Jaundice. To a new parent, it can sound terrifying and look even worse.

Fortunately, health care professionals can usually clear up jaundice—a symptom of an excess of the waste product bilirubin in the blood—simply by exposing the infant to special lights that break down the bilirubin.

And because insurers and physicians alike realize the cost savings of doing this phototherapy in the home, it can be a profitable niche for HME providers who offer pediatric phototherapy equipment. Approximately 8% to 10% of infants born annually are candidates for home phototherapy and the average treatment is 3 to 5 days.

Unfortunately, pediatric phototherapy can be a challenging niche to fill. Many HME companies steer clear of offering the service due to staffing requirements and the necessity of providing 24-hour on-call services for infants who need treatment in the evenings and on weekends.

Dealers offering phototherapy services must be flexible when scheduling staff for the initial setups, warns Mary Lisa Shatilla, vice president of pediatric phototherapy service provider Vitech Complete Pharmaceutical in Staten Island, NY. In many instances, her company must deliver the units on weekends or late in the day. “There are many situations in which the pediatrician sees a patient as late as 6 or 7 at night and then decides home phototherapy is necessary,” she says. “In these cases, we need to get somebody to the patient’s house that evening.”

Being there for the patient as soon as possible is critical. Not only may extremely elevated bilirubin levels be toxic to the central nervous system and cause neurologic impairment even in healthy term newborns, but nervous parents demand immediate attention.

“Parents are often petrified when they are told their baby has jaundice and will need home therapy,” Shatilla says. “The individuals going out to the patients’ homes need to show compassion and take their time answering all the questions of the parents.”

Jaundice on the Rise
According to the American Academy of Pediatrics, infant hyperbilirubinemia (the clinical name for jaundice) has increased since the 1970s. One theory is that early hospital discharges have caused jaundice to be discovered after the baby comes home. In the past, babies stayed in the hospital for at least 3 to 4 days, when bilirubin levels peak. As a result, the hospitals used to manage this problem without much attention. Now it has become an outpatient problem with parents playing a critical role in the treatment.

Luckily, advancements in home phototherapy technology have created a more effective means of treating infants with jaundice. “Physicians are definitely a lot more interested in these newer phototherapy devices compared to the past,” says Lynn Gray, director of quality improvement for Genesys Health Enterprises, a pediatric phototherapy provider in Flint, Mich.

One of the biggest advantages of this new generation of home phototherapy technology is that the units are now easy to use and also promote better parent/infant bonding. Most have a fiberoptic pad that is placed directly against the baby while a light source bathes the skin in light. The absorption of this light leads to the elimination of the bilirubin. With most of the systems, continuous treatment can be given to the infants while they are asleep and awake. The child can even be diapered, dressed, held, and nursed while being treated.

“Years ago, the home units were designed so you couldn’t touch the baby,” Gray says. “The newer devices allow the parents to cuddle with their babies while they are receiving therapy.”

The end result is that compliance with the treatment protocol has improved as parents have been able to interact normally with their infants.

Flexibility is Key
Despite the prevalence of newborn jaundice, physicians have varying views on which bilirubin levels dictate the use of phototherapy. In general, many physicians will prescribe phototherapy if the jaundice appearing after the first day scores a bilirubin concentration level greater than 10 in preterm newborns and greater than 15 in full-term newborns. However, physicians tend to set their own criteria for home phototherapy prescriptions.

According to Shatilla, physicians also have different ways of handling phototherapy services. Some rely on her company’s nurses for performing the set-ups and daily heel sticks to take bilirubin level readings, whereas other physicians will do their own blood work because they prefer to have greater control and supervision of the treatment of their patient.

To succeed in the home phototherapy market, Shatilla stresses that home care providers need to gain the support of their local pediatricians, who refer the majority of cases. “We try to be as flexible as possible because physicians have different ways of handling these types of cases,” she says.

Because of these differences in physician preferences, Nampa, Idaho-based MedNow Medical Supply—with four HME stores in Idaho and eastern Oregon—provides its phototherapy service in two ways. Two of the stores contract with home health agencies that use nurses to perform the setups and evaluations. The other two stores rely on their own respiratory therapists to perform these duties.

Since parents are usually unfamiliar with infant hyperbilirubinemia and have many concerns about the health of their baby, it is essential that the home health representatives who make the visits are good teachers and listeners. “The parents are usually eager to work with us and it’s gratifying seeing how fast their babies improve once they start receiving treatment,” says Jennifer Freeman, RRT, one of the MedNow therapists trained to handle phototherapy.

During the initial visit, the therapist or nurse should explain how to use the unit and what signs to look for while the baby is receiving treatment. For example, babies undergoing phototherapy often have frequent and loose bowel movements, which usually stops when the treatment is completed. The skin in direct contact with the pad can also become red or blotchy. HME dealers who offer phototherapy may provide a 24-hour answer line to field parents’ questions.

Profitability is Possible
Despite phototherapy’s challenges, Gray believes that, if it is managed effectively, it can contribute positively to the bottom line. She points out that dealers who maintain a high volume particularly need to pay close attention to their distribution system to ensure efficiency. Genesys Health Enterprises learned this the hard way. According to Gray, an internal quality control study found that the company acted promptly in sending the units to patient homes but would then take almost a month to reclaim them.

“Since then, we have implemented a new process, which has greatly improved the utilization of these units,” she says. Now the average turnaround time for pick-ups is 7 days, compared to an average of 18 days in the past.

Due to the cost-effective nature of home phototherapy, insurance companies prefer this type of treatment to hospital-based care. Reimbursement is usually not a problem as long as a medical professional is making regular home visits to obtain bilirubin levels. Although insurance coverage is generally adequate, Freeman points out that Medicaid cases often are challenging because the infant needs to be enrolled in Medicaid in order for reimbursement to be processed.

“Many of these parents are trying to get their babies a social security number, but it can be a slow process and we need to stay on top of the case,” she says. “Sometimes they need a little help from us in getting the paperwork started.”

Since many of these units are ordered after business hours, another problem is that obtaining authorization from insurers. “Often we are not sure whether we’re considered inside the insurer’s network or outside of their network, so we must be creative after hours in doing what’s necessary to get the proper reimbursement,” Shatilla says.

Another challenge is getting some parents to comply with the treatment requirements. Even though the newer units are easier to use, there are always some parents who do not follow the guidelines.

“It’s better than it used to be, but we still occasionally run into a situation where the parents are not complying with physician orders,” Freeman says.

Despite the challenges of offering phototherapy services, dealers like MedNow Medical Supply believe it represents not only a consistent source of revenue, but also fills an important need.

“It doesn’t make sense to keep infants in the hospital when they can be treated effectively in their own homes,” Freeman says. “The doctors, insurance companies, and parents all seem to agree on this.”

Carol Daus is a contributing writer for Dealer/Provider.