Equipped to heal at home

Editor’s Note:  Healing at home requires a strong, vibrant home care industry.

From: PennLive/Body and Mind

Sure, we know where to shop for the hottest fashions, but when it comes to buying home medical equipment, our shopping savvy can drip away faster than an inverted IV bag.

Our doctor adds glucose meters, a commode, a wheelchair or a walker to our shopping list, and suddenly, we are foraging for products we never imagined we would need.

Experienced patients, such as Kelly Soule of Lower Allen Twp., reassure novice clinical consumers that they are not alone: There are services to help.

Battling cancer for six years, Soule cares for herself at home, where she can continue to heal in the company of her son Michael, 9, and husband George.

While undergoing infusion therapy four years ago, Soule gave herself IVs every day through an implanted port, allowing her to take in much-needed nutritional supplements and medication to cope with the side effects of chemotherapy.

A nurse from Comfort Care, a home health agency, came into their home to train Soule and her sister on the equipment. Although Soule has received care at Penn State Milton S. Hershey Medical Center and Johns Hopkins Medical Center, much of her treatment has been as an outpatient.

She also went to American HomePatient on Hartzdale Drive in Camp Hill to be fitted — and then re-fitted — for a CPAP mask for sleep apnea, a side-effect of her treatment.

Having worked with end-stage heart failure patients earlier in her career, Soule already possessed some working knowledge of home medical equipment. But she recommended that first-time buyers work with hospital care managers or discharge planners, who know the agencies and insurance companies.

“It’s important that you know you’re not by yourself. There are professionals here to help you and people to help you set up these things,” Soule said.

Some items can even be bought at your neighborhood pharmacy, or superstores such as Walmart and Target, which carry bigger equipment items, such as canes, crutches and diabetic supplies, Soule said.

Steve Burkholder, owner and president of Family Home Medical in Carlisle, serves hospitals within a 40-mile radius. Other companies serving the region include Central Medical Equipment in West Hanover Twp., which has a showroom floor and displays, and is set up for over-the-counter sales; Young’s Medical in Lower Paxton Twp., which concentrates on filling prescriptions remotely; and GSH Home Med Care in Lebanon and Palmyra.

Burkholder said the “primary driver” of where you go and what you buy is Medicare.
Companies can usually tell you up front whether the equipment you need will be covered by Medicare, Medicaid or private insurance, Soule said. If it is not covered, charitable organizations such as the VFW and the American Legion often help, and patients can borrow equipment through groups such as the local Area Agency on Aging.

Most of the cost of Soule’s equipment, including a hospital bed and wheelchair, has been covered by private insurance and was delivered directly to her home and set up for her.

When you are discharged from a hospital or long-term care facility, the discharge planner will usually help you order a hospital bed or other equipment to help you with the three necessities of living: eating, sleeping and toileting, Burkholder said.
Often, if you do not have a preferred provider — and most do not — the planner will tap into the provider closest to your home. Family Home Medical will receive an order for equipment from the planner, record insurance and demographic information, and set up a delivery time, for example.

“Insurance companies have a philosophy that they want to provide the least costly device that will maintain your independence and safety in your own home,” Burkholder said. For example, Medicare will pay for a semi-electric bed, not a full hospital bed, but Family Home Medical will provide a full hospital bed anyway, despite the added cost they must eat, Burkholder said.

Often, his company is thrust in the middle between what the doctor orders, what insurance will cover and what the patient or his or her family wants. These conflicting goals set up a battle pitting convenience and luxury against medical necessity. Burkholder said “it’s the tightrope we walk” between finding the highest quality medical equipment and what the insurance company will pay.

Patients who do not mind paying out-of-pocket can upgrade to a more bells-and-whistles model.

John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, said most medical equipment, including oxygen, requires a prescription from your doctor, especially if Medicaid and Medicare are being billed. Strict reimbursement rules come into play — such as, you cannot have a walker if you use a cane, to prevent “over-paying and over-utilization,” Shirvinksy said.

Some people choose to buy medical equipment over the Internet, but Burkholder cautions against comparing prices that way, because it is not an apples-to-apples comparison. A wheelchair or scooter can be shipped over the Internet and dropped in a crate on your front porch. Consumers must then uncrate, assemble and teach themselves the product, with no help with repairs, breakage or maintenance.

In contrast, a local company like Family Home Medical not only provides the wheelchair, but delivers it, teaches patients how to use it, maintains it and helps with the billing process — and these costs are often spread out over 13 months.

Medicare might even pay for setup and delivery charges, so it’s worth it to have someone help you, Burkholder said. He urges clients to select a local, reputable, established company “who has a direct interest in providing care to people in the community.”

A local company with a permanent storefront location and regular, posted hours shows they are not just a “ship and drop” operation and do care about customer service.

And, just as you would from your doctors, don’t hesitate to get a second opinion from a medical supplier.

Look for accreditations from agencies such as the Joint Commission on Accreditation of Healthcare Organizations. Companies also must be accredited to work with Medicare and know vital information such as sterilization standards. Also, look for places with around-the-clock emergency service, same-day delivery and trained customer service staff. Some companies even have trained respiratory therapists on staff.

And unlike most shopping sprees, these purchases are about life and death. If your oxygen malfunctions in the middle of the night or your power wheelchair dies in the middle of the street, you need help immediately, Shirvinsky emphasized.

The stakes are high. Cutting costs can translate into real danger.

“Remember, you get what you pay for.”

-Written by DIANE WHITE MCNAUGHTON, For The Patriot-News

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