Home Health Care Dealer/Provider spoke with Laura M. Steelquist, president and CEO of Hawaiian Islands Medical, a Honolulu-based HME provider, about the benefits of offering delivery service for incontinence products. Hawaiian Islands Medical, started in 2001, delivers incontinence briefs, underpads, and gloves.

Dealer/Provider: Your company makes dedicated van deliveries for incontinence products. Why did you decide to take this unusual step?

Laura Steelquist: Those were the first deliveries that we made when the company started on May 1, 2001. We had incontinence deliveries set up before we even had a warehouse from where we could deliver them. When we started the company, there was a huge chunk of clients who had just been cut off from another company that had decided to discontinue incontinence altogether. It just happened that these were the first deliveries we started because those clients were looking for someone to provide that service. It didn’t require a Medicare supplier number at that time—which we were still waiting for.

D/P: Do customers who start out needing only incontinence products eventually become customers for other products and equipment? If so, what kind?

Steelquist: Almost all of them do eventually become customers for other products and equipment—anywhere from hospital beds to manual wheelchairs to rehabilitation wheelchairs. We do a lot with incontinence products for medically fragile children, and those frequently turn into wheelchair cases as well.

D/P: Are your incontinence patients a good source of word-of-mouth referrals?

Steelquist: Everyone you service on this island is a potential word-of-mouth referral because we all know each other and we all talk to our friends.

D/P: When hospital discharge planners arrange for equipment and supplies for clients, does the fact that you provide and deliver incontinence supplies give you an edge? If so, why?

Steelquist: I do think it gives us an edge. The easier their job is, the more they will want to use us. The fact that they can do one form for Medicaid patients (Medicaid is the only insurance that covers incontinence products) for not only the incontinence products, but also the shower chairs or hospitals beds or wheelchairs or anything else—that is one less piece of paper and one less trip to find the doctor to get a signature. It makes it easier for them, and therefore, they use us. I think the discharge planners assume that everybody delivers, and it is only when people complain to them later that they had to go pick up something themselves that they even become aware of the fact that other companies may not be delivering.

D/P: How do you make incontinence deliveries financially viable? Do you combine incontinence deliveries with other equipment deliveries?

Steelquist: These days, with the price of gasoline, it may not be viable. We are probably going to lose money on this month’s deliveries, but I’m not going to discontinue them—because we have great hopes that it is going to recover somewhat in the near future. If not, we are going to have to go back to Medicaid to have them look at adjusting the prices, because everybody’s going to have the same problem, whether they’re making deliveries or not.

Every month, we have 3 days that we predominantly just do incontinence deliveries. We fill up the cargo vans and we are done in 3 days, and the warehouse goes back to normal. It is a very limited business interruption. Deliveries on those days are almost exclusively incontinence products, unless we are delivering to the far outlying areas, and then we will look around to make sure there is nothing else that has to go to that area. As new clients come on, they get their deliveries with other equipment, and then self-paying clients who come in during the month are routed into the normal schedule.

I have tried it both ways: delivering incontinence products solely and with other product deliveries. One problem is warehouse space. I don’t have to warehouse incontinence products this way; our local distributor brings them over the day we need them, and they are out of the warehouse after that. We don’t have to keep getting deliveries and building purchase orders. Everything is done with one invoice.

D/P: What are the marketing advantages of delivering incontinence products?

Steelquist: Our marketing person loves to go to the association meetings for residential care homes because she can tell them that we will deliver incontinence products to them. And again, it is easier for the discharge planners. Really, it is easier for anybody. When they ask what the charge is for that, and you tell them there is no charge, you have got somebody for life.

D/P: What is the reimbursement climate like for these products?

Steelquist: Incontinence products are covered only by Medicaid, so most of our incontinence clients are Medicaid patients; the others are private pay. There is no private insurance that covers this. Our private pay clients usually go in the other direction: They have gotten something like a wheelchair from us and liked the service that they received, and then ask what else we do. Then they find out that instead of going out to buy incontinence products, they can get them delivered through us. Having discovered that, of course the next time they need anything, they call us up.

D/P: You once referred to incontinence products as the “seemingly innocuous stepchildren of the HME business.” What did you mean by that?

Steelquist: Nobody wants to do it. Incontinence products are considered a necessary evil. There are a lot of people here who will not deliver incontinence products under any circumstances; if you want them, you have to pick them up. They say, ‘The margins are very low. I can’t make this delivery.’ That is true, and if you are somewhere where nobody does deliveries, that is fine. You get them into your storefront and you can do a retail sale at the same time. That philosophy works for some markets. On our island, we have not only the larger HME suppliers, but also probably five or six little providers who do nothing but incontinence products—and they all deliver. We don’t do it because of them, but we don’t stop it because of them.

D/P: Among HME providers, what is the biggest misconception regarding the sale and marketing of incontinence products?

Steelquist: The larger HME providers just don’t think that incontinence products are of any value whatsoever. That’s the impression I get. It certainly is not the most important piece of my business; it is not the second or the third most important piece of my business, but it’s something that we offer because of the fact that it is just a few products. We went through the trap of giving everybody what they wanted instead of what they needed, and we pulled that back. We offer a very limited number of products, and if they don’t want that, we have to send them someplace else.

D/P: What type of marketing do you do to boost referrals? What type of marketing would you be sure to avoid?

Steelquist: We do very little direct marketing for incontinence products. When our marketing person goes to doctors’ offices to pick up certificates of medical necessity, she mentions we have incontinence products, but that’s not why she goes. She also visits residential care homes and senior fairs. We are not going to spend money on newsprint or TV ads for products with very low margins.

D/P: What other types of equipment do you carry?

Steelquist: We are primarily a rehabilitation supplier. We do all of the higher-end custom seating and positioning products. We also have basic DME, such as hospital beds, wheelchairs, bath items, and walkers. DP

Danielle Cohen is associate editor of Dealer/Provider.