In the world of health care, the future is now. Today’s home monitoring systems can “watch” patients with chronic illnesses and transmit data about their changing conditions to clinicians in another location; smart shirts can keep a running record of heart and respiration rates, body temperature, and calorie expenditure; and smart houses can incorporate all of the above and more in monitoring patients around the clock. From an office management standpoint, electronic certificates of medical necessity (CMNs) are easing the reimbursement process and imaging systems are offering providers a more streamlined approach to their business.

The dazzling array of new products at any HME trade show is certainly appealing to today’s provider, but it is important to keep things in perspective. How many of them are worth investing in right now? And what is the minimum that dealers need to do to stay competitive? The choices may be daunting, but providers need to keep in mind what is a right fit for their business, what will serve the true needs of their clientele, and what the reimbursement picture is like for emerging technology.

Patient Monitoring
Providers can first of all behoove themselves by staying abreast of the trends in technology, paying attention not just to the options that are currently available but also to those coming down the line.

“What concerns me greatly is a lot of people in HME are not thinking or preparing for this,” says Schyler Hoss, president of Northwest Healthcare Management, Vancouver, Wash. “The evidence of trends is clear and compelling, and dealers need to be concerned about the application of technology to the future of their business. There is a natural evolution occurring with technology, and right now we are in the first phase, where the focus is on monitoring patient status with home systems.”

The second phase involves diagnostics by sophisticated devices that can determine data commonly obtained by laboratory tests, such as monitoring medication levels for patients taking the blood thinner warfarin. The third phase is actual intervention in the home to address disease states and significantly change patient status. This may mean an adjustment of dosages on an infusion pump, or the administration of electric stimulation to the heart, Hoss says.

“We are moving quickly across that spectrum, and I anticipate that within 5 to 7 years we will have the actual interventions taking place in the home,” he says. “Patients already are going to the hospital and the physician’s office less often these days. They are hardly ever there for observation, and soon we will start treating and managing these patients on an off-site basis.”

The final phase is also known as telemedicine, and while providers should plan on having a role in it eventually, they also should recognize that the platform does not currently exist for it to be very efficient.

“Telemedicine will have more far-reaching opportunities when it is interactive,” says Joseph Lewarski, BS, RRT, national respiratory director of the MED Group, Lubbock, Tex. “Much of what is called telemedicine today is one-dimensional. We use it to check on compliance or send a message back, but there is not a lot of working with the patient and exchanging information. When the technology becomes rapid and instantaneous, then telemedicine will become a lot more practical.”

Once the technology does catch up, Hoss sees home monitoring devices and telemedicine as huge opportunities for health care providers.

“So far, the bathroom scale has been the major medical device in the home for relatively healthy people with no problems. At some point, however, a normal appliance or tool in the home will be capable of daily capture of temperature, heart rate, oxygen statistics, estimate of body fat, and other basic health indicators,” Hoss says. “This is all opportunity for the dealer as well, because there is setup, training, calibration, maintenance, and repair. These are all things dealers know how to do, and this kind of technology will rely on that expertise more and more.”

Mobility Products
More likely, providers are now looking to invest in high-technology versions of their current line of products, such as wheelchairs. Hoss notes that, in terms of high-end chairs, a whole slew of applications are giving greater flexibility to the patient.

“Electronics are being applied to wheelchairs in terms of preventing tipping and adding energy conservation for batteries,” he says. “They also can respond to patient input, and capture and trend that information.”

David Kruse, CRTS, with Wheelchair Works Inc in Portland, Ore, and president of the National Registry of Rehabilitation Technology Suppliers, says he has been seeing much more sophistication in electronics and the suspension systems of wheelchairs in particular. He advocates suspension systems because they make the chair much better at positioning and safer for the end user.

“Comfort also is becoming a real issue for people, and seating and positioning are more contoured and focused on ergonomic support as opposed to the old flat backs and seats,” Kruse says. “There is a bigger focus on bariatrics today as well, because the marketplace is growing for that niche. I think we will soon see an affordable power-drive wheelchair that will handle higher weight.”

But high-technology and bariatric products may not work for every HME provider, Kruse says. “[It is] not really a general dealer market,” he stresses. “Anytime we start dealing outside of basic scooters and wheelchairs, we are encroaching on the rehab side of things and dealing with special needs. When you are loading a 600-pound person into a power wheelchair, there are other issues such as the stability of the floor. So that is really a niche market.”

Respiratory Care
In the respiratory care field, most of the trends have been in making oxygen therapy more efficient and minimizing unnecessary interactions, such as some delivery or service visits. Lewarski notes that there is more sophistication in auto-titration, memory, and compliance systems.

“I think we will continue to see advancements in sleep therapy technology,” Lewarski says. “We have already started to see improvements in pulse oximetry technology, such as artifact algorithms that make it more accurate and efficient. Also, sleep diagnostics technology on the horizon will enable us to evaluate disorders through forms of monitoring other than multichannel polysomnography.”

Portable ventilation already has been starting to change, and Lewarski predicts further advancements in that technology due to sophistication of the turbine vent systems, which will create smaller, higher-capability ventilators.

“Technology is advancing for the concentrators that fill the oxygen cylinders as well,” he says. “Portable concentrators have been on the drawing board for a number of years, but so far no one has been able to overcome the various hurdles. There also are ceramic membranes and other far-out methods for making oxygen through other formats, but no one is yet able to do it to produce enough oxygen consistently to make a production-level unit.

