Provider Perspective

Respiratory Problem Solvers

QualiCare Home Medical Takes on High-Acuity Cases

• May 01, 2010

A relatively new company, QualiCare Home Medical was established five years ago by experienced therapists Dan Shields, RRT, vice president of clinical services, and Bob Shellenberger, CRT, vice president of operations. The respiratory specialist has four branches in Pennsylvania, in North Huntingdon, Uniontown, Bridgeville and McMurray. It’s an area that Shellenberger says is home to the second highest geriatric population in country. And an area where QualiCare has differentiated itself by providing comprehensive clinical services for patients with complex cases. In an interview, Shields and Shellenberger discuss their clinical commitment and their outlook on the future.

RSM: Tell our readers about why you founded QualiCare and its driving principles.

Shellenberger: We started out as a clinically based respiratory company with a focus on the management of obstructive sleep apnea and treatment of COPD. It developed into other areas, including ventilator management in the home. We also have a wound care program and diabetic supply program.

Our principal goal is to provide comprehensive evaluation and follow-up so patients can have therapeutic outcomes. We establish why they need therapy. We make sure they are using therapy. And we check that the therapy works for them.

Shields: Additionally, since we were a new company, we were able to get the latest and greatest technology. We weren’t stuck with any old stuff. Both Bob and I had been in the business for 20 years at other national and regional companies, so we had a good idea of what works and doesn’t work. We went for the really high-tech products and didn’t limit ourselves to the low-end stuff.

RSM: How have you structured the specific respiratory offerings and what do you think differentiates your company from others?

Shellenberger: The biggest thing is our clinical involvement. We have a large staff that provides services in the home and provides information back to the referral sources. Our people really focus on the clinical needs of the patient, so for example, when we do a CPAP setup, there is a true clinical assessment, clinical evaluation and clinical education of the patient.

We have four full-time therapists and 12 contracted therapists. The 12 therapists are on board not only because of their skills and background, but because of their geographic location in our large service area.

Shields: They are people who we have come to know over the years. They have special expertise and have worked in home care. We have a lot of associates, so we picked the cream of the crop.

Shellenberger: We need the therapists because we get a lot of difficult patients, from the ventilator patients with neuromuscular issues to the most difficult OSA patients who are having problems tolerating therapy.

RSM: When you get a patient who needs extra care, how do you go about solving the case?

Shields: Specifically, we get a lot of patients transferring to us for bilevel therapy. They tried CPAP therapy with another company and were instructed a little, but didn’t understand how to use the equipment and were uncomfortable. Then, their physicians get upset because the patients aren’t using therapy, so they send them to us. We assess the patient’s history and find out what they have already done. We have access to virtually all of the masks on the market — and we will try them all to find one that works. We do an extensive process with the patient and say, “If this didn’t work, let’s try this.” We keep going back until we can get the patient compliant.

Shellenberger: The key here is that we have established a very good working relationship with all the manufacturers. Sometimes the manufacturers’ reps even get personally involved with the patients. We call on their expertise and their background as well. There are times when we meet them at the location to help us out with the patient.

RSM: That’s an interesting ally to call on. So your company is not only the problem solver for the tougher cases, but you call in extra help for problem solving.

Shellenberger: Yes, we are facilitators many times. That’s why when we talk about our sleep apnea program we emphasize that it is a comprehensive program. It covers every aspect that’s possible to manage the OSA patient, and we have every component at our fingertips.

RSM: What percentage of QualiCare’s business is oxygen vs. sleep?

Shellenberger: In a month, we get about 25 new oxygen patients, compared with 125 PAP setups, so about 20 percent is oxygen and the rest is sleep.

RSM: How has the oxygen cap impacted your business?

Shields: Like everyone else, we are trying to adopt the nondelivery model with home transfilling systems. We’ve tried equipment from three different manufacturers and are settling on one system now that seems to have a lot of promise. We still do liquid, but we shy away from that as much as possible. Plus, we have portable oxygen concentrators that patients use primarily for the portability component. Patients have stationary concentrators for in-house use and portable ones for going out. We are also using a new device, the SmartDose System, by Inspired Technologies, with liquid and gas cylinders. It’s a pulsing conserver that saves oxygen and regulates the patient’s saturation based on breath rate. It senses respiratory rate so the patient doesn’t have to increase the flow rate for exercise, and it slows down again to the baseline at rest. It’s pretty impressive.

Shellenberger: Again, that’s using high-tech equipment to meet the needs of the patient and improve the quality of life and the provision of services.

RSM: Discuss your provision of ventilator care. That’s so clinically intensive. What led you into that market?

Shields: The condition of one of our longtime patients deteriorated, so she needed a ventilator. We didn’t want to give up caring for her. So this past summer, we entered the market and now have 12 patients. It’s very intensive when you first get new patients to train them on everything, but once they are trained, maintenance is not as difficult. They need to know how to respond to alarms, how the ventilator works and how to take care of routine procedures, such as filter changes. Once they learn those things, it’s manageable.

Shellenberger: It’s going to be a very big growth area for us. It’s not as highly competitive as everything else is because it is so labor intensive.

RSM: How important is vent care as a revenue source?

Shields: It’s certainly not a windfall; we get paid, but we earn it.

Shellenberger: It’s another revenue source and having diversity is important.

Shields: We feel that doing things like ventilator care right will support the entire organization in all respiratory lines. If we take on the tougher cases for referral sources and we do a good job, then maybe they will give us a regular oxygen patient to take care of.

RSM: Given the turmoil in the respiratory field, what does the future hold for QualiCare?

Shields: Catastrophe. [Laughs]

Shellenberger: No, really, I see opportunities. People are going to need this care. It’s up to each individual business to establish itself as a competent, reputable company that focuses on quality services. You have to drive that from the clinical perspective. And from a business perspective, you have to watch how you operate so that you can make a decent profit to stay in business. It’s the merger of the technology and the services with the reimbursement issues. That’s the challenge ahead of us.

We have to be vocal with legislators, so they understand that there still has to be a profit in this business so we can provide quality service. About the bill to kill competitive bidding, we have beat up everyone we can. We have visited our legislators, written letters and attended conferences. Only one of the five congressmen in our area hasn’t signed on to H.R. 3790. By the way, we have been active in lobbying since Day 1, not just in the past two years.

RSM: Keep it up! Congratulations on your success.

This article originally appeared in the Respiratory & Sleep Management May 2010 issue of HME Business.