The Right HME Stuff

Ever hear the one about the home medical equipment deliveryman who simply left the oxygen concentrator on the end-user's front porch and drove off?

How about the tale of the temp who picked up the phone but, unable to answer any of the caller's questions, finally told the customer to call back in three days?

Then there was the customer service representative who responded to a caller asking if the manager was in by saying only, “No.”

These are just a few of the horror stories of the HME business, tales from the trenches of staffing and training gone wrong. Such incidents, say industry consultants and providers, can slice into profits by undermining your reputation, increasing the number of after-hours and emergency calls and driving up turnover because you've hired the wrong person for the job.

According to the experts, proper staffing and training of employees, not to mention retention, are critical components of a successful HME business. But perhaps because of the urgency simply to get the job done, they often are low priorities.

“You want the service to be as if it were for your own grandmother,” says Mike Kuller, chief executive officer of Concord, Calif.-based Allstar Oxygen. “But it's not often that you see it practiced that way.”

How can you change that?

“You need to have a commitment to make [proper staffing] an issue,” says Louis Feuer of Dynamic Seminars & Consulting, Pembroke Pines, Fla. “Because if not for the service, what is the difference? The only difference [between providers] is the people. Everyone has the same wheelchairs and oxygen concentrators.”

The Right Staff

Success starts with staffing. That means finding the best person for the job — a task that may not be easy but one that is vital to business success. The wrong person in any job can result in problems, including damaged relations with customers and/or referral sources, weakened employee morale, high turnover and late or lost reimbursement.

To hire the right employees and thus guard against such problems, you first must know all the elements of the position you are seeking to fill, says Lisa Thomas-Payne of Albuquerque-based Medical Reimbursement Systems.

Many providers, Payne says, “don't take the time to draw up a really good job description. They may have [the job descriptions] for a clinical position or a few other positions, but it is not uncommon for the provider to slide by the seat of their pants and not have a job description for a customer service person or a biller.”

Without that guide, a provider is very likely to hire someone with inadequate skills for the position, Payne notes, adding that providers often use poor interviewing and hiring techniques. “Combine that with a job description that is just bullet points or doesn't exist, and you've got big problems,” she says.

Finding the right person for the job is complicated by the fact that many HME providers do not have a huge pool of potential employees from which to draw.

“Sometimes it's slim pickings,” says Miriam Lieber of Sherman Oaks, Calif.-based Lieber Consulting. “In desperation, [providers] put an able body in a position rather than taking the time to interview properly to get the right person for the job.”

Greg Conrad, director of finance for Memorial Health Care in South Bend, Ind., would rather leave a position vacant than fill it with the wrong person. “If you believe that you are only as strong as your weakest link and you spend your days hiring weakest links, how strong are you going to be?” Conrad questions. “It's better to have no one than the wrong one.”

That doesn't mean he waits to fill positions only with people who have home care experience. “Some of our best employees have not had home care experience,” Conrad says, “but … they have had personalities we think will mesh well with our teams and they have had an aptitude to learn.”

Kuller follows a similar philosophy. He prefers hiring employees who have an HME background, but a positive attitude carries a lot of weight. “You can teach people skills, but you can't teach them to be pleasant, to be happy and to have a good attitude,” he says. Kuller also prefers applicants who are adept at multitasking and who can retain information. “We want people the referral sources will enjoy dealing with, who can meet their needs and respond quickly.”

Allstar also places high importance on customer service representatives and delivery people. “The two most important people are the people who answer the phone and the people who do the deliveries, because that's where your customer interface is,” Kuller says. “You need people [to fill those positions] who are knowledgeable, friendly, can think on their feet and like to solve problems.”

To further ensure that Allstar is getting the best person for the job, applicants who are invited back for a second interview get a tour of the company, a complete picture of what the job entails and an explanation of the company philosophy. “It gets people to talk, and you hear what they are interested in, what their goals are, what questions they have,” Kuller explains.

Conrad says the hiring process at Memorial includes peer interviews. Potential employees interview with supervisors and at least two or three peers with whom they would work. “[The peers] then take some responsibility for that person's success if they serve on the interview panel,” he says.

The Right Training

Miriam Lieber has one word for training: “Constant.”

“It's never enough,” she says, adding that if you don't constantly train your employees in policies and procedures, governmental regulations and equipment, “you set yourself up for failure.”

Yet, for many HME providers, training is a hit-or-miss proposition.