“However, I believe we could potentially see self-generating, very small, ambulatory oxygen systems that wouldn’t rely on liquid or gas,” Lewarski says. “At least one company has a device already that takes oxygen concentrator gas, chills it down, and converts it to liquid for greater portability. That recently received US Food and Drug Administration approval, and the company is in the process of developing production technology, which may take another 1 to 5 years.”

Electronic Offices
While many technological improvements in home health care are 1 to 5 years down the line, some are already here. Those include imaging systems to streamline filing systems, an issue dear to the heart of Lisa Thomas-Payne, president of Medical Reimbursement Systems and lisathomaspayne.com, Albuquerque, NM.

“For years I have been recommending document imaging of all records and billing files,” Payne says. “Paper files are notorious for loss and damage; they can get decentralized, redundant copies get made, there are access problems for employees, and the files take up a tremendous amount of space.

“Simply put, document imaging allows multiple people to access files without losing paper,” Payne says. “This has an increased importance now that we are so client-sensitive. Also, the information that we image or put in file folders is largely subject to audit, so dealers will have problems if they cannot locate the documents.”

Many providers have put off adding such a system, according to Payne, because of the cost and time investment necessary.

“Sure, it is expensive and time-consuming to convert to an imaging system,” Payne says. “But the longer dealers wait, the worse the conversion gets because they will continue to accumulate new patients and more folders. All the time and money are worth it, especially compared to the amount of energy spent on chasing information, filing paper, and making copies, plus the amount of dollars lost when dealers cannot find the documents to support their reimbursement. Add up all those costs and you can pay for imaging systems three times over.”

Hoss admits that he was skeptical about a paperless office in the past, but he notes that given the technology he has seen and the way people use it, within 5 years paper will become a thing of the past.

“Colored manila folders with three-letter codes are going to become obsolete in favor of payment information, clinical documentation, and CMNs all tied together and flowing back and forth electronically,” Hoss says. “We will not go to files as the primary place to look for what is happening with a patient.

“Very soon, it will be expected that patient information related to how they are using medical devices, device effectiveness, and any other medical information will be sent to referral sources in the form of a digital record,” Hoss continues. “This puts a burden on the dealer to accept all the financial, health status, and demographic information electronically.”

Hoss estimates that within 3 years, electronic CMNs will become the standard as well.

“For CMNs, all the pieces are in place, and some dealers already have an electronic CMN process,” he says. “We are past the technical hurdles on this. It is not a matter anymore of technology or regulatory groups, it is just a matter of the format gaining acceptance.”

The Reimbursement Side
Even when providers grow to accept all the new technology, there is still one hurdle to cross: reimbursement. However, as more information comes out, Hoss says payors are becoming more interested in supporting advances in technology.

“Currently, I have four or five conversations per month with insurers looking to cover some of this. They are trying to understand it because it is moving very quickly,” Hoss says. “For instance, if you have remote telemetry systems in the home, you can eliminate emergency room visits and reduce the number of hospital admissions. Payors therefore are much more interested in funding this because the efficacy has been demonstrated.”

In some cases, demonstrating that efficacy will still be the burden of the provider. For instance, in mobility products, Kruse notes that the assessment and evaluation of equipment now include the issue of pain from chronic long-term sitting.

“That relates directly to comfort, or making someone less pain-free,” he says. “It is a game of semantics, but now we end up with a person who can spend more time in their chair and less time with caregivers.”

Less caregiver time saves money, of course, but providers must still demonstrate the savings related to any new technology to payors. “Technology is always way ahead of the reimbursement curve,” Kruse says. “So we need to really examine how to legitimately justify an accessibility issue with the American Disabilities Act in place. If all buildings have to be accessible and you have a wheelchair that goes up and down stairs; unless it is a private pay situation, that will not be a big seller.’

Serving the Client
Ultimately, making the appropriate match of technology to needs will be what drives a provider’s decision on whether to invest in the latest stand-up wheelchair or smart data card. Syd Gubin, president of The Seating Center, Home Health Supply Inc, which has provided custom seating for 10 years in Palm Springs, Calif, says his company’s plan is to avoid being dazzled by new options and instead concentrate on what the company does best. “As technology evolves, we plan to make it available to our clients,” he says. “However, we need to fully understand the applications first, because it all comes down to what is medically necessary. We already have misapplication of technology. Some providers are dispensing high-tech products without any medical necessity for the item. For instance, we cannot fund gear-less brush-less motors for those who need it because too many companies are requesting those without medical necessity. The only hope we have in terms of those types of denials is that we can get funding restored for the appropriate individuals.”

Kruse agrees that misapplication of technology could be a roadblock to providers looking to provide the latest devices to their appropriate clients. “In terms of scooters, for instance, there always are unscrupulous dealers interested in making a quick buck, so that market has gone away for those who really need it,” Kruse says. “Now there is either no equipment or more expensive equipment. We are all hoping for the ability to pre-authorize equipment for Medicare clients, but right now we take a lot of risks as a dealer. There is a premise that we may get paid if all the ‘i’s are dotted and all the ‘t’s are crossed, but we still take the risk of providing a product before we can bill, and having little recourse if we are denied.”

Gubin maintains that dealers should not steer away from anything, as long as they do what is medically necessary and least costly for the client. “High-end mobility products are not something you add to increase the profit margin,” he says. “As technology becomes available, we will look for ways to apply it appropriately.”

Liz Finch is a contributing writer for Dealer/ Provider.