It is the nature of any business to get customer complaints. And for home medical equipment providers — whether they come from referral sources or patients — those complaints must be acknowledged and addressed.
Most often, HME providers say, their complaints concern the overall complexities of the U.S. health care system and range from a misunderstanding of insurance coverage to unmet expectations.
“We find that most complaints, both from referral sources and customers, are due to the lack of understanding of the sale and delivery process itself,” says Cindy Ciardo, CEO of Milwaukee, Wis.-based Knueppel HealthCare Services.
“They especially do not understand or appreciate that much of what we request of them, or need before we can dispense a product, is dictated to us by insurance companies, state Medicaid plans and Medicare — specifically the burden of determining or proving medical necessity and the time and effort it takes to do so.”
What's more, according to training expert Louis Feuer, president of Dynamic Seminars & Consulting, it must be acknowledged that there are going to be some legitimate mistakes.
“We're in a people business,” says Feuer. “As long as you have people dealing with customers and delivering equipment, you are going to have mistakes. They happen,” he says. But he adds that addressing those mistakes and handling customer complaints allows providers the chance to improve processes and service.
Here are some of the most common complaints providers say they receive:
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“I want it — why can't I have it?” When customers are unfamiliar with the products that their payer will cover, they can become angry and upset.
Ciardo says the most frequent complaints Knueppel employees receive regard out-of-pocket costs associated with choosing deluxe products that the company cannot dispense under its restrictive managed care contracts.
“The difficulty is that when they check with their insurance company, customer service simply tells the beneficiary that the item is covered, which is misleading,” she explains. “When they come into our facility and choose, for example, a designer cane over a basic aluminum one, they feel it should be covered in full, even though the designer paint or inlaid rhinestones have nothing to do with meeting their medical need.”
Dick Clark, owner of Resp-I-Care Home Medical Services in Kingsport, Tenn., says most of the complaints his company gets also are related to insurance problems. “There is always a great deal of confusion about insurance,” he says.
Scott Higley, COO of Adorno Rogers Technology, Nashville, Tenn., says most often complaints are received because of these misunderstandings.
“Customers think just because the physician prescribes a product that it is automatically approved,” he says. “A lot of times they don't realize that products aren't covered or that, even though an item may be covered, the amount that is covered does not pay for the item.”
And Steve Slater, general manager of Grand Rapids, Mich.-based Airway Oxygen, adds that in his state, where HMO advancement into Medicaid and Medicare plans is escalating, customers are generally unaware of what product coverage they have, as well as the limitations on where they can obtain the products. Many are frustrated to learn their HMO has signed an exclusive contract with a particular provider.
“They go to these seminars and are told that it is the same as Medicare with added benefits,” explains Slater. “Then, when they go to their original provider, they have to be told, ‘you can't come to us — you have to go to XYZ provider,’ which may not even be in the same area.
“I see people complain at McDonald's over a 50-cent Coke — they berate the poor kid behind the counter,” Slater continues. At Airway, he says, “most of the time, they are mad about their coverage and will take it out on us.”
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“Can I just get the product already?” The amount of paperwork involved in processing a claim for HME products is undeniably overwhelming. Customers — both patients and referral sources — can easily become frustrated with the numerous forms and the time that it takes for all parties to complete them.
Ciardo says complaints relating to the required paperwork are challenging because HME providers have no control over them. “A common complaint is the frustration over the involved intake process, the paperwork and the time involved in reviewing all of it,” she says, adding that the list can include the likes of AOBs and ABNs, a myriad of checklists, the Medicare supplier standards, patient/client rights and responsibilities, privacy notices and other specialized paperwork that may be needed for the specific products prescribed.
“The paperwork often takes longer than the sale process or fitting,” Ciardo says.
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“My equipment broke. Why haven't you delivered a new one?” Products break. It is a fact of life. However, repairing or replacing them may not be so simple. And in all likelihood, customers will have to wait for repairs to take place.
According to Higley, the variation in manufacturers' parts has a substantial impact on the process. Especially with power mobility products, he notes, “with every manufacturer using different motors and, even to some extent sometimes using different wheels, [there is a waiting period].”
