Lee Conn, president of Birmingham, Ala.-based MediRest, calls it karma. “For every little thing we've done when no one's looking, we have without fail been rewarded tenfold with something good happening to us. It's karma; when we do the right thing, the right thing gets done for us.”
For the 10-year-old company, doing the right things means being staffed completely by clinicians, thinking of patients' needs first — and how to pay for those needs dead last. That could sound like a risky business proposition for some, but according to Conn, it's a “no-brainer.”
“We realized that HME was and is one segment of health care that is not traditionally delivered by clinicians. We had a problem with that and set out to raise the bar for HME providers and clients by offering clinical solutions to medical equipment problems.”
According to Conn, it was clear that by hiring mostly clinicians, “our staff would be comprised of patient advocates rather than traditional salespeople. It seems like a no-brainer now, but when we first started offering an outcomes-based wound healing program headed by a CETN/WOCN RN, clinicians to go out and measure wheelchairs with digital pressure mapping capability and clinicians to fit all orthotics, we were met with a lot of raised eyebrows.”
Conn explains what he sees as his company's difference. “We find that most of our competitors operate under a cookie-cutter formula where a customer service representative with little or no medical training will take a referral for a wheelchair, for example.
“The only clinical questions the CSR might ask will generally be ‘How tall is she and how much does she weigh?’ Obviously, that is about 5 percent of what you need to accurately fit a wheelchair … Then another employee, maybe a driver without any medical training, will select a chair from stock, drop it off at the patient's home and — good luck with it!
“In this scenario, no health care professional is involved with the provision of health care benefits to this patient. Maybe the chair might be perfect and will serve the [patient's needs], but maybe not.
However, Conn continues, “that will be the only chair the patient will get for at least five years, so it is important to find out about any pertinent medical history like skin integrity problems, seating and potential positioning issues, caregiver status and home environment.”
He adds that staff members check the patient's home setting to make sure that the chair requested will fit between all the doors, and to instruct the caregiver on proper loading techniques.
“We do not get paid any more to have clinicians help provide the equipment, but the patient gets a clear benefit in terms of getting the appropriate equipment for the present and hopefully, future,” Conn says.
While the process takes time, he continues, it “helps ensure that the DME dollars are not wasted by either the patient's not using it or dollars wasted if the chair causes additional problems such as a pressure sore or a fall. By using health care professionals to help procure medical equipment, the patients and the system seem to benefit. We use a similar approach to our wound care patients, our enteral nutrition patients and others.”
Conn is quick to point out, however, that his staff is not involved in direct patient care or case management. Instead, they use their clinical expertise for product selection, fitting and education only, serving as a “tool” therapists and nurses can “use to streamline their ordering process and save themselves time and hassle.
“They were used to just calling in an order for a patient lift, for example, and [having it] delivered by a delivery tech with little or no instruction,” Conn explains. “We do full patient caregiver training on every piece of equipment, so by the time the therapist or nurse goes back, the lift is being used as intended, not as a government-funded coat rack.”
Waste Not
According to Conn, an important element of MediRest's business model is focusing on what the company is able to do well, and to develop that particular strength. “One decision that we made early on was to determine our strengths and continue to develop them. It is important to understand that we … are a DME/rehab provider that specializes in mobility, safety and nutritional services,” Conn says. “We let the competitors cut each other to ribbons for each respiratory referral while we just work away at what we do best.”
All of the company's business comes by word of mouth or clinical referrals. In fact, Conn says he tried media marketing and abandoned it, dissatisfied with creating demand for products and health care services.
“It was just against our goals and vision of health care,” he says. “We have also found that our colleagues in the health care community at large frown on that type of ‘pharmaceutical’ marketing for DME. We are not in business to pressure doctors to prescribe equipment when their patients see an ad on television. We prefer that the doctors refer us patients that they determine have a particular need.
“In turn, the doctors respect us, trust us and refer to us because we are honest about what we find in the field. Many times, we can be their eyes and ears in the home setting and can prevent wasteful expenditures.”
While avoiding waste of both time and resources is a recurring theme in Conn's discussion of MediRest's values and vision, he does not spare expense when it comes to staffing. Labor costs are high when you employ clinicians instead of traditional HME salespeople.
The company's insurance premiums also are high, but they make it possible for the entire staff to be able to touch patients, the only way to properly train them on equipment, according to Conn. He says he tries to make up for the expenses in additional referral volume and decreased marketing costs.
As for the return on his investment, Conn says the company “has seen consistent growth, our employees enjoy what they do, we have a good reputation in our industry and we usually have a pretty good time at it,” he says.
Reaping the Rewards
So far, MediRest is the only HME in its region that is clinically staffed. Conn cites “shortsightedness and group think” for the lack of direct competition, at least in terms of how the business approaches patient care. “I just think [our model] is better for patients, and good patient care and outcomes drive our model.”
Plus, he says, “Our clinical team has a much easier time working with other clinicians in obtaining appropriate documentation than any traditional salesperson would.”
Conn says the company has been rewarded for its model in a variety of ways. Area health care professionals refer patients to the company “knowing that they will be handled professionally and with an eye towards solutions, not just profits.”
The same goes for managed care providers. “They are especially attuned to cost savings, and most of them have realized that our approach can cut down on wasteful spending. Doing things right the first time can increase their member or beneficiary satisfaction and head off the potential additional costs of incorrect fitting or training.”
Continues Conn, “If we had wanted to be a pizza delivery, we would have chosen that. But we are health care professionals, and our vision is to help solve the medical problems that our clients have. We sleep well at night knowing we are doing the right things for our clients.”
Overcoming Coming Obstacles
For service-oriented providers, DME regulations currently hurtling down the pike — competitive bidding among them — rarely factor in good service as a selling point. Like most providers, Conn says he'll cross that bridge when he comes to it.
“Should we get to point where financially it is not possible to work under our model, we'll just quit doing it,” he says. “We'll go down this road as far as we can go, and when we can't go any farther, we'll change our model.”
Conn also points out that being a small business has advantages. “Because we're a small local provider, we don't have to take a long time to adjust to changes. We can make decisions on the fly; if one product is not working or if we find a new product that seems really exciting or helpful, we can easily adapt to the change. That flexibility will help us.”
Patients Get Better, Business Grows
What's noteworthy about MediRest is that the company is staffed completely by clinicians. Also interesting is that its owner Lee Conn started the company when he was only 23 years old.
A graduate of North Carolina State University in Raleigh, Conn developed his “do-the-right-thing” vision while he was a manufacturer's rep in the wound care division of a large manufacturer. “Here's billions being spent in an industry that is not being overseen by any health care professionals in any way,” Conn says. “I thought, ‘One day I'll do this for myself. I will have all clinicians providing clinical care.’ It just made sense to me.”
Moreover, he explains, “The core vision in any health care business has to be helping patients, to look at the long-term benefits and [realize] that if your patients get better, your business will get better by default.”
In 1995, Conn decided to strike out on his own, and following his values, the company has grown into a $5 million business with a staff of 30 over the last decade.
Concludes Conn, “I was out to save the world. I was eaten up with wanting to do this. I had a great opportunity, and I jumped at it.”
