HME Goes on the Road

• By David Kopf
• Jan 29, 2008

Serving up travel expertise and products could open new opportunities for providers
We Americans love to travel. By planes, trains and automobiles, we definitely get around — and that includes your patients. HME customers are no longer satisfied with mainly living in their local area. They want to hit the road and live life to the fullest.

And who can blame them? Life doesn’t stop with disability and enjoying life means getting out seeing the world. Besides, addressing increasing requests from patients for help with travel gives HME providers a tremendous opportunity to tap into providing new service and ways to cement patient relationships.

Two key product categories that can help providers do that are portable oxygen concentrators and auto access. Patients with limited mobility or respiratory conditions are two customer groups with some of the greatest travel needs, and helping them hit the road could create customers for life.

POCs: Cutting the Leash
For oxygen users, travel has historically been a dream more than a reality, as many users were essentially tethered to their homes because of past oxygen equipment’s limitations.

“LOX and GAS portable systems store a limited amount of oxygen, which curtails the amount of time available for ambulation,” says Bob Jacobson, vice president and general manager of the Medical Products Division of AirSep Corp. “This is a big concern for patients; will they run out of oxygen before getting back home? Travel is not really practical or possible with these systems that hold a ‘limited oxygen supply.’”

But then along came portable oxygen concentrators, which cut that leash.

“Almost all patients have special family and other social events that warrant the need to travel with the freedom that only POCs can provide,” he says. “Reunions, weddings, anniversaries, and other beloved, once-in-a-lifetime events are often missed by many oxygen patients due to the difficulties, logistics and fears of running out of oxygen when they do not have access to a POC.”

In a nutshell, the key benefit of POCs for oxygen travelers is that they make, and therefore provide, all the oxygen for a traveling oxygen patient without the need to coordinate “arranged” and expensive oxygen deliveries while traveling, according to Jacobson.

“POCs give oxygen users the independence to travel without worrying if they have enough tanks to last for the trip,” says Celeste Belyea RRT, RN, AE-C and the editor of The Pulmonary Paper, a not for profit organization that for 20 years has published a nationwide newsletter geared toward educating and supporting patients with chronic lung disease.

From the airport to the aircraft, during connections and layovers, and at the destination, POCs provide oxygen users with a seamless approach to travel, Jacobson says.

“POCs allow the freedom to just go,” he explains. “It’s unlimited ambulation, while taking advantage of multiple power sources available during travel. The simple benefits and unique advantages of staying out longer, taking trips and enjoying spontaneous overnighters, while eliminating the anxiety and fear associated with running out of contents are achieved only for oxygen patients who have access to portable oxygen concentrators.”

“They all plug into the power outlet in the car to conserve battery time while driving,” Belyea says. “CPAP users can even use the SeQual at night.”

That said, the independence POCs helped usher in wasn’t overnight. It was a steady evolution, Belyea says.

“When AirSep Corporation introduced the Lifestyle, the first POC, it opened up a new world to oxygen users,” she recalls. “As with any new technology, in the ensuing years, newer models brought improvement on the old.

The batteries on the Lifestyle lasted for approximately 45 minutes each when used at 2LPM. The Inogen One came along with batteries that lasted for three hours. AirSep introduced their new model, the Freestyle, a smaller unit that lasts for six hours with a battery belt and comes in designer styles. The first and only POC to offer continuous flow is Sequal’s Eclipse.
Respironics now offers the Evergo and the newest POC on the market is XPO2 from
Invacare.”

Now, POCs have had a long enough time on the market that they are tried and tested in travel environments, which should allay any patient concerns regarding their reliability. Jacobson notes that the LifeStyle was introduced in 2002, and FreeStyle, the first “wearable” POC, has been marketed for more than two years. “These products have proven durability and reliability,” he says.

And now, the number of patients able to use POCs and travel is growing, representing a big opportunity for providers who want to serve their travel needs.

“A high percentage of the low liter flow patients on 2 and 3 LPM are able to ambulate,” Jacobson says. “These same patients, in focus groups, express that they would like to stay out longer to enjoy activities and go on trips. Wearable POCs — those under 5 pounds — facilitate this by providing ‘unlimited’ ambulation possibilities in an ultra-lightweight solution.”

Traveling With POCs
“One of the main questions I have always been asked was. ‘How do I travel with oxygen?’” Belyea says.

