A look at how to hire the right people for your HME business "THE JOB OF ANY MANAGER IS to accomplish work through the efforts of others," says Kathy Taylor, director of education for The Med Group, a Lubbock, Texas-based group purchasing organization. "And in order to make that happen, the manager's first job has to be to get the right team assembled."

Of course, that's much easier said than done - especially if you have no training in human resources and no budget for an HR professional.

"Proper hiring techniques aren't part of many [business] courses, so you don't find that a lot of people have had much training in this area," Taylor says. "Unfortunately, many people also assume that it's a fairly simple job. They think, `What can be so hard about hiring someone?' but it tends to be a little more difficult than that."

Mary Miller, president of Lake Alfred, Fla.-based Encore Respiratory, goes one step further. She calls the process of hiring new employees for her business "a nightmare - a total nightmare."

And, in fact, most providers would agree that finding the right staff for an HME business is neither easy nor pleasant. But with a little care, you can find the people you need.

The Right Stuff ANY HIRING PROCESS, regardless of the position you're trying to fill, should begin long before you see a single job applicant.

"Effective hiring has to start with a written analysis of the job and its functions," Taylor says. "As the interviewer, you have to know very clearly what kinds of tasks you will be asking that person to perform. You also must know what skills are needed to perform those tasks and what personality traits would have the most likelihood of being successful within the context of the job."

It's tough to slap a one-size-fits-all sticker on what personality traits and skill sets best suit certain positions. You also have to take into account your company's internal culture and public persona.

"What you want to portray businesswise should determine what type of employee you are looking for," Miller says. "For me, professionalism is always going to be number one. And we have pretty high standards here. When my employees go into a home or are seen on the street, I want people to look at them and think, `They're professional.' That's the image of my company that I want portrayed.

"So when candidates first walk in my office to apply - I hate to say it this way - they're almost immediately judged on how professional they look," Miller continues. "If they come in here in shorts and a T-shirt, then they don't portray what I'm looking for in an employee. They have to care enough about themselves to care for others."

Miller says she has attracted customers from her HME competitors simply by having a well-groomed staff. "We've had patients switch over to us because their former respiratory provider allowed drivers to visit patients wearing a T-shirt and jogging shorts and have long, scraggly hair. They were generally scuzzy looking, and the patients were scared to let them in. And when they did, they felt like they were casing the place."

Attitude You Can't Buy ALONG WITH APPEARANCE, Taylor ranks good attitude near the top of the list of desirable qualities in an employee.

"You have to ask yourself if they are not only capable of doing the job but if they are also willing or motivated to do the job," she says. "Almost all of us have worked with people who have the skills necessary to do the job and they actually can do the job, but they perform poorly on a daily basis. Maybe they have a lot of complaints but very seldom bring up any possible solutions to those problems.

"The person doing the hiring needs to uncover these kinds of attitudes upfront. This is the point of asking interview questions such as `Why do you want this job?' or `Do you enjoy working in the same environment frequently?' You also need to know if they have a long list of previous jobs - and why."

Miller, for one, says she looks for people who take their work seriously, no matter how simple the job is. "I want people who call here to have a pleasant experience and not feel like they're calling a bunch of idiots who don't know what they're doing or aren't even capable of taking a patient's name down," she says.

It's especially imperative for entry-level employees to realize the importance of their positions, and Miller tries to impress this fact on them, explaining that they're just as important as the person who's collecting the money for the business.

Her company, for example, has a call-back position in which the employee's main function is to go out every 45 days to all patients' homes, check the equipment and drop off supplies. "It's a simple job, but it's essential to our business because these people are the ones who are going to keep patients for us. They're the ones who are out there developing relationships and bonding with patients."

Experience or Eagerness? SHOULD YOU HIRE people who already know what they're doing or people who will do things your way? That is the question - and the answer once again depends on the company and job in question.

"You can hire [people for their] characteristics and then train on job skills, but keep in mind that training can take a lot of time, especially with billing clerks," says Amy Ryba, managing principal at Rapid Link Medical Billing, Bristol, Conn. "I'm not saying that there shouldn't be opportunities for those who are new to the HME industry, but it can be quite costly to train them."

Even when people have health industry experience, it still takes time for them to adjust to their new jobs and come up to speed with your unique operation, Ryba adds. "You don't get a lot out of [new hires]," she says. "Maybe they had experience in physical therapy, for example, and now are learning DME. It's a whole new world. And billers in DME - especially in DME - need to dot every I and cross every T or you're not going to get paid."

As a supplier of respiratory equipment and oxygen in the Florida competitive bidding demonstration, Miller says she can't afford to entrust her cash flow to inexperienced people. "Right now, we're getting paid in 14 days, and that's excellent," she reports. "When it comes to my billing and A/R, I don't fool around. We have to make sure we get our money and get it fast, so people better have some good credentials.

