Dealers Discuss

Julia Prins, Department Head of Respiratory Care, Wright & Filippis

• Jun 01, 2008

Describe your company's background.

It's a 63-year old company. We started out as an orthotics & prosthetics company. Our founder just passed away a year ago. He was a bilateral, below-the-knee amputee at the age of 12, and his name was Tony Filippis. His first set of legs was made for him by a gentleman named Carl Wright. As Tony grew up and had to get a job, he was let go from the first three jobs he had once they found out he had prosthetic limbs. They labeled him as a 'cripple' and let him go. He went to Carl Wright, and Carl Wright hired him on the spot as an apprentice. They worked side by side 15 years before they started the company Wright & Filippis. He has always put patients first. Our company motto is 'first to serve, first to care.' Our Web site is www.firsttoserve.com. We started out in prosthetics, and we went into HME because those were the things people needed that had the disabilities.

We have people who have worked here 50 years, which is unheard of in this day and age.

Tell me about the respiratory component of your business.

Right now, we have 36 locations and we have respiratory in 30 of those locations. We have a respiratory staff of just under 50 for the company, and that includes some of my techs. We, as a company, are doing more for the patients to try to get the better care out there. We have a program called Breathe Right. At no charge to the patient or to the insurance or the physician, we go out and we do a full assessment, including a home assessment, full physical assessment, respiratory rate, blood pressure, breath sounds, pulse ox, resting, waking and overnight. We do over an hour of education on diaphragmatic breathing, diet changes that could help produce less CO2 — smaller meals with less carbohydrates and more protein creates less CO2, so you're having to work a little less — teaching them tricks about don't be afraid to sit down and do a lot of your daily activities resting. For some of our patients, it takes them three hours to get ready in the morning to go to the doctor. If we can help them conserve some of that energy and just teach them some of the smaller tricks, it's better for everyone. Obviously, we do the smoking cessation.

It's sounds like you have a bit of a pulmonary rehab component.

It is a little bit of pulmonary rehab, exactly, in the home where they're most comfortable. Oftentimes when we go into a home and tell people, 'Your doctor has asked us to teach you a little bit more about COPD. Do you know what that means?' And they say no. Well, chronic obstructive pulmonary disease, and you get the answer, 'I don't have a disease. No one told me I had a disease. I only have emphysema.' They have no idea because no one's been able to take the time to teach them about their own disease process.

A lot of them find out when they're in the hospital and feel worse than they've ever felt. You're going to have this disease the rest of your life, and you're going to have all of these new medications. They're just happy to find out that they're going home again. That's a horrible time to try and teach somebody information that's going to be with them the rest of their lives. In the doctor's office, they don't have the time to teach COPD in depth. If we can do it in the comfort of their home, they seem to learn a lot better. We also go out every six months so that we can reassess and go back over that education because they don't understand everything or retain everything the first time they hear it. We continue doing that until either the physician or the patient tells us don't go back anymore.

You are adding respiratory therapists at a time when a lot of people are considering cutting them. Why is that important?

We have been because our business is continuing to grow. The need for therapists is continuing to grow. We make sure that we have therapists doing the clinical things that some of the other companies aren't using therapists for anymore. It's kind of unheard of that you're going to send therapists out to do education when there's no reimbursement. But if we don't keep patients healthier when they're at home, they're going to wind up back in the hospital, and that's a huge increase in health care costs.

We actually will call the physicians if they order a nebulizer from us and say that the patient has COPD. Would you like them to have the education at no charge? We have very few people say, 'No, don’t teach my patients.' Then the physicians also get a chance to see the overnight oximetry because any physician's office can get a resting and a walking sat, but they can't get the overnight component. That's when patients first desat in the COPD process is when they're not taking those deeper breaths, when they're asleep. The other thing that the G.O.L.D. standards are showing is that there are two ways to prolong a COPDers life: smoking cessation or early oxygen. If we can help prolong life and not just treat symptoms, that's a good thing.

With regard to the financial aspect of keeping a lot of RTs on staff, how are you able to do that? Is it helping you grow your business?

It is. It snowballs because you're actually taking good care of the patient. You get the reputation for taking good care of the patients. You get more referrals from those same physicians because you're following back up with these physicians. You get more business.

No one's ever gotten in trouble for taking too good of care of a patient. We make sure that the patient's needs are met. We still have to be financially responsible, but we need to take care of the patient. I have been in homes personally where other companies have dropped off equipment and the patients have never seen anyone again. With some of these patients, some of the equipment was unusable. It was frightening some of the equipment that we would find, suction machines that didn't work or the battery backup didn't work, and they were in rural northern Michigan! The power goes out, you're saying you don't have a way of suctioning them? I tell my therapists, 'Please treat the patients the way you want your parents or grandparents treated. You have a medical background. You know the questions to ask. Your parents or grandparents probably don't.'

What has been the most challenging job responsibility you've had over the last year?

Finding the therapists to fill the positions. There's a national shortage of respiratory therapists — and finding therapists that are patient oriented, that have the technical knowledge but still have the right heart. Home care is so much hand holding. It's taking care of people at some of the worst times of their lives. It takes a big heart, and you're guests in their homes. Once you've got the right people, it's the best job in the world.

This article originally appeared in the Respiratory Management June 2008 issue of HME Business.