Stayin’ Alive in Home Care Takes Creativity

Stayin’ Alive in Home Care Takes Creativity

By Francie Scott

There was a time when durable medical equipment and home health care companies did not have to be creative. Owners and staff could make a decent living with bread-and-butter services like oxygen therapy and medical equipment, but that time has passed.

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The infamous Balanced Budget Act of 1997, with its cuts in Medicare reimbursement, added insult to injury on top of previous cuts in reimbursement for oxygen therapy. These days, home care company operators are getting creative in their quest to stay afloat. Some are adding new services. Others are pursuing contracts with HMOs.

“We are marketing heavier and working harder,” said Herb Karkheck, RRT, owner of Pulmocare of Pinellas Inc., Pinellas Park, Fla.

He and his staff have pursued nursing home accounts for durable medical equipment. RTs do double duty, delivering oxygen and medical equipment so they can educate patients in their homes.

Some RTs working for Home Health Care of America (HHCA), Largo, Fla., also double as delivery techs, according to Rae Ketchum, CRT, respiratory care coordinator for the capitated insurance program at the Largo branch of the national chain. Ketchum also serves as a case manager for third-party payers, especially HMOs.

“We actually review every respiratory order to identify the need and approve it,” she said.


Pulmonary function testing is a new service offered by HHCA in Largo. RTs take portable units to patients’ homes when doctors want PFTs quickly and patients have difficulty getting to a hospital. The portable units do everything hospital units do except oxygen washouts, Ketchum said.

Brent Soward, CRT, vice president for the West Florida HHCA branch in Tampa, offers pulmonary function testing and ultrasound diagnostics. Most of his clients are based in nursing homes and clinics. Other diagnostic services on Soward’s menu include Holter monitoring and cardiac event monitoring, but these services are not indicative of company expansion.

“We started 15 years ago as a diagnostics company and diversified into respiratory care,” Soward explained.

Bob Strief, RRT, president of Midwest Home Health Care, Lombard, Ill., runs a mobile GI lab that has proven to be an asset to the company and patients in the area. RTs learned to place pH probes in the esophagus to diagnose conditions like gastroesophageal reflux. Sometimes they take the mobile GI lab into hospitals, especially neonatal units. Other times they go to someone’s office to place the probe, saving the patient a loss of work time. They also take the unit into homes.

Staff leave the probe in place for 24 hours before removing it and downloading data for the ordering physician.

“The test not only confirms whether they have reflux, it also give the degree of how bad it is,” Strief explained. The company conducts an average of 20-25 tests a month on babies and 4-6 tests on pediatric and adult patients, Strief added.


Multichannel sleep studies is another service Strief has added to diversify the business. Staff often take equipment into hospitals to test babies before they are discharged if a doctor suspects apnea, desaturation or bradycardia.

Pediatric nursing services for patients who need around-the-clock care represents the bulk of his business, Strief said, and he intends to venture into the adult market in the future.

Strief and a colleague, Cindy Mont-gomery, RN, recently purchased their branch from HHCA, which is reorganizing the company.

“It is well known that home care is a community-based service that can’t be dictated from four states away,” he said.

Each market is different. In California, for example, Patrick Dunne, MEd, RRT, FAARC, is director of corporate compliance for HomeTech Medical Services Inc., which joined forces with several other home care operators two years to provide regional coverage for HMOs and other health plans.

This move paid off on several fronts. As a regional player, the company earned capitated contracts with HMOs. Although the Fullerton area, where Dunne is based, includes a large Medicare population, many of them have selected the HMO option, so Dunne’s company has not been hit hard.


Even then, the company does not take its bottom line for granted. The company recently appointed a vice president for sales and marketing to survey the operating area to find out what clients want.

“There is a variance between regions in what consumers and physicians want,” Dunne explained.

He expects new programs and product lines to be developed from the marketing research. The company is considering the addition of asthma management programs in response to HMO interest, for example.

Working with HMOs has made utilization management an issue for Dunne’s group. “We have to verify benefits, medical necessity and eligibility every month,” he explained. “Utilization management has become a very dominant part of our day-to-day practice.”

Providers of home care and durable medical equipment have had to come to terms with many changes during the past few years, and the future promises to provide even more challenges.

Francie Scott is an ADVANCE senior editor.

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