Issue link: https://read.dmtmag.com/i/36987
HME NEWS / AUGUST 2011 / WWW.HMENEWS.COM A power chair avatar Inside a virtual reality model, a power chair performs the role of avatar. The avatar is inside the kitchen of a cottage for an elderly resident. Above the sink is a map show- ing the avatar in rela- tion to the cottage. A menu to the right provides options for controlling the avatar. The menu to the top left provides avatar quests, beginning with making break- fast. Amigo Mobility has designed a 3-D model scooter, which will shortly replace the power chair. Put on your 3-D glasses How virtual reality can help the HME industry cut costs and increase satisfaction BY JOEL SOLKOFF T HE PROJECTORS BEHIND the three, 8-foot screens show a virtual reality world that can improve the environment where home medical equipment is used. Pro- fessor John I. Messner’s Immersive Con- struction (ICon) Laboratory at Penn State’s Architec- tural Engineering Department is a dark, windowless room where the healthcare facilities being viewed seem so real there is a special world for it: immer- sion. When Kaiser-Permanente began constructing a medical building in downtown Washington, D.C., pharmacists traveled 140 miles to State College to see how their workplace would appear. Among their suggestions: a partition so when two patients are served simultaneously, their privacy is ensured. There is substantial growth in constructing healthcare facilities—from hospitals to housing for the elderly. Previously, a model of how a building would look required physical materials like wood and nails. By comparison, virtual reality offers inter- active models early in the design process. The result- ing efficiency and cost savings (making changes to a building before it is built) are creating a boom in the use of virtual reality in the architectural, engineer- ing and construction (AEC) industry. Expectations exceed the ability of the AEC industry to have vir- tual reality applications ready as quickly as desired. Sonali Kumar, a graduate research assistant at Penn State, is developing a 3-D model for an inde- pendent living facility for elderly and disabled indi- viduals based on the concept of experience-based design. Experience-based design often refers to a body of academic literature, primarily health-care related. Designers are urged to consider the perspec- tive of the individuals who build, maintain, work and reside in the facility, including patients and residents. A common example is the decision of a Philadelphia hospital to build its bathrooms closer to patients’ beds. My perspective on Sonali’s effort comes from my status as a disabled resident of a primarily elderly independent living facility. For example, I look at Commentary LETTERS TO THE EDITOR A challenge to the industry W E ALL WORRY ABOUT MEDICARE cuts and regulations, but we often seem to neglect the importance of risks to Medicaid funding. In each state, there are many issues HME providers have to overcome and individual companies are not always effective when trying to cope with and resolve all of these. This is where your state association comes in. A strong central voice is needed and that comes from your state HME associa- tion. Therefore, I am issuing a challenge to the industry. I am asking every current member of their state and national asso- ciation to please call the providers they know who are not members and encour- age them to become members. My goal is to bring close to 100% of an early version of Sonali’s model showing a bath- tub in the bathroom and say, “No. There should be a roll-in shower here.” I show an early prototype to Travis Barr, co-owner of T & B Medical here in State College. While fixing my scooter, Travis says, “There should not be cabinet doors in the kitchen. Doors are a nuisance for people with disabilities.” Sonali’s model is based on a Blue Roof Technolo- gies’ cottage in McKeesport, Pa. Pennsylvania has a larger number of elderly people in its population than any other state except Florida. The need for elderly housing is acute. In McKeesport, where the factory for steel pipes closed down leaving a near-ghost town and an elderly population of more than 20%, Robert Walters, a retired Penn State professor, created Blue Roof. The cottages are con- structed of pre-fabricated housing and have special sensors inserted in the walls to remind residents when to take their medicine (the walls talk) and to call 911 if a resident falls and does not get up in a timely fashion. Sonali’s model of a Blue Roof cottage makes use of interaction, the most significant new development in virtual reality. Look at the screen shot Sonali took of the power chair inside the kitchen of her model cottage. For those readers who have not spent their productive hours playing video games, an avatar is a virtual reality representation of an actor function- ing in a 3-D environment. The avatar in the Sonali’s kitchen is a power chair. The power chair makes coffee and toast, opening the refrigerator door to get eggs and milk, and scrambles eggs on a stove the avatar has just turned on. Interactivity is key to understanding how practical people in the construc- tion industry have come to use 3-D technology for practical purposes. Interactivity is arrived at slowly as Sonali experi- ments with a wide range of software. I suggested that Sonali replace the 3-D power chair with a scooter. In my experience, a scooter is more mobile and less likely to damage walls and take bathroom doors off their hinges. I ask a manufacturer to provide a 3-D scooter file, but for reasons I cannot explain (because I do not understand), the file does not yet open. Sonali explains, “We are in the process of inte- grating the computer model obtained from Amigo Mobility.” Keep your 3-D glasses on and await future developments. HME Joel Solkoff writes about disability issues from a custom- er perspective. He is an adjunct research assistant at the Department of Architectural Engineering at The Pennsylvania State University. HME providers together to join forces with their state and national associations. If every HME provider would be a par- ticipant in his or her state association, there would be sufficient power to influence politicians—not only for you but also for every one of your customers. Our industry does not have the same capability to obtain funding that the AMA, AHA or the pharmaceutical companies get. However, we do have a secret weapon. It is the ability to influence votes. Votes keep politicians in office. Your good rela- tionships with your patients, family caregivers and customers are valuable. You and your employees are a positive influence to them as they are voters. They face the same problems you do and will welcome and appreciate your guidance. When your voice is heard in a collaborative way, it will be louder and clearer. That is why state association membership is critical. If you are not a member, join now! The future of your com- pany is at risk. Shelly Prial – SHELDON “SHELLY” PRIAL, shelly.prial@att.net Be serious to be taken seriously R OBERT IS SPOT ON (“The state of long-term oxygen therapy,” HME News, July 2011). I would add that as O2 is considered a medication, more emphasis on ongoing O2 evaluation is critical in the MD office. Addition- ally, separating the cost/reimbursement factor from clinically based model is not realistic. Shrinking reimbursement for expensive delivery systems, in conjunction with unfunded RT home visits, is increasingly not feasible for the HME. This necessitates more direct physician involvement in the ongoing evaluation of O2. At every physician encounter, regardless of the specialty, the MD should address medica- tions, and especially O2, with documentation in the medical record speaking to use, need and continuing need at least at six-month intervals if not more. If we as HME providers take our clinical involvement seriously, with less of a Wal-Mart approach, perhaps the payers will as well. – DAVID HOSACK RN, manager, HME Respiratory Services, Healthy @ Home, CMC Home Infusion and Equipment Here’s an idea to fight fraud H OW ABOUT HAVING CONGRESS pass legislation that the NSC has to have a surety bond to cover all the new fraudulent suppliers that it lets into the DMEPOS sys- tem by issuing supplier numbers to crooks (CMS takes new approach to fraud, see page 1)? And legislation that would not allow the NSC to pass on the cost of surety bond to taxpayers. How about setting a line of credit for each new supplier for the first 90 days of claims submitted to the supplier’s surety bond amount? If the supplier thinks he can service and bill $5 million dollars in claims in 90 days, he can buy a $5 mil- lion surety bond. Then the surety bond company can chase crooks when DMEPOS computer stops EFT at $5 million and finally raises the red flag to stop payments. The line of credit concept is used by vendors to limit loss by new accounts. Should work for DMEPOS, too. – JOHN MISHASEK 15