2018 HME Business Handbook: Enternal Nutrition
How To Get Started In Enteral Nutrition
Given the patient population and variety of products, providers looking to expand their revenues should look into enteral nutrition.
As providers review different market opportunities to help them grown and diversify their revenues, one category they might have skipped in the past is enteral nutrition. Given the size of the market and the variety of patients, it’s worth giving enteral nutrition a second look.
In very basic terms, enteral nutrition helps patients who cannot eat food due to an illness or injury. The problems could be as simple as decreased appetite or physical difficulties with chewing and swallowing. When a person is physically unable to eat, they must get nutrition through enteral nutrition, which is also known as tube feeding.
In enteral nutrition, liquid food mixture known as nutritionals are delivered into the stomach or the small intestine via a tube. These nutritionals contain the sorts of things a person needs to live: protein, carbohydrates, fats, vitamins and minerals. There are various types of tubes, such as a nasogastric or nasoenteral feeding tube that is fed through the nose, or gastrostomy or jejunostomy that are fed through the skin.
In terms of supplies, there are various items that the provider can offer to enteral nutrition patients and their caregivers. These include the tubes, various connectors, feeding pumps that feed the nutritionals into the body, the nutritionals, and accessories and related items.
THE ENTERAL NUTRITION MARKET OPPORTUNITY
There is considerable market opportunity for enteral nutrition. The global market for enteral nutrition devices market is projected to grow at a compound annual growth rate of 4.1 percent from $1.15 billion in 2015 to $1.52 billion by 2022, according to a new report from research and consulting firm GlobalData. Here in the United States, the annual enteral pump and set market is estimated at approximately $250 Million, depending on which study you read. That figure covers pump and pump sets used to deliver the nutritionals (i.e., formula), but does not include the nutritionals.
The growth will primarily be driven by the global aging population and rising prevalence of indications such as cancer, stroke and premature birth, according to the researchers. Another significant driver for the market expansion is the shift from acute hospital care to a community-based approach and the benefits of enteral nutrition not observed in patients receiving parenteral nutrition.
As enteral devices grown more sophisticated and technologically advanced, the shift from parenteral to enteral nutrition will increase in both hospitals and homecare. In turn, raising awareness of enteral nutrition’s beneficial role in disease treatment and prevention will foster market expansion, according to GlobalData.
In terms of key patient groups that need enteral nutrition, typical patients include those suffering from malnutrition, neurologic disorders, swallowing disorders, head/neck surgery, radiation therapy, cancer, and digestive disorders. Those patients will be transitioning from the hospital or long-term care to the home, and that’s where the provider comes in. In terms of referral sources, the most common referral source are GI Discharge Planners within hospitals.
Other patient groups and market opportunities a provider might want to study are Long-Term Care facilities and Hospitals. Hospice is another market that often requires enteral nutrition.
FUNDING SOURCES AND CONSIDERATIONS
The main funding sources for enteral nutrition are Medicare, Medicaid and private payer insurance. Under Medicare DMEPOS, enteral nutrition is subject to competitive bidding. Medicare will pay the single payment amount for a month’s supply only to contract suppliers. Maintenance and servicing (MS) payments for the enteral pumps are also paid to the contract supplier, and enteral nutrition items cannot be grandfathered.
Under competitive bidding, a Medicare beneficiary must obtain related enteral accessories, nutrition, and supplies from a contract supplier, as well Only oxygen and oxygen equipment and rented durable medical equipment (DME) can be grandfathered, depending on the amount of time the equipment is rented.
If the enteral nutrition pump was rented for less than 15 continuous months upon implementation of a round of competition, the rental of the pump must transition to a contract supplier. The contract supplier will be paid the remainder of the rental months and subsequent MS until a determination is made by the beneficiary’s physician that the equipment is no longer medically necessary.
If the enteral nutrition pump was rented for at least 15 continuous months upon implementation of a round of competition, the previous supplier (whether a contract supplier or not for the current round of competition) that provided the item in the 15th month of the rental period is the responsible party. It must furnish, maintain, and service the enteral equipment as long as it is medically necessary. However, in such a scenario, the beneficiary must obtain related enteral accessories, nutrients, and supplies from a contract supplier.
Retail-minded providers are probably wondering whether or not there is a cash market for enteral nutrition. Right now, while pumps and sets are prescription items, there is a movement to make enteral syringes available over the counter (but that has yet to materialize).
Also, it is important to recognize that enteral nutrition has been identified by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) as a source for errors in claims and has been a target for various claims audits programs, such as Comprehensive Error Rate Testing (CERT) audits. In fact, enteral nutrition topped Jurisdiction D’s list of Targeted Probe and Educate errors rates for the Fourth Quarter of 2017 (see “News, Trends & Analysis,” page 6, to read more about those findings).
POINTS TO REMEMBER:
- The global market for enteral nutrition could hit $1.52 billion by 2022. In the United States, the market for the annual market for pumps and pump sets is currently $250 million.
- There are a variety of patients that need enteral nutrition. Because they are being discharged from hospitals, the referral sales process is largely the same as other types of DME items and supplies.
- Typical funding sources include Medicare, Medicaid and private payer. It’s important to note that enteral nutrition is subject to specific competitive bidding rules.
To learn more about enteral nutrition, check out these online resources from the American College of Gastroenterology, American Society for Parenteral and Enteral Nutrition, and PINNT:
This article originally appeared in the June 2018 issue of HME Business.