HME Heroes: COVID-19 Edition

As the nation battles COVID-19, Home Medical Equipment (HME) providers are partnering with hospitals and health departments to meet the medical needs of their communities.  The extent of this public health emergency is unprecedented in modern time, but the HME Industry is no stranger to rising to provide critical support and services in times of crisis.  

While most of America shelters in place, HME providers answer the call of essential service workers, braving the elements and working around the clock to preserve the homecare infrastructure that enables hospitals to quickly free up beds and safely discharge patients.  HME providers deploy their Respiratory Therapists and delivery technicians on the front lines to care for those with COVID-19, suspected cases, and other health conditions requiring treatment at home.  Meanwhile, millions of Americans rely on their HME providers to continue receiving their needed equipment, supplies, and services in a home-based setting to avoid health complications that would otherwise stress the already thinly stretched facilities.

These unsung heroes stand on the front lines of patient care, providing crucial services and equipment not only during times of crisis but every day of the year in meeting our country’s health care needs.  Meet a few from our nation’s COVID-19 hotspots.

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Serving the heart of New York City and its five boroughs, Hampton Homecare is operating in the midst of America’s most extensive outbreak of the virus, working relentlessly to meet demand for area hospitals and patients being cared for at home.  Past rounds of Competitive Bidding decreased the number of HME companies serving the metro area, straining the resources available to meet the need of hospitals as they discharge patients as quickly as possible and make room for additional COVID-19 patients.

Hampton Homecare is working closely with its manufacturer partners to get equipment as expeditiously as possible, noting an extraordinary 10-fold increase in orders for oxygen concentrators alone.  As soon as the UPS driver pulls up with a new shipment of equipment, warehouse staff is on standby to quickly process the inventory and get products out the door to patients who need them.  

“I told our UPS driver that every box off the delivery truck goes to help save somebody’s life,” emphasizes Joe Candiano, Director of Operations. “He said, ‘wow—I feel a lot better knowing what I’m doing today because I’m handing this off to you, and you’re getting it to someone who now won’t have to go to the hospital and can stay at home.’ And it’s true.  We are doing everything we possibly can to get this equipment out—to prolong lives.  When you pull up to that house and you have the equipment that will make someone’s loved one feel better or more confident in their day-to-day life, those family members look at you like you have a cape on.”

Vice President Joe Coticchio described the calls pouring in from area hospitals, nursing homes, hospice organizations, and physician offices.  “The last few weeks have been crazy for us.  Hospitals are trying to get stabilized patients discharged ASAP to address overcrowding,” explains Coticchio.  “Nursing homes are buying high levels of concentrators to prepare for the role they play in this.  And doctors are trying to keep their patients from having to go into the hospital in the first place.  Accessing products is the biggest need.”

As concerns of ventilator shortages grew, Hampton Homecare donated several ventilators to area hospitals.  “They need them, and we felt it was the right thing to do not to make any money off of the situation,” Coticchio recalled. 

The majority of Hampton Homecare’s staff is now working remotely while preserving their same service levels to patients and referral sources thanks to the technological investments the company made over the last couple of years.  Therapists are trained to do virtual setups for new CPAP patients, decreasing the exposure risk for customers and staff.  

It’s all hands on deck for company personnel.  Hampton Homecare’s President David Chase explained, “we have calls twice a week with managers and directors and are constantly assessing the situation and reallocating employees to find the best way an employee can contribute.”  Sales staff have been helping with deliveries, warehouse functions, open order reports, and anything needed to support the business activities. “When things like this happen, you see what your team is made of,” Candiano noted. “I’ve seen nothing but people rising to the occasion.”

“Every time we make a delivery, we’re helping people, both before and after COVID-19,” explains Chase.  “It’s all about helping people.  We aren’t selling toaster ovens—we are providing equipment and services that saves or improves people’s lives.  This is what drives us.  People want to heal at home.  And in a hospice situation, they want to be surrounded by loved ones and families.  Homecare is the solution to that.  It’s a stressful but rewarding job, and it’s frustrating that payers don’t understand it as well as we do.  But at the end of the day, there’s always a purpose as a homecare DME provider.  What the HME Industry does is absolutely necessary for the health care supply chain.”

