Inside the evolving—and thriving—home healthcare sector and what it means for HTM professionals
By Chris Hayhurst
Years ago, when he was in high school, Jeff Ruiz, CHTM, knew he wanted a career in electronics. He enrolled in an electrical engineering technology program after graduation, and before long he was looking for a job—anything that might help him pay his way through college.
Ruiz didn’t realize it at the time, but the work he eventually found was a sign of things to come. He took a part-time job as a driver picking up pneumograms from people’s homes and delivering them to their physicians to read. “I had no idea what the tapes were for at first,” he recalls, “but I learned they were recordings of infant heart rates and respiration rates, and they were used to determine if a baby was at risk of SIDS.”
His employer, Ruiz says, was a home healthcare company that soon became his inroad to the world of healthcare technology management. From shuttling pneumograms, he went on to work in the company’s repair department—“a little shop in the back of a warehouse.” It was Ruiz’ first real exposure to the biomed community, and from that point on he focused on HTM. “I finished school and then went to work for them, and then I worked at another home care company and stayed there for 21 years.”
Home Care: A “Booming” Industry
Home health alone hasn’t defined Ruiz’s career (since 2010, he has worked in a hospital setting), but the equipment and technologies that are used in the industry have always been an important part of his job. Today, he works with TriMedX as a technology manager overseeing services in a hospital in Holland, Mich. His team handles all kinds of equipment, but their home-related workload is growing all the time, he says.
“You talk about a booming industry. I can remember, back in the day, when we had 20 telehealth units total and maybe 10 would be in use at any given time. But now, the numbers—they’re staggering: It’s hundreds of devices, and when they come to us we have to get them finished as quickly as possible.” His team’s responsibilities, Ruiz explains, include inspecting, testing, and inventorying all devices the facility dispenses in the home environment, from blood pressure monitors and fingertip pulse oximeters to the tablet computers patients use to communicate with providers.
“The maintenance strategy is entirely different than what you have for hospital equipment. In the hospital, you can go ahead and hit your departments at their specific months, but in home health, you’re at the beck and call of the patient. You don’t know when those patients are going to be discharged from the hospital, and therefore you don’t know when they’re going to be assigned these devices.”
His HTM team typically does all of its home-device work in the hospital’s shop, but on occasion they’ll send a biomed to the field, Ruiz says. “Usually, the home nurses are the ones that dispense the equipment and bring it back in, but if there’s really high demand, we’ll try to be proactive and do the inspection in the patient’s home.” As a manager, he says, he hasn’t personally done a “road trip with nursing” in a long time, but he can remember clearly what it could be like. “In the hospital, the infrastructure is established. You have hot water, cold water; you have oxygen that’s pumped in; data lines; Wi-Fi. You have all the key components that keep a facility viable.”
The home care environment, on the other hand, may include issues related to cleanliness that could result in device contamination, and some homes lack basic amenities. “You may not have Wi-Fi, you may have dial-up. And even electricity may be a problem,” Ruiz notes. He recalls going to a number of homes where the patient—behind on their utility bills—would have their oxygen machine plugged into extension cords that were hooked up to their neighbor’s house. “There’s a lot you can’t control in the home environment, so you have to be ready for anything.”
The Home as the New Hospital
Chances are good that nearly every biomed has some experience working on home medical equipment. With a growing body of research showing cost savings and improved outcomes when patients are moved out of the hospital environment quicker, more organizations are adding home care to their service offerings and home care equipment to their HTM workload.
“The home is becoming the new hospital room,” says Donna Martin, senior vice president of global healthcare business development at the business-process management company HGS. A study published earlier this year in The American Journal of Accountable Care found that patients who received follow-up care at home after a trip to the emergency department cost $7,000 less to treat over three months than those who remained in the hospital ($13,012 vs. $20,325).
Readmissions among the home care group were also less common, leading the authors to conclude that home-based alternatives to hospital-based treatment will become increasingly important as care-reimbursement models move away from the traditional fee-for-service models and toward those rewarding cost-effective, quality care.
Indeed, according to one recent analysis of healthcare trends, the global market for home care topped $306 billion in 2018 and is expected to expand at a compound annual growth rate of nearly 8% through 2026. That report, from Grand View Research, pointed to rising incidence of chronic diseases, combined with the aging population, as the primary drivers of the home health market, and other analysts have said the same.
The U.S. Bureau of Labor Statistics anticipates that employment of home health aides will grow 36% between 2018 and 2028. “As the baby-boomer population ages and the elderly population grows, the demand for the services” of home health professionals “will continue to increase,” the BLS reports.