With POCs that comes downs to power management. “The new concept that POC users readily embrace is managing power instead of oxygen contents,” Jacobson says. “Since POCs manufacture oxygen from multiple power sources — internal batteries, external batteries, AC and DC power supplies, even solar power, patients learn to take advantage of, and utilize power sources to remain active away from home as long as they like.

Those power sources are abundant he adds. During most of oxygen users’ activities, electrical outlets can be found for use, such as during dinner, or on the road using a car power outlet. When plugged in, the POC’s internal battery is being recharged while the patient gets the benefit of the POC’s oxygen-making capability.

Where air travel is concerned, it depends on the airline. Each airline has its own specific regulations when it comes to accepting POCs on-board flights, Belyea explains. She adds that it is important to note that United Airlines remains the only major airline that will not accept a POC on-board.
“For air travel, patients are permitted to carry on and use only one type of oxygen technology on board aircraft — the portable oxygen concentrator,” Jacobson says, adding that only certain POCs are approved by the FAA for commercial airline use”.

Providers looking for readily accessible answers to patient oxygen travel questions can look to vendors for providing quick and easy references. Airsep lists the domestic and international airlines for which its POCs are approved and provides links to each air carriers oxygen travel policies. SeQual Technologies provides an entire online resource center with tips on how to travel with oxygen for air, sea, rail and road. Good online advice to relay to oxygen patients looking to travel by air includes:
•    Patients must inform the airline they will be using a POC.
•    They should carry a physician letter with them and provide it for inspection, if requested.
•    Bring enough fully charged batteries to power a POC for the flight plus enough for unanticipated delays.
•    Arrive at the airport early since security screening personnel might require extra time to inspect a POC.
•    While waiting to board a flight, patients can conserve battery power by using a nearby outlet and their AC power supply.
•    Patients don’t have to turn off their POCs during taxi, takeoff and landing if their physician’s written statement requires them to receive oxygen during these periods
When it comes to dealing with airport and airline staff, the interesting thing is that since POCs are a part of their daily lives, the oxygen traveler often knows more about the rules than the airline representatives. “Bringing their doctor’s prescription and a copy of the airline’s regulations is always recommended,” Belyea says.

Besides doctor’s letters and notifying the airlines, power management is the main issue for oxygen travelers. “Bringing enough batteries for the flight is usually the only calculation the traveler has to make,” Belyea says. “Carrying an outlet adapter to share an electrical plug in the airport will save battery time.”

Travel Test Drives
To help patients get a feel for traveling with a POC, one option for providers is to rent them to patients, and Belyea says some providers are providing these services. This affords a way for the patient to try out a POC before he or she buys.

This could create a whole new side business with varying service tiers. Firms that rent POCs provide varying rates and many different levels of service – and service is the key word, Belyea says.
“If something goes wrong during the trip, a reputable company will have a backup plan and/or [referral] company for the traveler en route and when they reach their destination,” she says.

Also, Belyea suggests that before oxygen users purchase a POC, that they give it a test “drive” long before their first outing. “It is very important to be sure the oxygen user tries the POC that their home care company will lend to them before the trip to ensure they will maintain adequate saturation levels,” she explains. “They will then feel comfortable with the equipment and be able to ask questions and experiment with liter flows knowing how long the battery life will be.”

On The Road Again
Back on terra firma, many patients want to enjoy the Great American Road Trip. Who can resist it? Patients with limited mobility want to travel the nation’s highways and byways as much as anyone else, and fortunately, a whole host of auto access products and converted vehicles is there to satisfy their wanderlust.

“What they want ultimately is freedom,” says Greg Moll, Global Sales & Export Manager for Roll-A-Ramp, which makes auto access ramps that roll up for storage while traveling. “The vehicle access market is growing, with more and more clients with every form of disability wanting to be more active. And, with the exploding aging demographic added in the trend for more access solutions and providers is only going to get higher. This makes for the real opportunity for the HME provider to get into a market that will be there for a very long time.”

And that’s where providers come in, but it is important to understand that auto access is a multi-tiered business. At the basic end, there are products that give providers an easy entry point into serving auto access needs, and at the complex end, lies complete auto access systems and vehicle conversions. That more complex end of the auto access business might be beyond some providers’ reach, but it still provides an excellent opportunity to develop referral relationships.

For providers just coming into auto access, ramps and similar products that do not require modifying vehicles or complex installs are an excellent entry point, Moll says.

“Getting into it with a product where there are no vehicle modifications or conversions is where they want to be,” he says.“Simpler is better and can get them the profit the quickest. It is not a difficult process for the dealer to enter the market on their own; provided they do so with a product line where the investment for both time and money is relatively low.”

