Walking out of the movie Spy Kids, my 7-year-old said, “Dad, that’s a four-star movie.” Even though my son doesn’t understand things like Medicare reimbursement, competitive bidding, and the Health Insurance Portability and Accountability Act, I do, and after reading this month’s guest editorial by Van G. Miller, CEO of The VGM Group, I said, “Now that’s a four-star editorial.”

Van has hit the nail on the head with an insightful look at why and how independent HME providers can and will remain survivors in the US health care system. Like Van, Home Health Care Dealer/Provider has maintained for the past 13 years that independent providers are the lifeblood of the HME industry. While other industries have experienced consolidation that has pushed independents out, the home health care industry is unique in ways that bode well for small- to medium-size businesses and pose harsh challenges for the bigger guys.

On the surface, walking into a retail HME store would lend one to believe that selling HME is not that different from selling sporting goods equipment or home electronics. But as they say in the restaurant business, you’re better off not venturing into the kitchen to see how the food is made.

Home care is an intense, service-oriented business that requires HME providers to operate 24/7, endure cash-flow challenges, and deal with policies and rules that change faster than Alan Greenspan’s handling of interest rates. Couple this with a harsh reimbursement landscape over the past few years, and home care can no longer be referred to as the “golden commode” industry. Making a decent profit is tougher than it was during the ’80s and early ’90s, and unless someone is truly committed to the home care business and willing to put up with a volatile health care system, most traditional retailers will avoid entering the home care arena.

Another unique aspect of delivering home care products and services is that home health care remains a local business, with many customers unsure of what products and/or services they need. While purchasing a DVD player may be as simple as locating the brand and model that suits your tastes and needs, and then locating a retailer offering it at an attractive price, doing the same with a CPAP device is just not going to work. The amount of education that an HME provider must provide to the customer—and in many cases, a family caregiver—plus the time involved with product demonstration, in-home setup, and customer follow-up make selling a DVD player look like a walk in the park.

Also unique to the home care industry are delays in payment. No DVD player will leave a store without being paid for in full. If only a HME provider’s life were that easy.

As the health care system continues to reinvent itself more often than Madonna, and as manufacturers continue to introduce new products and improve on existing technology, HME providers will continue to be instrumental in the delivery and servicing of home care products to customers, family caregivers, and referral sources. As for mass marketers who want to poke their heads into the home health care industry, they’re better off staying out of the kitchen.