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“I can't owe that!” Death and taxes are said to be two of life's certainties. So are bills. And when it comes to what they owe, providers say many customers don't understand that co-payments are required — or any other reasons for their bill.
“A sad fact of life in our business is that we have almost as many people taking care of the complexities of billing as we do taking care of patients,” says Resp-I-Care's Clark. He adds that confusion over co-payments and deductibles generate numerous calls into the company's customer service department.
Carol Laumer, executive director of Rice Medical in Willmar, Mass., agrees. Delays in billing that occur because of the current reimbursement structure leave many customers confused about the amounts they owe. “The timeliness of the billing is certainly a concern,” she says.
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“Why is it taking so long?” Providers with a rehab specialty also face unique challenges when it comes to meeting customer expectations.
“With our rehab department, most clients do not understand the lengthy process of assessment, obtaining authorization following insurance review, ordering, assembly and customization,” explains Ciardo. “Although unrealistic, any wait time over three or four weeks is a point of frustration.”
Higley emphasizes that in these scenarios, “consumers become very frustrated when a physician writes an order for a wheelchair — whether manual or power — and then realize it is not as simple as taking it to one of our locations and having it filled. We must do an evaluation, measure them and complete the paperwork.”
Delivery of rehab equipment also can be frustrating. “Sometimes products take quite a bit of time to be delivered,” Higley adds, although he notes that “manufacturers are becoming more and more aware of it and working to shorten the lead times.”
So how should providers handle these common complaints, or any others?
Keeping Customers Satisfied
The worst mistake any provider can make is to ignore a complaint.
Gary Schwantz, director of educational services for The MED Group, Lubbock, Texas, says the first response should be an apology. Then, he recommends just listening. “There are times that people need to vent, so let them vent,” he advises. “When we are attacked, the first response is to try to defend ourselves. Try to overcome that and just listen.”
Clark agrees that it is important not to argue with the customer. He recently replaced an oxygen concentrator because his customer thought it was “just not right.
“Perception is reality,” Clark says, pointing out that it is better to replace a piece of equipment and keep a customer happy than to lose that customer's business.
Because listening is a learned response, Ciardo says Knueppel's employees get extensive training in this area. “We continually spend time with our staff teaching them to problem solve,” she says. “It is important that we maintain our caring attitude and handle each customer fairly and consistently.
“Most importantly, we tell [employees] to actively listen, to sit down if possible and stay at eye-level so as not to inadvertently assume a position of superiority or condescension. Our mantra is to offer the client options. [That may not] give them what they want, but it does give them some control over the decision-making process.”
Of course, says Schwantz, after listening, you have to fix the problem. He emphasizes that it is critical to keep the customer informed as you work toward a resolution.
Laumer points out that while taking the time to communicate is often difficult with employees' time pressures, it is critical. “The most important thing is that you keep your customer or referral source informed of what's going on, even if the product is on back order or there is another delay,” she says.
She also says providers should never wait for the customer to call. “We should always be calling them, so it is a proactive resolution rather than waiting to react to their complaints.”
Dynamic Seminars' Feuer says employees need to realize that “customers are not an interruption of our work — they are the reason we are in business.
“Anytime you sell something it comes with a set of challenges,” Feuer says. “One of the challenges for this business is dealing with the customer's understanding of everything that goes into getting them their equipment.” He suggests that developing an FAQ (frequently asked questions) sheet that addresses and explains some of the most common complaints could help.
Being proactive is also a part of Adorno Rogers' strategy, Higley notes. “We do full customer service training on how to not say ‘We don't do that’ or ‘That can't be done.’ Our employees may instead tell the customer ‘This will be a little difficult,’ or ‘Here is another way we can achieve the same goal.’
“We like to give customers options, and we try not to give them what I call ‘stopping words’ that just stop the topic and put the customer on the defensive,” he says.
This leads to follow-up. “If someone has a complaint and you resolve it to their satisfaction, 95 percent of [those people] will come back, and they will be among your most loyal customers,” says Schwantz.
Satisfaction can be directly correlated to the number of referrals a home care company receives.
