Kimberly-Ann Wigglesworth-Buggs is our unofficial “incontinence queen.” Her official title is director of operations and I suspect that the other more royal moniker is not the one Kimberly wants on her business cards. But the fact that our director of operations is in charge of tracking deliveries of incontinence products highlights the importance we place on these seemingly innocuous stepchildren of the HME business.

When we formed Hawaiian Islands Medical Corp on May 1, 2001, in Honolulu, we knew we would be a general DME supplier and rehabilitation wheelchair provider. At the beginning, we had four employees, a strong desire to provide excellent service, and about 40 Medicaid recipients who needed a delivery of incontinence products in June.

We found space, set up a supply chain, purchased a delivery van, borrowed money, applied for supplier numbers, and moved in to our new warehouse on June 6. The phone started ringing and most of the calls were from Medicaid recipients who needed incontinence deliveries. This was probably fortunate, since we had a Medicaid supplier number but were still waiting for our Medicare number and our private insurer contracts. In our brand-new office, we gave Kimberly a three-foot-long shelf, which she quickly filled up with incontinence patient charts.

Since then, we have grown rapidly and evolved into a company with a specialty in rehabilitation wheelchairs, with a certified rehab technology supplier (CRTS), a certified service technician, and 19 other customer service, delivery, billing, and support staff. We now have 56 three-foot-long sections of shelves for patient charts. Even though we have capable staff to take over the duties of monitoring our incontinence deliveries, Kimberly holds on tight to her incontinence clients, providing them with “knock-your-socks-off” customer service. And she still has her single three-foot-long shelf for her incontinence patient charts. Why does she still have only one small shelf?

Well, the total number of customers receiving incontinence products has quadrupled, but the number of customers receiving only incontinence products has stayed remarkably stable. Customers who start out needing only incontinence products quickly become customers who need wheelchairs, hospital beds, bath products, and even specialty rehabilitation wheelchairs. Because they are happy with our service in the little things, they trust us to provide the bigger items. And they tell their friends and relatives (in Hawaii, everyone is related). And these friends and relatives who don’t necessarily need incontinence products call us for their equipment needs.

I believe that efficient, friendly delivery each month of incontinence products is the least expensive form of advertising available. A single three-inch by two-inch column advertisement in our local newspaper costs around $500, depending on the day and frequency. Our major yellow pages advertising costs a minimum of $500 per month. And these sources do not target customers with medical needs the way going into a home where someone is using incontinence products does.

These “low margin, nobody-wants-to-do-them” products also serve as a service to our referral sources. Everyone knows that hospital discharge planners, home health agency nurses, and independent and government case managers want to make as few calls as possible to arrange for equipment and supplies for their clients. Just the fact that we are willing to provide—and deliver—incontinence products is sometimes the tipping point in our favor over the larger companies that will supply the hospital bed and wheelchair, but say, “You’ll have to get the incontinence briefs somewhere else.” Some of my fellow HME providers ask how we can afford to make incontinence deliveries. My answer is how could we afford not to?

In addition to the marketing aspects of delivering incontinence products, the fact that we go into a customer’s home every month affords us the opportunity to monitor their need for other equipment we may be providing. It also gives the customer or caregiver the opportunity to ask questions. Because our regular delivery staff makes the incontinence deliveries, they are usually able to answer any questions. This enhances the customer service perception that keeps our customer satisfaction levels above 98%.

So how can we do incontinence deliveries without going broke? First, we actually did a cost-based analysis on our incontinence deliveries and determined that pulling and packing a route by area, loading up a van, and having one driver dedicated to doing only these products 4 days a month was more efficient than combining the incontinence deliveries with our regular deliveries (except for the far outlying areas.) This also is beneficial for the clients and their caregivers, because after the initial delivery (usually on discharge from a hospital or long-term care facility), they know they will get their deliveries between the 15th and 20th of the month. This eliminates the need for repeated phone calls to set up delivery schedules. This also means that we can place an order with our supplier and receive the products in our warehouse the day before we start deliveries, so we have limited inventory to maintain the rest of the month. This is critical, because warehouse space is expensive in Hawaii.

Another positive factor for continuing deliveries of incontinence supplies is the fact that claims generally pay out the week after the claim is submitted. Rehabilitation suppliers freely admit that the Medicare payment climate is definitely unfriendly to those of us trying to legitimately provide custom wheelchairs and seating systems. As soon as the K0011s started to loosen up and began paying without going to review, we were faced with K0108 wheelchair cushions which required additional documentation and justification and are still going to review.

Once our Hawaii State Medicaid office authorizes our incontinence products, the claims processing flows smoothly. Incontinence products are one of the few where we can get paid for the products before we have to pay our vendor. Our small company always needs cash flow, so it is nice to have one bright spot in the reimbursement picture.

Laura M. Steelquist is president and owner of Hawaiian Islands Medical Corp, Honolulu. She can be reached via e-mail: laura@himed.cc.