Jane Swoboda, RRT, and Donna Smith

Creating a successful ventilator home management program is a labor-intensive endeavor that requires solid relationships with hospitals, billing know-how, vigorous advocacy, and an unflinching willingness to work with caregivers for as long as it takes.

Every ambitious businessperson aims for success, but the measure of success can vary. Consider HME providers in the home ventilator business. Here “success” means empowering caregivers for starters, and literally saving lives in the long run. It is a tall order, but one that the professionals at Home Care Medical in New Berlin, Wis, have been achieving for close to 30 years.

As a general HME provider, Home Care Medical has served the home ventilator market since the company was founded some 28 years ago. However, according to Donna Smith, manager of the respiratory department, the company has made its most significant strides over the past 10 years. “Over the last decade, we have really focused on enhancing the service component of the business,” says Smith. “Our goal is to make the process of living with a home ventilator more personal and comfortable, while instilling confidence and empowering caregivers—because frankly, that is what saves lives.”

While ventilators are often used in hospitals and ICUs, many patients must bring one home to survive illness or serious injury. Common reasons include neuromuscular problems, spinal cord injuries, apnea, and genetic abnormalities that create anatomical problems such as a jaw too big or too small. In all cases, the person cannot breathe on his or her own and the ventilator is a critical life support system.

At Home Care Medical, patients on home ventilators range in age from 8 months to 80 years old. And while every patient is precious, Smith and her team take particular pride in the young patients they serve. Children whose prognosis was dire have sometimes progressed to the point where they are going to school, playing at day care, and enjoying camp. In fact, one third of the home ventilator patients the company serves are youngsters under 18 years of age. “The best part about the business is watching the babies grow into teens,” says Smith. “Some of our kids have been with us 16 years.”

Indeed, Home Care Medical has developed a ventilator home management program that has scored exceptional marks in the health care industry; the JCAHO gave Home Care Medical a 98% on some intensive standards, including patient interviews, equipment checks, home site visits, and RT interviews.

What is Home Care Medical’s prescription for success? “There are a number of factors that contribute to success in this field,” says Smith. “But I think the number one asset you can have is a highly trained, professional staff.”

Jane Swoboda, RRT, leads Home Care Medical’s “hands-on” team. A respiratory therapist for more than 25 years, Swoboda recently won the Therapist of the Year Award—an honor coveted by therapists throughout the state of Wisconsin. Swoboda helped create the organization’s home ventilator management program that has set an example across the country.

A Parent’s Grief
Talk to Donna Smith and Jane Swoboda and you soon realize that a home ventilator program is really all about, well, being at home. Caregivers need to be “at home” with the technology and with the needs of the patient. Up-front services are absolutely imperative. “We meet with the caretakers at the hospital, get to know the family, and assess the home environment,” says Smith.

One primary mission of a home vent management program is to make the caretaker comfortable. A sick child is a traumatic experience for parents, and dealing with life support equipment may seem overwhelming at first. The goal is to build their confidence so they can perform both the routine tasks as well as handle disasters.

Home ventilator systems can require a good deal of equipment. For example, a typical setup might include the ventilator itself, humidifiers, portable suction machines, tube feeding pumps, apnea monitors, and nebulizers. It is therefore vital that the environment be thoroughly assessed for electrical power needs. “We make sure outlets are properly grounded, and we know on which circuits we can add additional power,” says Smith. All of this is critical because if the power fails, the patient’s life is threatened.

Assessing the home environment is only one aspect. The real work begins while the patient is still hospitalized. “We educate caregivers about everything from tube feedings, tracheostomy care, and medication compliance to dealing with equipment and responding to emergency situations,” says Swoboda. In fact, patients are not released from the hospital until the caretaker passes a test on essential caretaking functions.

To say the home ventilator market is labor intensive is an understatement. Home Care Medical has eight full-time RTs on staff. “When a patient is released from the hospital with a home vent, we are right behind the ambulance,” says Smith. “We meet the family at their doorstep.” The mission of the provider is to ensure a smooth transition from hospital to home.

Swoboda says her team meets with the patient and the caretakers on a daily basis initially. Once the caregiver is comfortable with the ventilator, an RT from Home Care Medical visits the home three times a week for a while, then gradually steps down the visits to ultimately once a month. “It is very important for the provider to visit once a month, even after the caregiver is comfortable and the patient is progressing,” says Swoboda. “People tend to relax after a bit and they may forget how to care for or clean the equipment.” A presence at the home—and building a partner relationship with the caretaker—is what ensures patient safety and successful treatment.

Big Challenges, big Rewards
In addition to recruiting and building a top-notch team of RTs, providers in the home vent market say it takes a knowledgeable billing staff to handle reimbursement issues. Home vents for babies retail for about $18,000 to $20,000. Medicare and Medicaid typically reimburse one third less than private insurers, and many of the supplies are not covered at all.

Breaking into the home vent niche requires cash flow and a long-term outlook. General HME providers may not be fully aware of the sheer quantity of equipment. Smith notes, for example, that in some cases two home vents are required, but only one will be reimbursed. Moreover, in a time-consuming business, providers are not reimbursed for their time. Rather, reimbursement is strictly for equipment. “When it comes to reimbursement, you need a top-notch staff,” says Swoboda. Home Care Medical says its administrative team understands the ins and outs of the system along with the countless forms and approvals like “prior authorizations,” and generally, has the gumption to stand up for what is right. “We absolutely fight on behalf of the patient,” says Swoboda. “For example, a second resuscitation bag could be a matter of life and death—that should be covered.”

Perhaps the biggest challenges occur when there are life changes in the patient’s family (parents divorcing or a nurse retiring). “At times like these, we have to go in and retrain new caretakers,” says Swoboda. An equally important change is when the family moves from one residence to another. In such cases, the home vent provider must do a new evaluation.

Allies at the Hospital
To thrive in the home vent market, a provider needs to gain the trust and confidence of hospital personnel. Providers must have the acumen to work well with a variety of specialists including ENTs, GIs, pediatricians, and pulmonologists.

Home Care Medical is a preferred home care provider for Children’s Hospital of Wisconsin. “We communicate with hospital home care coordinators, pulmonary nurses, and doctors on a regular basis,” says Smith. “We are the primary liaison, and they know they can depend on us.” In fact, Home Care Medical has even invested in training nurses for home care and the company works closely with the Make-A-Wish Foundation of America to ensure that vent kids who take dream trips are fully equipped.

Still, at times, Home Care Medical has had to “stand up to our referral sources,” says Smith. For example, if a hospital releases a patient too soon, such as after 2 days, there can be problems. “Patients and caregivers need more time to adjust to and get educated about the equipment,” says Smith.

It is no surprise that Home Care Medical continues to grow with referral business from hospitals, nursing homes, and long-term care facilities. But the greater rewards are in the work itself. Not so long ago, many children lived their entire lives in the hospital. Now, with laptop ventilators, vent-dependent kids can live at home, take trips, and be on the move. “It is very gratifying to see how our work, and the work of the entire field, is liberating kids every day,” says Smith.

Home ventilators save lives, but only if caregivers are fully trained and feel empowered to respond to everyday needs and emergencies. “Our kids rarely end up back in the hospital,” says Swoboda. “So many of them are thriving and that’s when you know you’re doing a good job.”

Marianne Matthews is a contributing writer for Dealer/Provider.