Becoming a Complete Post-Mastectomy Provider

In a brief published last year, the Agency for Healthcare Research and Quality says, while breast cancer rates have remained constant, the rate of women undergoing mastectomies increased 36 percent between 2005 to 2013, including over a tripling of double mastectomies.

“This brief highlights changing patterns of care for breast cancer and the need for further evidence about the effects of choices women are making on their health, well-being and safety,” says AHRQ Director Rick Kronick, Ph.D. “More women are opting for mastectomies, particularly preventive double mastectomies, and more of those surgeries are being done as outpatient procedures.”

With one in eight women being diagnosed with breast cancer in their lifetime, the growing population of women undergoing breast surgery needs counsel and direction both before and after surgery procedures. That’s where a compassionate, knowledgeable HME provider can add tremendous value and give patients the confidence and products they need to return to a normal post-surgery life.

In 2017, an estimated 252,710 new patients will be diagnosed with female breast cancer, says Nikki Jensen, vice president of member service group Essentially Women. She pointed out that most of these women will undergo a mastectomy or breast-conserving surgery as part of their treatment.

 “Patients are very much in need of guidance on what to do after surgery,” she says. “While they will find most of what they need to know about their diagnosis from their physician and clinical resources, the care for what they need post-surgical is best served by visiting a local HME provider who is certified as a mastectomy fitter to help them understand what is available and best suits their individual needs.”

Katie Magennis is manager of Figleaf Boutique. There are five Figleaf boutiques located in Indianapolis, two of which cater to pregnancy and childbirth issues. The other three focus on post-mastectomy products and have certified mastectomy fitters. Of the three catering to post-mastectomy patients, two locations are in oncology centers on hospital campuses.

“There’s so much more opportunity for a patient to be educated about mastectomy products post-surgery because you have a patient who gets this traumatic diagnosis, and her life is going to change,” she says. “They have to figure out how to live this new normal.”

Magennis says her goal is to be part of that journey with them, which today more typically falls toward the end of their journey, helping them recover after surgery. But she is working to take the journey with them toward the middle and even at the beginning, where she says HME providers can be extremely helpful.

“I used to say we are the bow on the package,” Magennis says. “We still are the ones who satisfy the end of the journey, but at the same time, education about our products during the journey is very important.”

SERVICING THE POST-BREAST SURGERY PATIENT

To service the post-mastectomy patient and bill Medicare for reimbursement, the HME provider must be certified. Certification includes a number of

steps, including submitting an application, fielding a site visit and passing an audit of your facility. This is in addition to having a certified mastectomy fitter on your staff. (See the sidebar, “Becoming a Certified Mastectomy Fitter.”)

Kim Zeise Neel, Cfm, a breast cancer survivor and president of Alala LLC, an HME provider offering post-surgical support to mastectomy patients, agreed that guiding mastectomy patients through their journey is definitely needed before and after surgery. About 80 percent of her business is spent serving the post-mastectomy patient group.

When asked what HME providers need to know to have a successful one-stop shop for post-mastectomy patients, she says, “Mastectomy bra manufacturers each have a training class to get you started. After that, joining professional associations, such as Essentially Women, helps you network. Finally getting credentialed is an arduous task. We have four nationally certified fitters. Each CFM completed formal training, completed 250 fit hours with a credentialed fitter and passed a three-hour nationally administered exam.”

To get the expertise needed to serve post-mastectomy patients, Neel suggested that practice is the best teacher.

“Each person is different in the surgery she has and how her body responds,” she says. “To help with this, we also have regular staff meetings and attend conferences for professional development. As part of keeping our national certifications, continuous education hours are required, so we get a chance to swap notes nationwide while getting our CEUs.”

• Neel’s top tips for running a successful post-mastectomy store include:
• Open your heart and don’t close doors
• Don’t take short cuts, but constantly work to keep costs down
• Continuously strive for improvement
• Help others
• Remind yourself every day you are working to make the world a better place

“HME providers should be interested in this market due to the additional revenue source it provides,” Jensen says. “From the compression garments immediately following surgery, skincare for sensitives during cancer treat­ments, off-the-shelf and custom breast prosthesis, mastectomy bras, hats, wigs and lymphedema treatment are all part of the suite of products a breast cancer patient may need. While many of these are reimbursable items, there is a healthy amount of cash sale items as well.”

