The Building Blocks of Pediatric HME

Much like constructing a building of stacked blocks, fitting pediatric clients with the proper home health products requires a steady hand, careful placement, patience and a bit of creativity. It's no mystery that home health providers face unique challenges with pediatric clients, but exactly what does it take to make the pediatric segment of the business work?

Laying the Foundation

Randy Harrington, of Price Rite Medical Equipment, in Bozeman, Mont., says that about 20 percent of his business is dedicated to pediatrics. Though the provider supplies oxygen, CPAPs, nebulizers, bronchial dilators, orthopedic bracing, wheelchairs and standing frames, Harrington says the biggest need he serves is wheelchair positioning. "I'm a pharmacist by trade," he says, "and I do wheelchairs just because I like doing them."

Providing seating requires just the right touch. "Obviously your primary concern is the child," says Harrington, but providers also must consider the needs of the school staff and parents. "Is the school staff going to be able to position this kid correctly? Or are the parents going to be willing to do this every day, four or five times a day, without getting burned out or exhausted trying to get the positioning correct on a child?"

For that reason, Harrington considers the needs of the caregiver, from transportation to assembly and disassembly, when fitting equipment. "The more things you put on (the equipment) and the more cumbersome it is, I think the less chance that the child will be positioned correctly," he says.

Joseph Nassef, RTS, Golden Valley Medical & Oxygen Service, San Bernardino, Calif., agrees. "Pediatrics is not difficult, it just takes common sense, asking questions and being there for anyone in time of need," he says. "Increasing business comes with being supportive and not overdoing anything you try. I still after all this time follow the KISS (Keep It Simple Stupid) Method."

"When working with peds, you need to understand the diagnosis and the growth rate of the disease and especially the child," says Nassef. "This determines how to construct the chair. It tells you how much growth or what kind of equipment or accessories you need to add to the chair."

A much larger percentage of Corpus Christi, Texas-based Wheelchairs N Stuff's business is devoted to pediatrics — around 60 percent, says owner May Villarreal. Villarreal offers custom power and manual chairs, custom seating, special needs car seats, standers, gait trainers, special needs strollers, and service and repairs of wheelchairs. To make business run smoothly, Villarreal relies on the support of doctors, clinicians and the client?s family.

Product technology has helped Villarreal meet the needs of his clients. "It has allowed our clients to become much more independent, which is often one of our goals," he says.

The Art of Design

Addressing pediatric needs requires a bit of skill as well, and that means continuing education to stay current on disease states and billing issues. When encountering a disease that he is unfamiliar with, Harrington heads straight for the Internet. On disease-related homepages, he finds "basic knowledge about … the typical characteristics that happen in the first 10 years or what statistically is something we can we look forward to. Those are issues that I try to just get out of the Web site, and what medication they're on. Are we going to see changes, for example, in tones with medication?"

Harrington also looks to periodicals, but he says the best sources of information are the classes offered at shows like Medtrade and the International Seating Symposium. "I think you have to go to those things whether you like to or not because there's so much stuff coming out that you've got to stay up on it."

Villarreal builds relationships with people in the industry to keep up with the nuances of pediatrics. "(There are) so many things you must consider during an evaluation, but I must say the most challenging is dealing with funding issues," says Villarreal. Talking with other providers and manufacturers helps him stay on top of those funding issues.

Getting certified as an ATS also helps providers brush up on their knowledge. "I've been doing seating for 10 years, and I just got certified last year. I learned a lot of things by just doing the course. … It forced me to really study and learn more. And I think that's a habit that in this profession you've got to be in."

Nassef, whose clientele consists of 90 percent pediatrics and 10 percent former pediatric clients, says he's built his business through referrals. "I grow my business only with what allows me the time to service my clients the best," he says. "My increase in business has been through referrals. There is only so much time in the day to do things the best you can. Overextending yourself can only cause errors."

Meeting the Neighbors

Marketing to clients requires less advertising savvy and more relationship know-how. Harrington says he doesn't advertise for pediatrics at all. In fact, the majority of his clients come from word of mouth and the rest from clinician referrals. Villarreal and Nassef agree.

"I think parents communicate more than we think as far as I think they look to each other as support groups," says Harrington. "Because it sure seems like people will come in and say, 'Well, Amy's mom told me about what you did with her, and now we're interested in what you can do for us.' It sure seems like word of mouth is invaluable with pediatrics."

In fact, Harrington limits pediatric marketing efforts to putting stickers on equipment that he sells. In that way, parents who see equipment they like will know where to find him. Harrington also says he works closely with the school system, which has its own networking system. The school district "(calls) us when they need stuff and the teachers all have our (cards)."

"I think it's important when you provide a piece of equipment that you give a little bit of in-service on how to (use) it," says Harrington, "…because those things are, they're just intimidating and they don't need to be. I just try to give a little in-service and make sure everybody feels comfortable, and make sure they feel comfortable calling with questions.

"I just make sure that our pharmacy staff along with our DME staff works synergistically to give the best possible information to the parents when using the equipment," says Harrington.

Villarreal says the best piece of advice he'd give providers looking to increase pediatric business is "one word, service."

"For me, children are much easier to deal with (than other clients), although, you will have on occasion those challenging cases," says Villarreal. "Personally, knowing the issues of our daily grind, children always are very grateful for what we do."

"Rewards come differently," says Nassef. "They can be making someone comfortable that wasn't. They can make someone sit who never sat upright. They can make someone mobile and independent who never thought it possible."

Harrington, Nassef and Villarreal were recommended to HHP by manufacturers Kids Up, Altimate Medical and Freedom Designs, respectively.

This article originally appeared in the October 2006 issue of HME Business.

About the Authors

Ellen Z. Harrison is director of the Cornell Waste Management Institute.

Robert McCoy RRT, FAARC, is the managing director of Valley Inspired Products, a provider of research, testing, application and marketing for the respiratory industry -- from patients to manufacturers to providers -- and is based in Apple Valley, Minn. He can be contacted at (952) 891-2330.

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