More Complex Systems
For complex auto access systems, the best place to start is by assessing patient needs, says Staci Frazier, manager of Training and Development for Ride-Away, the largest dealer of modified vehicles in the country. For starters, whether or not patients can transfer out of their mobility device will determine what systems or vehicles they need.

“If a person uses a wheel chair or scooter, but can transfer out of it, they can use a wheel chair or scooter stowage lift,” says Frazier, also the past president of the Association for Driver Rehabilitation Specialists (aka, ADED; www.driver-ed.org), an association that helps professionals who work with drivers who have limited mobility. “That’s the first level of automotive products, and those type of devices can be put in a wide variety of vehicles, depending on how big the person’s wheelchair or scooter is.”

The next level addresses patients who cannot transfer out of a mobility device, or if it is too large. In those cases, Frazier says a lowered-floor minivan that provides enough headroom for a patient to get in and out of the vehicle, as well as ride in her secured mobility device or OEM seat, depending on his or her physical ability.

Full-sized van conversions with lifts sit at the far end of the complexity spectrum, she says. Converted vehicles must be modified by dealers that are registered with the National Highway Traffic Safety Administration to ensure they meet all safety specifications.

For patients who want more vehicle choice, new systems have become available that reduce the necessity to drive a modified van. Many patients want vehicles that are more mainstream, say Bob Smith, vice president of Sales and Marketing for Freedom Lift, which manufactures various auto access systems.

To address that need, Freedom Lift recently introduced its automated transport retrieval system (ATRS) to give those users more choice. The system is composed of a lifting device that goes in the back of the vehicle, which lifts the users’ chair or scooter and docks it into place. The ATRS doesn’t require permanent modification of the vehicle, and affords patients the choice of driving something else, such as a sedan or SUV.

An articulated seat using the vehicle’s original passenger chair extends out of the vehicle to let the patient easily transfer from the chair or scooter, before it is lifted into place. Smith says the chair operates smoothly and quickly while the chair is retrieved remotely. “The most important thing about the ATRS is the complete independence,” he says.

A resource that can help providers determine a patient’s vehicle needs are driver rehab specialists, which can get certified by ADED, Frazier says. These professionals will help determine a patient’s current capabilities and needs, as well as his or her future abilities. This is a critical step, she says, since auto access products are so expensive and not covered by Medicare and private payors.

“[Providers] need to establish good relationships with driver rehabilitation specialists and mobility dealers,” she says. “These vehicles represent a significant investment… It’s very different than an able bodied person going out and buying a car.”

Safe Travels
For all auto access offerings, simple to complex, safety is the penultimate concern for most customers looking to head out on the highway. “The biggest concern by clients when exploring vehicle access options is, ‘Will I feel safe using it?’” Moll says.

For more “entry level” auto access products such as ramps, these concerns usually come down to materials and construction durability, but for lifts and products that involve hydraulics and electric motors, the concerns get deeper. Bottom line, what happens when a customer is on the road and his or her lift refuses to work?

Besides ensuring that products are tested and certified, Mike Krawczyk, marketing services manager for auto access systems maker Bruno Independent Living Aids, says manual controls and 24/7 support are important backups for those worst-case scenarios.

Most lifts and automated systems include manual controls with wide enough gear ratios to let customers operate them without a motor if need be. That said, they are limited, Krawczyk says.

“The reality is that they can be hand cranked if someone has use of an arm. There’s no strength needed,” he says. That said, many customers often keep a battery-powered drill that they can use to do the cranking for them, just for the sake of safety and peace of mind, he notes.

Providing continual service is the trickier half of ensuring safe HME travels. Fortunately, providers need not staff their own call centers. Most auto access system manufacturers offer support lines and dealer networks to help providers assist customers when they are on the road, says Sarah Penix, business development manager for Harmar, which makes various auto access products.

Penix says to help patients on the road, as well as the providers supporting them, Harmar provides a support line to offer walk-throughs on using manual overrides and similar forms of support.

All safety concerns aside, at the end of the day, patients want to travel, and are looking for the expertise, assistance and products from providers that will help them do that. The key for providers wishing to serve those needs is to get started and let their patients know that there are solutions available to let them go on tour. That’s where the rubber meets the road.

“The number one thing is get the word out there,” Penix explains. “Consumers don’t realize all the products that are available to increase and enhance their lives.”

This article originally appeared in the March 2008 issue of HME Business.