Clinical jaundice (hyperbilirubinemia) affects approximately 60% of the 4 million babies born each year, but it still catches many new parents by surprise. For these parents, having to leave their infants in the hospital can be stressful.

That is where home care providers, such as Esprit Homecare of Leesburg, Va, play a key role. Jaundice is caused by too much bilirubin—a reddish yellow pigment normally found in the body—building up in the blood. Fortunately, bright light breaks down bilirubin, so jaundice can often be treated with phototherapy in the home.

“As common as it is, parents are always upset about hyperbilirubinemia,” says Syd Fortune, president and general manager of Esprit Homecare. “For a lot of parents this is their first child, and they already have quite a bit of anxiety going along with that. For some, the fact that the mother’s milk doesn’t come in soon enough and thus the baby is not getting enough intake can cause bilirubin levels to be elevated. So when their baby is jaundiced, there is a lot of added guilt and worry.”

Although phototherapy circumvents further hospital costs and allows for greater infant-parent bonding, it continues to be an aspect of HME offered by relatively few providers, Fortune says. Some HME companies steer away from offering home phototherapy equipment to their customers because of a perceived high level of hands-on care. “A lot of the HME companies simply do not offer it,” she says. “Their reasons are that it is too labor-intensive, because you have to have trained respiratory therapists to do the setups. This facet of business intimidates true HME companies without nursing staff because they do not have the clinical aspect to back it up.”

Instead of being intimidated by providing hands-on care, Esprit Homecare’s founders have embraced it with some surprising results. “[Phototherapy] is a relatively simple therapy in comparison with doing home ventilators or apnea monitors,” Fortune says. “It is not terribly labor-intensive or difficult; it is just done at odd hours and therefore not something you can schedule. The nurses have to do annual competency [training and testing] to continue doing setups, and we pay that cost as part of our staffing. We still are making money on this aspect of our business.”

The biggest challenge, Fortune says, is the unpredictable timing of phototherapy referrals. “They always come late in the day, because that is how long it takes for parents to notice jaundice, get the baby into the clinic, and get the lab [tests] back. Phototherapy is almost always an after-hours setup,” she says.

To be on call 24 hours a day, Esprit’s nurses work at a per diem rate and are available to do the setups late in the day or evening. They usually take phototherapy units home with them so they can do a setup at any time.

This commitment to the customer is part of Esprit’s philosophy. Five HME-industry veterans founded Esprit Homecare 2 years ago by buying the Leesburg, branch of another company. Their vision was that Esprit be a one-stop shop with a real personal touch, says Fortune. “We felt that with our combined experience, we could take this company and build it so we knew things were right,” she says. “The way we run our business comes back to the fact that the major employees are the owners. There is a lot of personal integrity going into this business, so it is important that we are taking care of people the right way.”

That has always included special attention to the pediatric side of the business. In addition to the full range of adult HME supplies, Esprit carries a wealth of pediatric items, including 25 respirators. The company offers bilirubin light panels, or blankets, that work by wrapping around the baby.

A team of pediatric clinicians works closely with the hospital discharge team to ensure a smooth transition to the home care environment. In every case, patient and family receive in-depth initial assessments, education, and support.

Although a few of Esprit’s competitors also deliver phototherapy equipment to the home, Fortune says no one else in her area offers the kind of instruction that her company does. Esprit employs several nurses and respiratory therapists trained in phototherapy equipment setup and patient instruction. The nurses also do follow-up visits and conduct heel sticks to measure bilirubin levels during treatment.

As a result of its investment in phototherapy, Esprit receives most of the physician referrals in the area. The company markets to local pediatricians and hospitals, and 100% of its business is referral. “It seems that nine times out of 10, babies who have this problem are 2 to 3 days out of the hospital, so the majority of the patients end up being referred from a pediatrician’s office,” Fortune says. “We depend a lot on our reputation to carry us forward. We put a lot of faith into doing things right so we get those calls again the next time. We don’t do a lot of bells and whistles with sales calls, instead we let people figure out who we are and that we will do a good job.”

The portion of customers requesting phototherapy equipment is relatively small—between 20 and 25 per month—but it represents a consistent source of business. Reimbursement varies by insurance company, but Fortune finds that as long as qualifying documentation is present, phototherapy is reimbursable about 95% of the time.

“Phototherapy is kind of a niche. It is such a short therapy that we don’t make a lot of money at it, but it is almost always covered by insurance and we are filling a need that hadn’t been filled,” she says. “It is not the biggest moneymaker by any means, but it is an adjunct to the whole pediatric side of the business.”

Liz Finch is a contributing writer to Dealer/Provider.