The coronavirus pandemic has created an acute need for post-acute respiratory care, resulting in a natural downstream impact for companies that repair or deliver life-saving home medical equipment (HME).
How enterprises provide their services also has changed, with revamped safety and sanitation protocols sometimes colliding with the unknown human element.
An HME client of Strongsville-based Repair Authority had a patient purchase brand new equipment just to avoid a driver coming over to collect a damaged device, CEO Jesse Keirn said.
Anecdotal examples aside, home care companies must still manage the enormous and evolving role they play in patient health. Repair Authority fixes ventilators, oxygen concentrators and CPAP machines, serving equipment providers via a seven-vehicle fleet facilitating pickup and delivery in six states.
COVID patients prescribed oxygen therapy are usually fitted with an at-home oxygen concentrator or noninvasive ventilator. Repair Authority provides maintenance for this equipment as well as for continuous positive airway pressure (CPAP) machines used to treat obstructive sleep apnea.
Respiratory repair comprises about 60% to 65% of company revenue, which has tripled alongside workforce growth since a new ownership group purchased the company five years ago. However, Keirn and his team are feeling the downward pressure of limited equipment supply not meeting skyrocketing demand.
"There are more patients coming onto the rolls, and we can't get their equipment returned fast enough," Keirn said. "Or we can't get the parts to fix equipment because the manufacturers are overwhelmed. We have 50 employees now and would like to hire 10 more. We just can't find the labor."
The company, formerly known as The Repair Center (TRC), was renamed Repair Authority upon acquisition by Keirn and two business partners — chief revenue officer Dan Meyer and COO and Jason Ziebro. The Strongsville headquarters includes a 35,000-square-foot repair facility, currently being expanded by an additional 10,000-square-feet to keep up with COVID-stimulated demand.
The virus has altered the ground rules around equipment pickup and delivery, too. Routes are now consolidated to limit the number of stops, while drivers sanitize pickups three times before they even hit a technician's bench. Though employees have no direct contact with patients at home — most customers drop off and pick up their machines at HQ — full PPE is a necessity both at the facility and in limited contact with HME dealers.
"The biggest wild card for us has been pickup and delivery," Keirn said. "Our process is the same, but our trucks are a lot fuller. From the driver's standpoint, it's masks, gloves, sanitation and social distancing — the same thing everyone's trying to do. That slowed us down at first, but it's been no problem otherwise."
HME providers are challenged in safely delivering to patients even as supply issues permeate the industry. A survey from HME News, an industry trade publication, revealed 86% of dealers are running low on oxygen concentrators, with 88% reporting difficulty in obtaining more.
Medical Services Co. (MSC), an Oakwood Village distributor of respiratory and sleep disorder-management equipment, has realized a 300% uptick in oxygen orders, indicating a larger pain point in the health care ecosystem.
"PPE and beds are what you hear about, but on that continuum to free up hospital beds, you must have proper care management," said Josh Marx, managing director of sleep and vice president of business development for MSC. "When a COVID patient is discharged needing oxygen or ventilation therapy, that transition is ours to do."
MSC cares for 100,000 patients annually, with a 350-person staff comprising respiratory clinicians, insurance claim processors, drivers and more. Early on, the company spent $5 to $6 each on individual N95 masks for drivers of its 60 vehicles. An increase in mask supply cut costs in half, though MSC is seeing a 30% price increase in hard-to-find oxygen equipment.
MSC has also heavily invested in virtual care technology, performing 1,500 online clinician-to-patient appointments each month in lieu of the in-person interactions the company administered pre-COVID. As for home delivery, equipment is now transported directly to a caregiver or dropped off on a customer's porch before being called in by a driver.
"We take every necessary precaution to protect families and our employees, but you can't control all behaviors of the people you're dealing with," Marx said. "That's a challenge in some communities, so we're doing all we can to not interrupt service for our patients."
Parma-based Health Aid of Ohio mostly deals in custom wheelchairs for patients with ailments ranging from spinal cord injuries to multiple sclerosis. Sleep therapy and oxygen encompasses about 20% of the company's $13 million to $14 million in yearly revenue, services that also include in-home repair.
Cortney Skory, former Health Aid vice president and now a company consultant, said customers initially feared having anyone in their homes. Necessity brought technicians back into the field, protected by PPE and a round of vaccinations received in late January.
"We'll service equipment outside the home, too, or if there's a nursing home with a COVID outbreak," Skory said. "We'll bring the tools and fix equipment in the van."
Business has rebounded to near pre-pandemic levels after a 40% drop last year. Skory said 17 Health Aid employees have tested positive for the virus. Although transmission occurred outside the company in each case, enhanced PPE measures are expected to continue in perpetuity.
"It's opened everyone's eyes that if it's not the coronavirus that gets you, it could be something else," Skory said. "We want to avoid a sense of complacency."
Marx of MSC thinks the coming months, and perhaps years, will be a continuing exercise of crisis management within the industry.
"I don't feel like we're coming out the other end yet," Marx said. "COVID is a short-term illness, but we don't know the long-term impacts. Will patients need oxygen forever, or over a short period of time? We're committed to supporting these patients and our community."
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February 13, 2021 at 04:00PM
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Home care equipment companies face pandemic challenges - Crain's Cleveland Business
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