IF YOU'RE A REP FOR A HOME MEDICAL equipment business and want to get on the good side of case managers, spare the sundries. Being reliable, accessible and service-oriented is more important.

"The easiest way to help facilitate the discharge is a liaison or on-site visit or having the ability to fax or make so many phone calls [for us]," says Kathleen Smith, director of case managers for Brotman Medical Center, Culver City, Calif., who supervises a staff of 13, including seven case managers. "That's our biggest need. It would save us from having to call and recall and get up to fax something. [That] is very time-consuming when you have 10 to 15 people discharging a day per [case manager]. Especially in the respiratory season when you're getting oxygen, you need the patient to be qualified, you need a portable tank for the person to leave, and you have to make sure the concentrator is at home, so if there's someone doing all that legwork for you, it really saves us time."

This can be a difficult task, however, in today's ever-changing health care industry. "The biggest problem facing most case managers, whether they're in a hospital, an independent company or an insurance company, is all the activity and volatility in the marketplace. It is difficult to keep on top of the changes within each company," says Catherine Mullahy, president-elect of the Case Managers Society of America.

Such industry volatility wreaks havoc for case managers because companies merge and acquire other businesses, causing turnover among company personnel and often resulting in a new HME rep. "A case manager can have a very good experience ordering a piece of equipment for a patient from a particular HME dealer and just two or three months down the road have an absolutely horrendous experience - only to find that the people [he or she] used to work with are no longer there," Mullahy says.

Then there are health care networks, which can add an interesting twist to a case manager's day. "Today [HME companies are] in the network, tomorrow they pulled out of the network, or maybe the network pulled away from them for whatever reason," Mullahy says. "All these kinds of things are making it tough on case managers. It's not just simply a shower chair or a cane a patient might need, it's equipment that needs servicing, and case managers aren't the ones that should be servicing it."

Service

IT'S A CONTINUING TREND - THE SMALL independent HME provider's being bought out by the large corporation. Unfortunately for case managers, it's a trend that can eat away at a business element that's already all too scarce in HME - service.

"The smaller companies that have been able to provide really, really good service are being gobbled up by the larger companies," Mullahy says. That's why when she finds an HME rep who gives good service and is reliable and accessible, she'll stay with that rep regardless of the rep's company.

"There is really a desire from case managers to have personal relationships with their HME reps," Mullahy says. "And when that person leaves and goes someplace else, we'll follow them, because I depend on the person, not necessarily the company."

Good people, she says, usually work for good companies in which service, reliability and accessibility are key operating principles. "And if there is ever a problem, I know this person has always been able to fix it for us in the past, and I know [he or she] will stand behind it now, and that's what we want," Mullahy says. "There's just so many people out there who, to be perfectly frank, will sell you anything and assure you anything. Sales is sales, but service is something else again."

Smith says a good HME rep also has a lot of flexibility and initiative. "You have to be flexible because you're working with 10 different nurses, and everybody has a different personality, and everybody has a different way they like for things to be done," Smith adds. "And then there's the ability to just act on their own. If we give them a face sheet, they should know what to do. That's our take on it. Our rep comes in, we tell him what we need - say oxygen - and he says OK. He's got the face sheet, and you hand him the chart, and that's it. The next thing you know, you turn around, and you've got a portable tank, and the patient has been serviced. And that's exactly what we're looking for and why he gets the majority of our business."

Reliability and Accessibility

PROBABLY THE NO. 1 COMPLAINT FROM case managers about dealing with HME reps is accessibility and reliability. Case managers want to be able to get whatever equipment their patient needs, and they want it waiting at the patient's home when the patient gets there from the hospital. And if that's not possible, they want a phone number at which they can reach the HME rep - at all times - so the rep, not the case manager, can deal with whatever problems arise.

"When you send somebody home and you're trying to keep somebody safe and functional in the home and things don't show up on time or things break down, it more than likely falls on the shoulders of the case manager, who already has a very full plate," Mullahy says. "What happens is, when the patient can't get ahold of the HME rep, [the case manager] becomes the point person, and that's a problem for all case managers."

A case manager, she says, can get the specs of a piece of equipment from the physical therapist or a physician but doesn't necessarily have a lot of knowledge about the intricacies of the device and is not equipped to trouble-shoot over the phone. "It's not a case manager's expertise, nor should it be," Mullahy says. "But, because we're the person who's expediting a discharge or getting a person from one level of care to the next, it does indeed become our responsibility because we can't tell a patient, `Sorry, we don't know anything about it.' If we don't know, then we have to find out and fix the problem."

Solutions

MULLAHY SAYS HAVING A POINT PERSON ON call 24/7 at the HME company would help remedy some of the major problems between case managers and HME reps.

"At the point of placing the order, we need to have somebody, if there's a problem, that we can call and then let them be the point person," Mullahy says. "I don't even expect that person to resolve the problem, but I expect them to be the person to get after the local vendor or whoever it was that fell down on the job or missed the appointment or didn't get the equipment to the patient's home when it was supposed to be there."

Mullahy also suggests that HME reps hold in-services at the case manager's office to "tell us about certain equipment that really seems to be changing or to tell us what's new out there in HME, what do we need to know about, what should we be recommending to patients."

Doing so, she says, "also helps to bring providers up to speed on what case managers need - and can help to establish a personal relationship between the two."