According to Jensen, an HME provider must have or carry the following to grow a successful post-mastectomy business:

• Certified mastectomy fitter on staff
• A portion of your floor space dedicated to women’s health, preferably a warm, inviting environment with private fitting rooms
• Post-surgical garments that allow for drain tubes
• Breast prosthesis – Off-the-shelf and custom breast forms are available from many manufacturers. While Medicare does not currently cover custom breast prosthesis, many third-party payers do. Some women may also be willing to pay for the option if it makes them more comfortable.
• Mastectomy bras
• Camisoles and lounge wear
• Swimwear
• Skincare
• Personal hygiene items
• Hats, turbans
• Wigs and hair pieces
• Breast cancer awareness gift items
• Lymphedema and compression garments

Agreeing with Neel, Jensen added: “Becoming a certified mastectomy fitter is not as easy as it sounds. In addition to the required educational credits and exams, a candidate must also work under another certified mastectomy fitter for a specified number of hours. The mentor must sign off that the candidate has completed the required experience and training for certification.”

But as noted earlier, certified fitters bring the knowledge and often the compassion needed to serve this population.

“It is important for HME providers to understand that women are used to being the caregiver,” Jensen says. “For most women, they’ve spent years putting their own needs behind those of her family and loved ones. Being on the other side of the table will bring out emotions of fear, anxiety and depression. HME providers and mastectomy fitters need to be encouraging and compassionate.”

Jensen also says that to be successful in this market, it is important to create a warm and inviting space for the patient to feel comfortable. Separating the post-surgical experience from the clinical environment is important in drawing patients in to a provider’s store.

Once a customer is in the store, there is a potential for cash sales. Magennis says her cash sale items include wigs, skin care products for patients going through radiation, non-metallic deodorants, and some compression items. Her tips for store success include:

• You can’t train a person’s heart and character but that’s what you need in your staff to make it successful. They must have compassion for patients.
• Along with the information your certified mastectomy fitter brings to the store and shares with other employees, mastectomy product vendors offer garment training that employees can attend. Attendees can then share that information with the rest of the staff.
• Build your referral relationships with surgeons, oncology doctors, physical therapists, etc.
• Understand compression because it can go hand-in-hand with mastectomy patients.
• Be innovative in your marketing. Understand what makes you special and use that to promote yourself. For example, when bedside with patients, we have created letters for them that let them know we are here to answer all their questions. We have also done business cards with surgeons and attached a special coin about the cancer patient’s journey and passed them out at numerous events.

 

MASTECTOMY PATIENT CHALLENGES

Neel says HME providers will experience challenges when becoming a post-mastectomy provider. Fewer and fewer items are being covered by insurance, coverage is being reduced, deductibles are going up, and health insurance companies are confused how to account for mastectomy supplies. For the patient, they are affected by the lack of coverage, along with rising deductibles and copayments.

“As a provider, we see more and more that health insurance companies are determining the medical necessity of their customers instead of the physicians, who are actually holding face-to-face office visits,” she says. “This, coupled with arcane reimbursement requirements for us as providers, makes this an industry not for the faint of heart. An example is the annual review of a physician face-to-face appointment to confirm loss of breast.”

But what makes it all worth it? Neel says that this patient base is an amazing network of strong, spirited women — and men. She pointed out that one out of every 400 men are diagnosed with breast cancer each year.

For Jensen, she says the biggest challenge is getting the patient in to see the mastectomy fitter before they have surgery.

“There is a tremendous benefit to the patient experience when they visit the mastectomy fitter and have a better idea of what products are available to make them more comfortable immediately following surgery,” she says. “The No. 1 frustration we hear from mastectomy fitters is when patients say, ‘I wish I would have known about you six months ago when I had my surgery.’ To help facilitate the communication, Essentially Women created a brochure called ‘Shades of Pink’ that can be branded by the supplier to help patients understand the local resources available.”

As mentioned earlier, two of Magennis’s Figleaf boutiques get patients to the fitter prior to surgery by operating inside an oncology center on a hospital campus.

“A huge piece of what we do is relationship building, whether it be with a patient or the doctor,” she says. “Being in cancer centers, the patients can come directly to us. But we still have to build trust with the doctors to service their patients. Also, before patients go into surgery at one of our hospital locations, we go bedside to the patient and provide a post-surgical camisole for the drains and the tubes for mastectomies.”

Magennis says they work diligently to create relationships with other hospitals as well. They also build relationships with plastic surgeons who may not work in the hospital they are located in.