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As the third largest ventilator provider in the United States, VieMed quickly stepped into action, placing bulk ventilator orders for hard hit states like New York and Louisiana.  VieMed also donated 40 ventilators to the local Lafayette, Louisiana hospitals near its headquarters.

The company quickly engaged its Respiratory Therapists to help staff hospitals and educate hospital employees across the country on how to use the various kinds of ventilators they were receiving.  

“A hospital may primarily use one kind of ventilator and is now getting eight different models.  We are teaching others about how to use each type of ventilator and created a series of educational YouTube videos,” explains Casey Hoyt, CEO and co-founder of VieMed.   [Show screenshot of YouTube channel]

With growing concerns about ventilator shortages in certain areas, VieMed developed an approach using the BiPAP AVAPS so that hospitals could use this invasively or as a secondary form of treatment.  They also worked in partnership with area hospitals to discharge patients who were able to be taken care of at home as quickly as possible to create room for COVID-19 patients.

“Patients with conditions like COPD are at high risk to catch the virus in the hospital.  The hospitals lean on the HME Industry to discharge these patients and free hospital beds for COVID-19 patients,” Hoyt explained.  Hoyt notes that advocacy outreach is paying off as the Centers for Medicare & Medicaid Services worked with the HME Industry to lift barriers that would prevent access to care during the Public Health Emergency.  “What CMS has done in the past few weeks has been amazing.  Lifting the rules and regulations, allowing seamless physician orders, and such are things that allow us to be swift and get people discharged efficiently.”  

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In Michigan, Binson’s Home Medical Equipment has already seen a 400% increase in overnight hospital discharges and a 50% increase in nebulizers since the beginning of the Public Health Emergency.  

“We are so grateful for our employees who show up every day and night in service to our patients; we couldn’t do this without them,” commended Stephanie Legree, VP of Government Affairs.  

“One doesn’t think something of this magnitude this will ever happen to your community, but it did,” Legree recounted.  “We quickly analyzed our operations and adapted to meet the growing need in our communities while helping ensure that our customers and staff are protected.”

Creating room in hospitals for the influx of COVID-19 patients was critical for hotspots like Detroit.

Binson’s Medical Equipment developed an oxygen discharge form for one of its area hospital systems to help streamline and expedite the discharge process.  “It’s specifically for COVID-19 patients but can be used for others with acute respiratory conditions thanks to the relaxed Medicare rules during the Public Health Emergency,” explains Legree.  “The form includes all of the information that we need from the medical record and allows the hospital to expedite the discharge process, keeping doctors focused on patient care instead of the cumbersome paperwork.”

Legree noted that local hospitals have white boards outside [insert photo] that point to the number of patients that get off of a ventilator or who were discharged after having COVID-19. “Those discharges are the HME Industry at work!,” emphasized Legree.  “We are the next step.  Our company provides essential services which allow hospitals to discharge patients and open up much needed beds for other patients.”  

“We are honored to be a part of the health care system during these uncertain times.  It’s in our hearts to care for our patients—and they know we’re here for them.  The other day, one of our oxygen patients who lives alone called us because she also needed a gallon of milk.  We’re the people they rely on, the people they turn to in times of need.”

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An hour outside of Seattle in Gig Harbor, Washington, Olympic Pharmacy prepared as one of the first areas of the country impacted by COVID-19.  

Olympic Pharmacy specializes in pediatric respiratory conditions and Complex Rehab Technology.  When COVID-19 surfaced in Seattle, they worked closely with Seattle Children’s Hospital to provide feeding pumps, suction supplies, enteral nutrition, and personal protective equipment to non-COVID-19 patients who were being discharged to free up beds for the anticipated influx of COVID-19 patients.  They also worked with the local military hospital to set up the growing number of nebulizer patients that were being discharged as well.

“There were a lot of unknowns in the beginning,” explained Kristine Hurt, RRT, the company’s respiratory department manager.  “A lot of the nursing case managers and social workers we talked to seemed kind of frantic in anticipation of COVID-19.  Everyone was preparing for it to hit.”

Olympic Pharmacy ramped up inventory and worked collaboratively with the pediatric pulmonary department to make sure that their patients had the ventilators they needed, both for use in the hospital and when non-COVID-19 patients were being discharged to continue treatment at home.  They have experienced notable increases in discharges and orders of equipment and supplies but have been able to serve all of their existing patients in addition to numerous new patients that others could not take on due to their medical complexity.