“Not that HME providers are a dime a dozen, but there's always somebody pounding on [the referral source's] door, bringing them cookies on Friday afternoon,” says Airway's Slater. “If your referral sources find out that somebody was rude to a patient or somebody didn't call them back, they are not going to mess around. Their time is extremely busy, and they are going to go with whoever gives them the best service with the least amount of resistance.”
Feuer, in fact, recommends that when you get a complaint, you send a thank-you note. “The truth is that if you didn't get the complaint you might continue to make the same error. Learning about a complaint gives you the opportunity to show the customer how much you care about their business. It's impressive when people can see what system you have in place for solving the problem and how you are going to fix it.”
According to Ciardo, “Often, simple suggestions from our customers have led to internal procedural changes that make a process more efficient or customer-friendly.”
But what happens when a customer just cannot be pleased?
“When you get a call from a customer and all they do is complain about your competitor down the street, you can pretty much bet that in less than six months' time you're going to be in the same boat as that other company,” says Higley. “As much as we'd all like to say we're the only ones that do it right, we know other providers are doing a good job, too, and it can't always be as bad as a customer says.”
If a situation gets to the point “where people become verbally abusive to your employees,” he says, you might just have to take the equipment back and terminate the relationship.
Keeping Track, Taking Action
Tracking complaints can be tedious, but the reality is there are true benefits to the process. And for accredited companies, it is a requirement under CMS' final supplier quality standards.
Mary Ellen Conway, president of Capital Healthcare Group, Bethesda, Md., says the requirement is more than just “busy work. The whole point of doing it is to educate your staff and improve your business — you don't do it to throw it in a drawer,” she says.
Conway recommends using a log to track complaints. “You can do it in any way, but the easiest way is to have a log that details who made the complaint, the time the complaint was received and the type of complaint, as well as a detailed description of the complaint and how it was resolved,” she explains. “At the end of the quarter, you summarize reports and determine what the issues were.”
Slater says his company's complaint tracking policy is in place to improve quality. It begins with a form that is completed to document the complaint and ends with a benchmarking report. “We use a benchmarking service where we send in both good and bad comments, and then the service rates us against other companies,” he says. “It is a great tool for quality improvement management.”
It would be impractical to think that complaints directed toward HME providers could become obsolete. Yet providers can lessen their impact and use the circumstances to change processes and improve quality.
“More than anything else, customers just want to know that their opinions have value and that we are listening,” says Ciardo. “They do, and we are.”
The ‘Five-A’ Approach to Handling Complaints
“There are some pretty simple steps that will help you when handling complaints,” says Gary Schwantz, director of educational services for The MED Group. “I call them the ‘five-A’ approach to dealing with complaints.”
- Attend
You may need to let the complainer vent. Look straight at them and listen, without interruption or defensiveness.
- Apologize
Don't be afraid to apologize to a customer, even if you have done nothing to create the problem. Use the simple phrase, “I'm sorry.” Not “We're sorry,” not “the company regrets.” Say, “I'm sorry.”
Telling the customer that you are sorry that the problem occurred does not mean you are admitting guilt. You are simply expressing concern for the customer. This lets them know their problem matters to you.
- Acknowledge
Think about the customer's feelings. Say, “I understand you must be frustrated.” (Or “angry” or “disappointed.”) Once the customer has finished talking, paraphrase back to them exactly what the problem seems to be. Avoid, if possible, the use of the word “you,” as in “what you don't understand,” or “who you'll need to speak to is ….”
- Act
Offer to help. Create a solution. Is the problem solvable? What action can and will be taken? Can you promise that action now or do you need to confer with someone else in the company? When should the problem be solved?
Speak in positive, action-oriented terms: “I will, I can, the product does,” not, “I can't, we won't, it doesn't.” It is important to explain the steps you will take to correct the problem. You may want to consider giving the customer some options.
Keep the customer informed. Explain the next step. If you have to go through steps to solve problems, tell the customer what you are doing. If you have to leave the work area, explain why.
- Appreciate
Never forget to thank the customer. They offered you the opportunity to solve a problem when, instead, they could have simply walked away.
