Compression: Thinking Outside the Socks

Success as an HME compression provider takes commitment, education and an understanding that there is more to compression beyond the feet.

CompressionThe compression sock is an integral product to carry for any HME provider committed to using compression technology to help patients. Compression doesn’t even need to be required due a medical condition – it’s an almost universal need. Sitting or standing for excessive amounts of time can be terrible for your health, especially the feet. For example, sitting with your legs crossed beneath your chair can cause pressure that results in swollen ankles or varicose veins. And standing all day at work can cause issues from your neck all the way to your feet.

“A lot of young, healthy athletes, doctors and nurses are on their feet all day,” says Sydel Howell, director of San Diego Homecare Supplies. “Hairstylists, athletes, military service members — anybody who is active or standing or sitting for long periods of time. You don’t have to be a senior with a swollen ankle to benefit from compression. All you have to be is vertical.”

Howell pointed out that when you’re supine, you have 10 mm of mercurial pressure from gravity on your body. As soon as you stand, you have 90 mm of mercurial pressure on your ankles.

So it’s easy to see why compression socks are very popular. But it’s not the only compression product that you should consider carrying in your store if you want to service a wide breadth of compression customers.

“While compression hosiery is the cornerstone, most providers are narrowly thinking about the classic medical products,” says Brad Wimsatt, director of business development, SAI Therapeutic Brands. “Compression wear, as it pertains to leg health, is a much broader subject. Pertaining to leg health, ‘stockings’ should be described as classic medical, athletic or fashion. Folks of the older generations are likely to continue to wear the classic medical stockings, while the younger generations are more likely to focus on the athletic and fashion products for preventative measures. Wraps and leggings could fit in this category under a wearables section with less emphasis on the medical aspect. Sleeves would fall into two separate categories. Lymphedema sleeves would most definitely fall into the medical realm, while athletic sleeves are tailored to active individuals.”

Helping Patients with Lymphedema

Lymphedema was once considered a niche, unknown market. Now it has taken huge steps in awareness, understanding the disease and management. It can affect different areas of the body and often requires nonhosiery compression products for treatment.

“Lymphedema is basically swelling because your lymphatic system is not processing the fluids through your body either due to a trauma or a cancer treatment, or an injury or a surgery,” says Howell. “It can be caused by many different reasons. Between 30 percent and 50 percent of women who are treated for breast cancer develop lymphedema at some point in their lives.”

Howell says that if you’re a mastectomy boutique you absolutely must carry lymphedema garments, because half of your population is going to need one at some point, and 100 percent of these patients should be wearing compression when they’re traveling, flying, or exercising. Also, education of the disease is very important. She says customer education has been better lately because of breast cancer and nurse navigators helping women through their cancer treatments. But that’s only in the last couple of years. Howell says she can speak only for the San Diego area, but it could be that in smaller metropolitan areas where nurse navigators don’t exist, the mastectomy boutique fitting is the first time that patients might hear about lymphedema.

Howell says that for many years, she was the first person to even mention the word “lymphedema” to a patient because many doctors didn’t want to scare patients into worrying about their arm swelling because of their surgery. Many patients would ask Howell why their doctor didn’t mention the disease, and Howell would respond by telling patients that doctors didn’t want to frighten them over something that might not happen.

“But if it does happen, it’s life changing,” says Howell. “So many women come to my store very upset because they’ve survived cancer and now they have a lifetime sentence of lymphedema, and that’s all in the way that you handle it in the fitting, too, and let them know that it’s not a death sentence, but it is something that they have to manage.”

Howell pointed out that she has many patients with primary lymphedema, which is not directly attributed to another medical condition. Once diagnosed with lymphedema and swelling, these patients must wear a garment for the rest of their life.

Tom Musone is director of marketing for Juzo, which develops compression garments for the HME industry. Whether its lymphedema, poor circulation, deep vein thrombosis, pregnancy, leg ulcers or edema, a customer may require a compression garment other than socks. Musone offered the following information about non-sock compression:

• Arm Sleeves — Lymphedema awareness is increasing, both in the medical world and for patients.

  • More than 10 million to 15 million patients have lymphedema in the United States and there are more than 150 million lymphedema patients worldwide.
  • The Lymphedema Educating and Research Network (LE&RN) is doing some great work in creating awareness (see sidebar).
  • Reimbursement for non-hosiery products is still good, and have not received the cut back that hosiery products have received.
  • The Women’s Health Act of 1999 requires insurances to pay for cancer-related products, such as breast prostheses, wigs and compression sleeves.
  • LTA is working on passing a bill to have Medicare pay for compression supplies.

• Wraps — For wound care and compression treatment, wraps are the gold standard.

  • Medicare pays for wraps and specialty wound care products.
  • Higher working pressure helps with wound management.
  • Medical professionals find it easier to use compression wraps than bandages.

• Leggings

  • Leggings are consumer-demand products that are in style and fashionable, and the leggings market has taken off, from Lululemon to wearable fashion leggings to Nike running leggings. The athliesure market is estimated by NPD Group to be $44 billion.

Making Compression Work

Howell shares the following tips for running a successful compression business, which involves carrying garments for both upper and lower extremities:

  • Compression is a repeat business. Patients need new garments regularly, typically every six months. Some insurances pay, some don’t pay, but ready-to-wear regular compression sleeves can cost between $70 and $90. A custom sleeve can cost between $200 and $400. Patients need at least two, and they’re going to need them for the rest of their life. It’s like needing glasses, you can’t just wake up one morning and hope that you’re not going to need glasses anymore.
  • Referral partners regarding compression patients include lymphedema therapists, nurse navigators, vascular doctors, general practitioners, cardiologists and dermatologists. And the only way to capture these partners is to get into their offices to let them know who you are and the services you offer.
  • I spend at least half an hour with every person who walks through the door for compression. And you can’t just hand somebody a box and say here you go, good luck. You’ve got to show them how to put it on, you’ve got to show them how to take it off, and you’ve got to educate them on how to wear it correctly. Also, you’ve got to teach them how to take care of it, why their doctor sent them to you, how it works, how their lymphatic system works, and how their vascular system works. You have to paint the picture for them because the doctor’s not spending half an hour doing that. He’s saying, ‘You have swelling. Here’s a prescription. Go get some compression socks, and go here because they’re really good.’
  • Having the right compression inventory isn’t cheap. You need to have arm sleeves, gloves, gauntlets, sports socks, dress socks, everyday socks, sheer stockings, thigh highs, knee highs, maternity panty hose, and wraps. You need to have at least one of every size. We carry products from two major manufacturers and between the two of them, there are 50 sizes.
HME Business Podcast