NEW YORK – More than 10 years have passed since my Mom’s death, and she would be among those daunted by the growing pace of change emerging around health care. She struggled every day of her life with the physical demands of daily routines as she aged into her 70s, living with post-polio syndrome, arthritis, and congestive heart failure.
If asked today, I believe she would still place a high value on the things that enabled her to move about: her walker; then her wheelchair; hospital bed; and bedside commode/transfer board. She would not be impressed by all the hoopla that accompanies the introduction of new health information technology (Health IT) devices and apps.
It astounds me, knowing how important her HME equipment was to her (and to me and my siblings who cared for her as she aged at home), that the HME sector appears to be sitting on the sidelines during the ongoing transformation of the healthcare delivery system.
I understand that competitive bidding took the wind out of many sails, but perhaps competitive bidding and health delivery transformation are two sides of the same coin? Basically, both appear to treat HME as a commodity, with suppliers, manufacturers, and models largely interchangeable—mass-produced overseas with little-to-no clinical value. And why wouldn’t they?
When I walk into a local HME supply store, it looks like a rummage sale. The other choice, the mail order catalogs with an endless array of gadgets and convenience items, is overwhelming. Computer searches produce pages and pages of choice with little understanding of why any one model is better than another.
With all of the above in mind, I have not noticed a tradition within HME of working with academics to provide evidence of HME value. Academic researchers have long studied the impact that HME has on disability rates (i.e., Emily Agree of Johns Hopkins and Lois Verbrugge of the University of Michigan) yet they struggle for funding.
In an industry that is as evidence-based as healthcare, where are the sector initiatives and funds to support such research? The sector should be formally measuring the valuable contribution that HME makes to a patient’s ability to age at home, and to a patient’s quality of life—and to relieve caregivers’ physical burden. Reducing and/or eliminating falls or other injuries is another benefit.
Such outcomes, formerly of no monetary interest to anyone, will have new-found value as the delivery system morphs from volume-based to value-based payment systems. Some individual manufacturers of complex HME appear to have recognized the need to capture outcomes data. However, most local suppliers lack the resources to accomplish this on their own.
Perhaps trade associations can pull together a toolkit of such best practices, convene a coding “hackathon” to encourage the development of smartphone apps that local suppliers can easily download, and/or provide samples of outcome measures that can be shared with MD offices, clinics, and hospitals.
The Institute for Healthcare Improvement (IHI) supports “collective impact” efforts around specific strategies and tactics for improving the healthcare delivery system. Perhaps the industry trade groups need to sit down with the IHI staff and build a framework for bringing local HME suppliers into the post acute care improvement initiatives.
HME is too important to remain on the sidelines. As a caregiver, I want you vibrant and present, making sure that my family member (and soon for myself as I age) have access to the equipment that will allow us to function on our own as long as possible. This means straightening out the pre-order/delivery/service/repair process issues, not in disputes with federal agencies, but as collaborators with local healthcare providers in a patient-centered healthcare delivery system.
It seems that many of the ongoing disputes over CMS policies reflect the old volume-based system; perhaps attention should be given to incorporating solutions that involve interoperability and a common operating picture of the HME needs of a given patient.
And for goodness sake, please consider reaching out to collaborate with technology companies to embed sensors that can capture important data about my functional level. Trended data about the number of times/pace that the wheels on my wheelchair turned, or the number of times my walker moved, will have much more value in influencing change in a positive/negative direction about my need for clinical attention. A little imagination can go a long way.
Peg Graham, MBA, MPH, is semi-retired after 40-plus years working in health care advocacy and hospital administration. She is active in Health 2.0 and Aging 2.0, pursuing improvements in toileting options available to people living with mobility challenges and their caregivers. In addition, Peg advocates on the value of including social service organizations as partners in health care transformation initiatives, and believes that HME is in a similar position of untapped value. She serves as chair of the Health Services Forum for the Yale Alumni NonProfit Alliance (YANA) in New York City, and can be reached via e-mail: [email protected]