"Generally, people are going to know what they're doing or they're not, and I did billing for 15 years, so I know if things are being done right," she adds. "I don't skimp on any type of billing personnel, and I don't take any chances with them."

However, some providers - including Lisa Gonzalez, general manager for Royal Care Home Health Equipment in Corona, Calif. - put less emphasis on direct experience. "Sometimes, people lack a little bit of the knowledge but have other good characteristics and qualities," she says. "If they show they can do the job if someone would just teach them, then I will hire them because of their confidence and attitude. I wouldn't have a problem training them because I know they'll listen and catch on quickly."

Gonzalez recently took her own advice and hired someone who had no background in medical billing. "She is one of my Medicare billers and learned how to do it in three months," she says. "She is awesome at it. She took the books home, she studied, she went to seminars, and now she's one of the best billers I have."

Proceed With Caution IF THERE IS one thing these providers would advise, it would be to not take anything at face value. "We'd like to think everyone is as honest and forthright as we are, but the fact is they're not," says Miller.

"One of the first employees we hired taught us a big lesson," she recalls. "This was a decent kid, young, came from a very influential family, and everything should've been fine. He came with really high recommendations from a physician we had worked with for years, so we went ahead and hired him." Then, after about a week, Miller did a background check which she usually does before she commits to a hire. "It came back that he had a suspended driver's license - with almost 21 points on his license - and he had grand theft with a concealed weapon."

Miller had a similar experience with a nursing candidate who had worked with the company in the past and was well-liked. "She was a really great person, and we were ready to hire her," Miller says, "but when we ran a check she had multiple driver's licenses as well as some assault-and-battery charges. It proves that you can't just look at someone all the time and know. You have to run those checks to know who you've got working for you. Our patients are too important to us to risk anything."

Gonzalez has had her share of close calls as well and warns that just because something is on a resume doesn't mean it's factual. "When billers turn in their resume , for example, a lot of them say they went to billing school, and we used to take it for granted that people are telling the truth," Gonzalez says. "Well, I checked up on one girl, and she had never gone to this school. Now, it's an automatic policy for us to call the school and verify that the applicant attended. And I ask for a copy of the certificate. I don't have a problem with [people being taught on the job] as long as they are not saying they've gone to a billing school."

Candidates for other positions also go through background checks, she says. "We make drivers give us their driving records, and they have to pass a physical and a drug test," she says. "RTs are pretty easy - all you have to do is make sure they're licensed and that the license is valid."

Miller has one last piece of advice to offer: Keep in mind that you're only human, and humans make mistakes. The key is to learn from them so you don't make them again.

"If everyone had the answer to the perfect employee every time, you wouldn't be doing this story," she says. "We all learn from experience, so you're allowed that one mistake - but don't ever do it again."

IT WOULD BE NICE IF, once you have your dream team assembled, you never had to worry about new employees again. But in today's booming job market, retaining quality employees is a constant struggle.

You might hear a lot of people say that money isn't the end-all in keeping employees happy - and that's true. But when it comes down to it, money matters.

"Unfortunately, money talks," says Lisa Gonzalez, general manager for Royal Care Home Health Equipment in Corona, Calif. "I pay my staff very well because I believe a business doesn't survive alone. You're basically dependent on your employees.

"Would you rather go through employees every three to six months, or would you rather keep people on staff for a long period of time because they're so happy they're never going to leave you?" Gonzalez asks. "You can pay people cheap, but then they'll probably leave in the next six months because they're disgruntled about pay and burned out. Or you can pay people what they're worth and keep them for a long period of time.

"I hate interviewing, so I'd rather keep my staff. I want all 25 employees that we have right now to be here in five years. And I feel with the crew we have now that's very possible."

She also offers ongoing incentives to keep her employees performing at their peak levels. "Whether it's having no customer complaints, no billing errors or getting logs completed on time, we always have some sort of incentive so everybody goes that extra mile," she says.

This is not to say that money alone will keep an employee on your staff, says Kathy Taylor, director of education for The Med Group, a Lubbock, Texas-based group purchasing organization. "I think the opportunity to move up, move on and to continue to be challenged at work is something that really keeps employees around," she says, adding that work environment can be a major factor in an employee's decision to stay with a company.

Gonzalez concurs. "To me it's all about environment," she says. "Making sure your employees are comfortable and that they're happy. I always tell my employees that they need to be glad to get up in the morning and come into work. If you wake up and aren't glad to be coming here, then we have a problem and I want to know about it, even if it's something small."

AT ROYAL CARE HOME HEALTH Equipment in Corona, Calif., all job candidates are evaluated on experience, skills - and how well they would mesh with existing staff, says Lisa Gonzalez, general manager. "I always have my employees interview candidates as well because they're the ones who have to work with them," she says

It's particularly important for Royal's billing staff to work together well because of the company's incentive program. If billing employees collect a certain amount of revenue, they get a 1.5 percent bonus.

