CONCORD -- Six years ago, veteran hospice nurse Brad Macy had an idea he knew would alleviate suffering for one man. He fashioned a simple catheter to deliver pain medication to his patient, who was unable to swallow.
The Concord resident figured that within his lifetime, his application of the catheter might allow two thousand patients to escape common, end-of-life discomfort.
In 2014, the Macy Catheter, receiving 510k approval from the FDA in February, has the potential to help millions of hospice and palliative care patients.
Traveling a notably short runway from idea to patent to development to testing to launch, the Macy Catheter is the privately-held Hospi Corporation's first product release. Designed to treat the number of people choosing to spend their last days in the comfort of their homes, the single-use rectal catheter allows patients to avoid hospitalization, infections and costs related to IVs, painful suppositories, or the inefficiencies of sublingual medications, which often must be swallowed in small doses and have irregular absorption.
Macy, 53, says he has "a pipeline of ideas, all focused on decreasing the burden on patients and caregivers."
With a B.A. in psycho-physiology from Cal State Long Beach, and a B.S. in nursing from the University of San Francisco, Macy co-founded Hospi in 2012. The medical device corporation specializes in products aimed at increasing comfort while reducing costs for serious and terminally ill patients.
In a news release, co-founder and CEO Igal Ladabaum says 2 percent of hospice patients require high acuity-care, causing a routine day rate of approximately $160 to balloon to $700 per day.
"CMS (Medicare and Medicaid services) could save over $1 billion per year if the high acuity days could turn into routine days," he says.
Along with Hospi's third co-founder, clinical cardiologist Richard Popp, M.D., Ladabaum believes Macy's invention could be instrumental in health care cost reductions.
John Cottrell, director of Aging and Adult Services Contra Costa County, knows all too well the formidable price tag on caring for the aging. Providing in-home support services for 8,000 low-income elderly and disabled county residents, he says everyone at his agency and across the health care landscape agrees that in-home care is more humane and preferable to institutional care.
The lack of planning for what he calls "the longevity revolution" has concerned Cottrell for two decades.
The National Institute for Aging reported in 2010 that 40 million people over the age of 65 represented 13 percent of the total population of the United States. In 2030, their projections show the figure could grow to 72 million and 20 percent.
According to a Dartmouth Atlas of Health Care report, "Patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations."
California state legislators, Cottrell says, have no strategic plan for covering costs and need to "step up to the plate."
"We know how to care for the aging, but not how to pay for the care," says Cottrell. "We have the smarts: we just have to come to grips with it."
Cottrell says federally-subsidized care for the very poor may cover the $7,000 per month cost of nursing home care, but that's only 4 percent of the population. The wealthy -- about 5 percent of the population, he estimates -- can buy the services.
"Between the low and the high, well, we're losing those people," Cottrell concludes.
His best solution is a two-part Social Security system allowing people to draw income upon retirement, then draw medical service support when a change in health triggers the need. He admits, enacting his idea would take years, requiring possible legislation mandating that people invest in long-term care insurance -- and a cultural shift for people unaccustomed to facing the "not pretty picture at the end of life."
Macy, operating bedside and weighing both comfort and costs for 17 years as a Kaiser Permanente hospice nurse, says health care has to consider both issues.
"We have to decrease costs without sacrificing care."
Medical start-ups similar to Hospi often require tens of millions of dollars and a decade to create a market-ready product.
"We're different," Macy says, explaining that although the catheter required testing in more than 30 categories, it didn't require years of clinical studies. Perhaps buoyed by positive response from the marketplace to his catheter, Macy is more optimistic than Cottrell and says funding for palliative care and symptom management is trending upward.
On a final point -- dealing with the surge in people living well into their 90s -- Macy and Cottrell are like-minded: increasing comfort and decreasing costs in caring for the aging is a critical, global, economic issue in need of solutions.