show that in 2000, there were 10.4 million asthma-related outpatient visits to private physician offices and hospital clinics, 465,000 asthma-related hospitalizations and 1.8 million asthma-related visits to emergency departments nationwide.
It is no wonder that insurance companies would seek ways to save on the estimated $14 billion annual asthma bill in the United States.
"The American health care system was designed to react to patients who seek out care, and does not facilitate organized monitoring and follow-up," said Susan G. Millerick, Aetna spokesperson. Based on its own book of business, Aetna estimates that asthma care accounts for an estimated 6 percent of medical costs.
"Aetna's disease management programs help patients understand their condition and their doctor-prescribed treatment plan. By supporting physician-provided care, these programs engage patients in managing their own care, help them feel better, and result in better quality of life," Millerick said.
Yet respiratory dealers across the country are doing fewer and fewer formal disease management programs. Tim Pontius, president and CEO of Young Medical Services in Maumee, Ohio, attested to his company's program slipping away. "I think there's validity in an asthma management program, we would love to continue doing it, but the fact of the matter is we are doing less asthma management than we did five or 10 years ago."
It seems that dealers would be naturally suited to the role of asthma provider. They're already in the trenches delivering oxygen, setting up systems and assessing homes for wheelchair access improvements. "The bigger step, and why the insurance companies were buying into it, was the logic that someone would give better education about the disease and actually have an in-home environmental assessment," Andrews said. "As time marches on these companies are just going to say, 'We can't afford to do the service.'"
Reimbursement cuts are truly impacting the service component of HMEs. Brian Groskopf, category manager of respiratory for Omron Healthcare said the manufacturers are functioning as a vehicle to keep costs down. "The DMEs are looking at the bottom line, they're trying to get their costs down as much as possible," he said.
Although each dealer will have to make the decision about providing asthma management information to their clients, there are advocates fighting in Washington to allow the service portion of an HME business to become reimbursable.
"If we're being pushed back to being equipment jockeys, we're being pushed kicking and screaming, because we're not going quietly," said Pontius, who has been working with AAHomecare in support of the COPD Caucus . He believes that many of the problems in the industry today, including reimbursement for services such as asthma management plans, can be managed under the COPD Caucus. "This may be the vehicle that we all need to understand that we need to be in over the next 15 years to truly manage the escalating health care costs in this country. COPD and asthma being the two primary diagnoses that payers are spending more and more on?the fact is the prevalence of the diagnosis of those two diseases is going to increase, so how do we control that?"
"The larger issue is, the United States needs to invest more in these homecare services and therapies," Reinemer said.
Moving Forward
Fry suggests HMEs plug into partnerships with their physicians or provider groups and discover the pulmonary group in their area, a practice becoming more popular as the industry moves toward performance-based physician pay. For doctors treating asthma, this means adhering to the Global Initiative for Asthma (GINA) guidelines, Global Strategy for the Diagnosis and Management of Asthma.
"The physician is now being measured on meeting the GINA guidelines, and if the HME can help him meet those guidelines in some way, they build a stronger partnership," she said.
HMEs can make their mark in the asthma field by simply having the right products such as nebulizers and peak flow meters. Technology has allowed asthma products to become smaller and more portable, and drug delivery is becoming more sophisticated.
"Trends in medicine dictate how equipment trends go," said Dave Henry, RRT, DeVilbiss respiratory education coordinator for Sunrise Medical. "I have been in the industry for over 30 years and expected compressor nebulizers to drastically decrease or be eliminated. This has not happened because compressor nebulizers have their place in treating patients with asthma and other related respiratory illnesses. So the need for this therapy will continue to exist."
Additional product lines that sometimes are overlooked in the asthma arena are those designed to treat allergy symptoms. The American Academy of Allergy, Asthma and Immunology's Web site reports that more than 70 percent of people with asthma also suffer from allergies, and 10 million Americans suffer specifically from allergic asthma.
Allergies have been named as possible reasons for the world's rising asthma rates, which increase the risk of developing asthma. Allergy products such as pillow covers, and sheets that minimize dust mites and air filters fit in on asthma dealer's shelves.
For those HME dealers interested in expanding their respiratory services, the National Asthma Educator Certification Board offers the AE-C® certification. The exam is available to licensed or credentialed health care professionals, and to those who have at least 1,000 hours of prior experience. Visit www.naecb.org Training courses are offered from the American Lung Association Visit www.amalung.org and from the American Association for Respiratory Card (AARC) Visit www.aarc.org
Pediatric Asthma
Centers for Disease Control and Prevention:
More than 14 million school days are missed annually due to asthma. Asthma is also the fastest rising diagnosed disease among children under the age of 18.
8.9 million children under 18 have been diagnosed with asthma.
In 2002, 4,261 people died from asthma; 187 were children under 18.
National Heart, Lung & Blood Institute:
Among children up to 4 years of age, asthma prevalence increased 160 percent, from 22.2 per 1,000, the lowest prevalence among any age group, to a 2-year average of 57.8 per 1,000 in 1993-94, the second highest prevalence behind children ages 5 to 14.
The prevalence among children ages 5 to 14 increased 74 percent, from 42.8 per 1,000 in 1980 to an average of 74.4 per 1,000 in 1993-94.
Pediatric Asthma Resources
Asthma Moms: Visit www.asthmamoms.com
Mothers of Asthmatics: Visit www.aamna.org
Pediatric Asthma Guidelines: Visit www.aaaai.org
Mothers of Asthmatics: Visit www.ginaasthma.com.
This article originally appeared in the June 2005 issue of HME Business.