Back in the day — the day being 1950 — when Merle Marx and his wife Jean opened Medical Service Company in Cleveland, business was all about doing the right thing.

Even as the Marxes massaged their company into a physician supply operation and expanded via two moves, they kept that focus.

It's a legacy they handed down to their son CEO Joel D. Marx, who with John Geller, his business partner of 25 years, has built Medical Service Company into a flourishing respiratory and durable medical equipment company with five locations (Cleveland, Youngstown, Canton, Mansfield and Marietta, Ohio). The company serves 28 Ohio counties and part of northern West Virginia.

The industry has changed drastically since those early days. For starters, there's Medicare and Medicaid, not to mention managed care, accreditation, surety bonds and competitive bidding — and perhaps no one involved in HME today is more aware of how much things have changed than Marx.

“I grew up in the business,” he says, adding that he remembers fondly the first time his dad let him punch the cash register keys and answer the telephone. “My parents started the business and my dad's been gone many years, but my mom stayed active until she passed away five years ago.”

In that time, Marx says, the industry has gone from getting its revenue solely from patients to getting its revenue almost exclusively from other payer sources. Still, he has never swerved from his parents' basic philosophy: “Doing the right thing for the right reason,” he says.

“The right thing is that if you take care of patients, the financial stuff will follow. But it's done in that order … You don't do it for the finances, you do it for patient care.”

The Trickle-Down Theory

Marx has a theory about quality patient care. It happens when a company's employees are paid a fair wage, have fair benefits, believe they are making a difference and are appreciated.

At Medical Service Company, there are 130 employees, and Marx knows all their names and the names of their family members. He knows who is getting married, who has had a baby, who is celebrating an anniversary. He personally sends birthday and anniversary cards.

“I regret when I don't remember a guy's girlfriend's name,” he says. “It bothers me because that isn't how it used to be.”

To be sure, it was a lot easier when the company was smaller. But even though the company employee numbers have swelled through acquisitions — three in the last few years, a pattern that looks to continue — Marx believes it is important to keep that connection. Before the company's annual meeting, he gets a “cheat sheet” of everyone's names and the names of their spouses. His wife quizzes him on those names.

The result of that conscientious effort is a family-style camaraderie that pervades the business' daily operations. New employees are greeted on their first day with a big breakfast for the entire staff. A team-style atmosphere prevails.

“No one works for me; everyone works with me,” Marx says. “There's a family feeling here.”

The company's mission statement has to do with service quality, integrity and compassion, Marx says. “The compassion piece is a big piece for us. Hopefully, [the staff] has that feeling of caring and compassion, and they can take it all the way through to the patient.”

It appears that is happening.

“Our people genuinely care for their patients,” Marx says. The company concentrates on respiratory care, which is about 70 percent of its business. But, Marx notes, “We do a lot of hospice work — which is 24/7 work — delivering equipment or medications at 11 at night and by the next morning, the patient isn't going to need it anymore.

“Our people are making a difference. They love to be a part of that. I call it noble, but it is almost a privilege to help a patient live a better life or die more comfortably.”

The employees are keen on reaching out to the community as well.

“We've always done different events, but they were organized on an infrequent basis,” Marx says. “About five years ago, we decided to allow staff to make it happen.”