"It's a team effort," she says, "so they'll be depending on new employees to do their portion in order to get the bonus. That's why I give my staff the chance to interview candidates and ask some questions. My current employees need to feel comfortable that the person I hire is going to participate and help them meet their goals so they all go home with a bonus. People have to be confident in the other people they're working with. Even when I hire a driver, it's the same. I always have other staff interview any job candidate."

THERE'S AN EASY RULE TO live by when it comes to hiring employees, according to Amy Ryba, managing principal for Rapid Link Medical Billing in Bristol, Conn. "If you make a hire and realize - or even have an inkling - that it is not going to work out in the long run, get rid of them. Otherwise, you're going to get stuck with the bill from the state.

"As soon as you've had an employee for 90 days," she continues, "the employee can turn around and sue you for unemployment. And that can be financially devastating, especially for a small company."

Then, not only are you paying to have someone replace that person, but you're paying the other salary continuously without getting anything in return for it. "And with the profit margins in HME, that's never something you want to get into," says Ryba.

Ryba speaks from experience, having once hired an employee who was very bubbly and vivacious but who raised some concerns.

"During the 90-day trial period, I had my doubts, but I kept telling myself, `Well, it might work out. It could work out. She's a decent person.' But it didn't," Ryba says. "After five months, one day she just threw up her hands and walked out, and within the hour she was at the labor board filing for unemployment. She walked off the job, but after several labor board hearings, they're still giving her benefits and billing me for it. She said that, as an employer, I made it very difficult for her to do her job and that the job description had changed. It basically turned into a `he said-she said' situation."

To avoid these kinds of situations, Ryba advises other providers to document everything. "Documentation, documentation, documentation of all employee actions are very, very necessary," she says. "Make sure you have good policies in place on paper and that employees read and sign that they understand them. Otherwise, when they leave, they could say they never saw them. It's not fair, but it's how the system works, and there's no getting around it."

Her last words? "If you even think that some of your employees are not going to work out, don't keep them."

ACTIVITY-BASED costing requires staff time and attention, but it can more than pay for itself by helping you avoid the following common pitfalls of less accurate accounting systems:

$ They mislead you to assume that overhead costs apply equally to every revenue dollar.

$ They hide non-value-added waste in your operation.

$ They focus on workers, not the work accomplished.

$ They report costs by type (salaries, supplies, etc.) instead of by transaction (oxygen setup, nurse visit, counter sale, etc.).

$ They overallocate cost to your high-volume transactions and underallocate overhead to your low-volume business.

ACTIVITY-BASED COSTING is relatively new to home medical equipment providers, but it is fast proving its worth.

Darryl Coplan, general manager at Lebanon, N.H.-based Keene Medical Products, heard about ABC at a Med Group conference last year. He says a fellow Med Group member reported to have saved 20 percent on her operational expenses by implementing ABC. "So naturally, when we set this up, that was one of our goals, to try to reduce our operational expenses by 20 percent," Coplan says.

Clearly, the desire to cut costs and increase profits is one good reason to learn about ABC. But in addition to finding ways to streamline operations, some HME dealers have used ABC to determine whether to accept managed care contracts.

Floyd Harwell, owner and president of Greeneville, Tenn.-based Home Medical Services, first learned about ABC two years ago at seminars hosted by the Homecare Providers Co-op and the Health Industry Distributors Association. He has since used the accounting system to see whether his company would profit from providing certain products to managed care.

"I know that a lot of people were just picking up contracts right and left, and then they'd try to figure out how to make money," Harwell says. "But I felt the smartest way was to know what it cost me to do business, and then I'd know whether or not to accept their contracts. The problem was that I was having a hard time trying to figure out what it cost me to run my business. So when I heard of ABC, I felt like that was exactly what I was looking for."

Coplan and Harwell were primarily responsible for collecting data and coordinating the ABC program at their respective companies. Both emphasize, however, that ABC is a collaborative effort. Employees must be informed about the program and involved in the entire implementation process, which can take six to eight weeks to complete.

"We educate the staff on what ABC is all about and what our goals are," Coplan says. "All the staff is aware of the program, and we solicit input, so they don't think, `Gee, here comes management with another time study.'"

When his company started implementing ABC, Coplan recalls, working with other Med Group members helped smooth the process. The Med Group had set up a group of providers that would go through the program together. The companies compared data and notes, made sure they were on the same track and discussed issues and problems they encountered.

This group was very helpful because when you first look at the program, it can be a little bit overwhelming," says Coplan. "Then when you look at your data, you can say, for example, that it cost me 65 cents a mile to put a truck on the road, but you still need to know what it's costing other companies nationwide. And because we were from different geographic areas, we didn't mind sharing data. We could look at how other companies are using their ABC information to help control costs or benchmark services."