In a firm with 1,500 employees, six key people make a significant difference at Atlanta-based Healthfield Inc.-and they aren't even on the company payroll. They are service technicians who work for a company that specializes in the delivery of home medical equipment for other HME businesses.

"We turned to outsourcing because in our industry, getting the equipment to the patient is our No. 1 concern," says Geoffrey Windley, operations manager. "But with the changes in capitated contracts and Medicare, the overhead was high compared to reimbursement."

So last September, Healthfield turned to Irvine, Calif.-based Medtech Support Services-and hasn't looked back. "The good thing about Medtech's services is that their employees work for us," Windley says. "We have the ability to say who they [Medtech] are going to hire and fire and when they are going to make deliveries. We have complete control even though they aren't directly Healthfield employees."

Within a year of setting up what amounts to a national personnel agency for HME distribution, Medtech had 14 clients, says Ken Watson, executive vice president. Four years later, the firm has more than 200 employees servicing more than 45 HME companies in five states. "The growth we've experienced in the last few years is basically unheard of," he says.

So what clicked? The industry's long-standing bias against outsourcing is shrinking as HME companies see that a firm that specializes in distribution can help trim costs, Watson says. Medtech only considers working with companies that require at least 35 stops a day and charges them per stop. The arrangement protects companies from having too many, or too few, delivery personnel on staff.

"We only charge our clients for every time we do a stop," Watson says. "If they have their own staff and the volume drops off or they lose a contract, they still have to pay for wages, vehicle maintenance and all the labor costs. This gives them the ability to increase or decrease to accommodate changing volume levels."

When a deal is struck between Medtech and a provider, a Medtech start-up team comes to town. Placed in the facility is a manager who tries to learn every aspect of the company's HME delivery policies and procedures. Medtech personnel interview local job candidates, taking care of pre-screening, background checks and the initial interview. The provider is required to sit in on second interviews and sign off on the actual hire. Medtech then puts the distribution specialists through a formal training program that exceeds the standards set by the Joint Commission on Accreditation of Healthcare Organizations, Watson says.

"Medtech has been great," Windley says. "They are always going above and beyond our expectation, like covering complete weekend calls for us."

While Windley couldn't say how much his company has saved, Watson says every Medtech client has trimmed distribution expenses by at least 20 percent. One client, he says, cut costs by a whopping 37 percent.