Martin notes that home health is good for health systems, good for patients, and—in the end—good for HTM professionals as they facilitate much of the real-time monitoring that’s required. Moreover, she says, “Remaining in the comfort of [one’s] home allows for care to come to patients, [eliminating] transportation or mobility issues, [and preventing patients from being in the presence of other sick people].”
And when it comes to healthcare technology management, “I think there is a tremendous opportunity,” Martin says. Home health is more accurately provided using the equipment and wireless devices that patients are provided with as they leave the hospital, she notes. “The more patient care moves to the home, the more demand we’re going to see for these devices—and the more we’re going to need HTM teams to provide care.”
Addressing the Demand
One HTM professional working to meet rising demand for home care medical equipment repair and maintenance is Scott Seymour, owner of Diversified Medical Supply Corp. in Fenton, Mich. His team of 12 employees, Seymour says, includes a mix of drivers and technicians, including two who are certified to service ventilators, infant monitors, and BiPAP and CPAP machines, and others who handle work on oxygen concentrators.
He launched the company in the late ’80s and started out repairing and refurbishing circuit boards, he says. From there, the company expanded to infant monitors and filling oxygen tanks, “but the crux of our business from the beginning has always involved work with home healthcare companies.”
The way his business operates is simple, Seymour says. Working with home healthcare organizations all over the state of Michigan, his company sends trucks to clients’ facilities to pick up equipment that needs repair and to drop off any equipment that’s been serviced. They typically provide each client with an estimate for the work they’re contracted to do, and then bring the equipment back to their three-building complex in Fenton.
One building serves as their oxygen-fill plant, while another is primarily used as an equipment workshop. When they’re done with the work, Seymour says, “we sticker the equipment as ‘certified’ and then bag it and return it to them patient-ready.”
He’s seen home healthcare change in many ways over the three decades his company has been in business, Seymour says. Fee-schedule changes from Medicare, for example, have cut reimbursement for oxygen therapy equipment “to only a third of what it used to be 25 years ago.”
From his perspective, the lower payments have been good for his company, he notes. “Because it’s not as lucrative for the home healthcare companies anymore, it’s more cost-efficient for them to have their equipment repaired, whereas before they’d just throw it away” if it needed work. Everything his company does with oxygen equipment is regulated by the FDA, Seymour adds. “So we have to keep detailed records, and we have to adhere to manufacturer policies and procedures.”
Looking ahead, Seymour predicts, home healthcare is bound to keep growing, and he’s confident his business is going to grow with it. “Times change and patients’ needs change, and things that weren’t such a big problem 30 years ago”—like chronic conditions and the needs of an aging population—“now they’re the issues every home care company is focused on.”
For Diversified Medical Supply Corp., for instance, these shifts almost always require adaptations as well, Seymour says. “My guess is there will be a BiPAP or CPAP in half the houses in the country within the next 10 years, and mini-ventilators will also be more common,” he posits.
When new home care equipment comes out—as it inevitably will—Seymour says he’ll be sure that his technicians get the training they need to service it correctly. “Home healthcare is an ever-evolving world,” Seymour says. “If you’re in this business, you have to evolve yourself if you want to keep up.”
Chris Hayhurst is a contributing writer for 24×7 Magazine. Questions and comments can be directed to chief editor Keri Forsythe-Stephens at [email protected].
Sidebar: Home Care Equipment
According to the Center for Devices and Radiological Health, the division within the U.S. FDA responsible for the regulation of medical devices, a home medical device is any technology “intended for use in a non-clinical or transitory environment, is managed partly or wholly by the user, requires adequate labeling for the user, and may require training for the user by a healthcare professional in order to be used safely and effectively.”
Such equipment is often “complex,” the CDRH states, and is regularly used under less-than-ideal conditions. “This, in turn, has implications for the safe and effective operation of these devices, especially those with sophisticated requirements for proper operation or maintenance.”
Another challenge with home medical devices has to do with the fact that they’re often different than the equipment HTM professionals are accustomed to seeing in the hospital. A report by the National Academies of Sciences, Engineering, and Medicine (NASEM) notes that models may differ, for example, and that home care devices “may be older or of lower quality—and professionals who encounter the devices, either in the home or when patients bring them to the clinic or hospital, may not be familiar with them.”
According to NASEM, here are 10 of the top medical devices currently used in patients’ homes:
- Hospital beds
- Lift chairs
- Pulse oximeters
- Electrocardiogram monitors
- Fetal monitors
- Dialysis machines
- Oxygen concentrators
- Telehealth equipment
- Infusion pumps