“We didn’t want the pediatric patients’ families having to come into our building where the other medical offices are seeing and diagnosing COVID-19 patients, so our ATPs are still doing final fits for our Complex Rehab Technology patients at home,” explains Amber Lacheney, Purchasing Manager and Inventory Control. 

Lacheney, who has been with the company since 2003, continued, “I know that if I can’t get them their equipment and supplies, I’m impacting their quality of life.  We always put the patient first; we always do the best we can.  All of us in this industry do that, even those of us who are behind the scenes.  We really care and want to do the best we can do to our part.”

Washington’s stay-at-home order appears to be helping level off the number of new daily COVID-19 cases, and Olympic Pharmacy is keeping its doors open to serve its community.  Despite downward reimbursement trends and a growing number of HME providers who have closed their doors since Competitive Bidding began in the Seattle metro area, Hurt is hopeful that this will shine a bright light on the value of the HME Industry, particularly in times of crisis.  “One of my favorite quotes is ‘at any given moment, you have the power to say this is not how it’s going to end’.  It’s what I live by, and it’s what I believe for our industry.”

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Meanwhile, companies throughout New York are meeting their communities’ localized needs while bracing for the overflow of COVID-19 patients coming from New York City into other areas of the state.

Quinlan’s Pharmacy & Medical Equipment has held multiple strategic planning calls with its four area hospitals in rural upstate New York, five hours away from New York City, focusing on the coordination of respiratory equipment, discharges, and delivery schedules.

“Our area hospitals have shortages in PPE and medical equipment such as hospital beds and respiratory equipment”, explained owner John Quinlan.  Quinlan is working with manufacturers to get hospitals what they need in addition to preparing for the increase in patients Quinlan’s Pharmacy & Medical Equipment will be taking care of as well.  

“We’ve already rented 100+ hospital beds, and we’ve seen a 20% increase in oxygen concentrator orders,” Quinlan noted.  “When it comes to times like this, HME providers are on the front lines, collaborating to solve any emergency.  A lot of folks are putting their own health and safety on the line to help others.”

Upstate Homecare was able to leverage their relationship with payers to open doors for discussions on how the HME Industry can help keep patients at home during the pandemic.  Its CEO, Greg LoPresti, used AAHomecare resources as a jumping off point for conversations on ways that payers could partner with HME providers to lift barriers that enable individuals to be cared for at home.

LoPresti noted that Upstate Homecare is still able to provide services for anyone who needs it, even with many employees working remotely.  The company is also coordinating with area hospitals from Albany to Buffalo to provide ventilators, BiPAPs, and CPAPs.

“A lot of the doctor and dentist offices in our area are closed,” notes LoPresti.  “However, that hasn’t been the case in this Industry.  In the face of danger, this profession has risen to the occasion to serve the patients day in and out.”

To date, the biggest request of Hometown Healthcare in Clifton Park, NY is to provide ventilators and oxygen concentrators to area hospitals according to its CEO, Casey Toomajian.  As these patients are discharged, Hometown Healthcare is “ready to support people coming out of acute care facilities and into the post-acute settings to ensure that the patient flow is not interrupted.  Our hospitals’ census is lower, but the patients they serve are sicker.”

Hometown Healthcare adapted its model to enable 50% of its staff to work remotely while establishing infection control and PPE policies to ensure the safety of those who are still working at the office, making deliveries, and engaging with customers.  They continue to see many patients virtually as well, easing fears of patients who needed health care but were afraid of face-to-face contact and exposure.  

LoPresti succinctly summarized that the HME Industry is an indispensable part of the health care system, particularly in a crisis like COVID-19.  “This is a war, and to be part of the front lines, be it as a Respiratory Therapist, biller, or driver—everyone is supporting it.  In a war, we’re in it together, and every link of that chain is important.”

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We know stories like these are just the tip of the iceberg of how the HME suppliers and manufacturers are stepping up to meet and help defeat the COVID-19 pandemic.  Thank you for your courage and compassion on the front lines.  We’re proud to stand beside you and fight for healthcare policies and share resources and guidance to assist in this essential and life-saving work.

Want to share your story?  Email Ashley Plauché at ashleyp@aahomecare.org.