Providing phototherapy for infants with clinical jaundice (hyperbilirubinemia) is labor intensive and reimbursement is minimal, says Rosemarie Long, location director DME for the north Georgia location of Pediatric Services of America (PSA), in Norcross. But for a full-service provider of pediatric care with more than 100 offices in 22 states to give up on phototherapy would be hard.

“It is a small part of our business and not a big moneymaker,” Long says. “We stay in the niche so we can offer one-stop shopping for our referral sources.”

Despite small profit margins, the need for phototherapy is strong. Today mothers often are discharged from the hospital just 24 to 48 hours after giving birth. This means that dealing with jaundice, which appears in the first few days of life, has become an increasing part of home health care.

Traditionally, a nursing agency sources the services through a liaison with an HME provider. Services also may come from a provider of pediatric care, such as PSA, that offers a comprehensive menu of services. For both, the situation has created opportunities as well as challenges.

Partnering For Profit
Richard Ford, RRT, is president of Accucare Inc, an HME company located in Asheville, NC, that serves a three-county area. The pediatric population makes up at least 50% of his company’s business, with phototherapy a significant part. Accucare partners informally with Visiting Health Professionals (VHP), a local nursing agency that provides maternal/child care in the area. “We are two providers who share a patient base, in this case newborns with a need for home phototherapy,” Ford says.

The customary scenario begins with a physician’s office calling either Accucare or VHP to initiate therapy. If VHP gets the call, the doctor will typically ask for an evaluation of the child, for equipment to be delivered, and, most likely, that the child be followed for monitoring of levels of bilirubin, a toxin produced as red blood cells decompose.

Accucare then swings into action, delivering the equipment and instructing the parents or caregivers on the operation of the light system. “At the same time, we congratulate them on the birth of their new child and reinforce the goals of phototherapy,” Ford says. “We explain the safety factors they should follow, and what they can expect.”

Most parents are delighted to have phototherapy at home, once they understand that the alternative is rehospitalization. In Ford’s experience, a jaundiced infant usually receives at-home phototherapy treatment for a period of 5 to 7 days.

Before the early 1990s, HME providers usually employed nurses to set up the phototherapy system, instruct the parents, draw blood, and provide related care, Ford says. “Today, more appropriately, home health has taken on the role of drawing blood and evaluating the infant,” he says. “The HME providers specialize just in the equipment.”

Accucare, now in its second year of operation, is seeing an increase in phototherapy business and Ford surmises it is due to greater physician awareness that jaundice is easily treatable at home.

Opportunities for HME providers who want to offer phototherapy begin with making their services known to local home health agencies. Pediatricians, family practitioners, and hospital discharge planners can also become good referral sources.

Nursing Support
For Accucare, one of the main sources of phototherapy referrals is VHP, which has three offices in western North Carolina that employ about 350 people. Phototherapy accounts for 6% of the company’s business, says Bill Engquist, RN, the pediatric coordinator for VHP.

When a hospital or physician’s office calls to refer a phototherapy patient, Engquist asks if they have a particular HME dealer they want to work with. If they have no preference, he calls Accucare and Richard Ford. “Richard often makes that first visit with the equipment,” Engquist says. “His checklist for the new mother includes keeping track of wet diapers, how often the baby nurses, and the baby’s temperature. It mimics how we would be doing it on our nursing side.”

Both Ford and Engquist say their liaison works well. Engquist spends a good share of his time calming distraught parents and helping them understand what is going on with their child, which he finds rewarding. Ford says that the natural excitement of having a new baby in a home helps his staff enjoy the pediatric business. “It is a nice balance with the larger part of our business, which is the geriatric population,” he says. “It is a good, positive mix.”

However, Ford cautions that any HME company getting into phototherapy should expect to do a lot more instant deliveries at all hours of the day and night than they would if they just serviced a senior population—and these odd-hour deliveries can get expensive.

Extra deliveries and other phototherapy service requirements are one of the main problems with realizing profits in this niche, Long says. “It is a labor-intensive service that requires equipment, a nurse’s assessment, plus subsequent nursing visits to draw blood,” she says. “Not only do nurses have to go to the patient’s home, but they also have to take the blood to a facility and wait for an analysis.”

Patients often are discharged from the hospital at the end of the day, which means a nursing visit late at night or on weekends. Even though parents receive instruction before leaving the hospital, the newness of the situation can be overwhelming. Hand-holding and comforting, along with reinforcing correct operation of lights and equipment, is a considerable part of what PSA nurses do, Long says.

Existing referral sources are eager for PSA to provide more phototherapy services, but the reimbursement situation is a significant concern when considering expansion of the business. “We want to provide only what we know we can do well,” Long says.

Providing phototherapy can be worth it, but one must consider all rewards, including goodwill from referral sources and personal satisfaction.

Judy Wade is a contributing writer for Dealer/ Provider.