“Training in this industry has always been like a second-class citizen,” Feuer says. “These are not big companies and they don't have big staffs. There are no revenue-making hours when you are in training. I think they are so desperate to get someone on the phone, put someone out in the truck [that they bypass training].”

Thomas-Payne says many providers offer training only when there is a problem, such as a customer complaint or not getting reimbursed. Instead, she believes, training must be intentional. “It needs to be a regular, repeatable event. The employees then know to count on it. They recognize that training is part of their job.”

Training can take a variety of forms depending on the topic and the company's resources. Providers can choose from one-on-one training, classroom sessions, small group training, teleconference seminars, computer-based training, seminars at Medtrade and other industry conferences and videos.

“You have to have structure and variety in training employees,” Thomas-Payne says. “When you are training employees, there isn't just some cookie-cutter [system] to follow. Every company has to imprint its own culture and personality and business model on training.”

Training sessions also must have clear objectives, she adds. “It's not just, ‘Let's get together and talk about the problem of the day.’ You always need to have written information. And the employees that have just been trained need to sign off that they recognize they have been in a training session and accept responsibility for the information they've been given.”

In addition to regularity and structure, training needs to be inclusive — that is, everyone in the company should go through training.

It's a daunting process, but one that has paid off for Health E-Quip in Hutchinson, Kan. “We have really made an investment and a strong effort in developing a program for new hires that takes them through the whole company,” says Velma Goertzen, R.N., general manager. “Instead of just learning their little piece of the pie, during the first three months here they rotate in all the departments.”

Every hire spends time in the billing department, in the warehouse, going on a call with a respiratory therapist and with a driver to observe a bed set-up, Goertzen explains. Each new employee also meets with the performance improvement team, is trained on compliance issues and even spends time cleaning equipment. The thorough training ensures that “they understand why this department is asking for information. Or, if we are hiring for customer service, they know what they are sending the delivery person out to do,” she says.

Memorial Health Care also subscribes to the idea of cross training, Conrad says. New hires are mentored, and the company has a system-wide orientation program about the company, its values, compliance and other issues.

But new employees also spend time in the retail store, the billing department and with those who specialize in certificates of medical necessity, as well as with drivers and RTs.

“They're going to understand the business,” Conrad says. “We want them to have an understanding of the actions that have transpired and the products. They need to be able to answer questions.”

Such training takes time, agree both Goertzen and Conrad. “If we hire someone with no experience, it's six months before they are functional, a year before they are at world-class level,” Conrad says. “You just can't hire someone and expect that two weeks later, they'll be functional.

“If you have a long ramp-up time, you better make sure you're hiring right and that you are retaining [those new employees]; otherwise, you're just going to churn and burn. If you're constantly churning people, you're going to be burning out your good people.”

Allstar's Kuller says it could take weeks before a new hire is on his or her own. “If we bring in a driver who has no experience, he'll ride with another driver for probably three to four weeks before we put him out on his own,” he says. “Before he goes out on his own, an RT will have him go through a set-up for each product and make sure he can answer questions. There's a check-off list. He has to demonstrate to the RT that he can do it.”

In addition to cross-training, Goertzen stresses basic skills. She insists, for example, that every new Health E-Quip employee participate in a class on phone etiquette. “Whoever answers the phone needs to know at least where to send the call,” she says.

A phone etiquette class might sound elementary, but Feuer applauds the idea. Too many HME providers, he says, have people answering the phones who are curt, unhelpful or argumentative. “You need to be polite even if it's raining or there's a snowstorm [and it will be a real problem to serve the person]. The customer doesn't care.”

Feuer feels it's imperative for employees to understand that each call represents potential business. He suggests putting a sticker on the phone that reads: “Pick up the phone — there's money on the line.”

As for ongoing training, Goertzen says Health E-Quip employees regularly view videos on topics ranging from infection control to specific equipment. In-service training sessions, such as one recently held on the Health Insurance Portability and Accountability Act, are filmed for the benefit of future hires.

“I plug into a lot of e-conferences because I can't afford to send everyone to Medtrade,” she adds. “They're fairly reasonable and they can be done at our facility. We've done a lot of lunch-and-learns.”

Goertzen also champions MED University, the online educational seminars sponsored by Lubbock, Texas-based The MED Group (see sidebar). As part of their three-month orientation, all new hires go through MED U's basics of customer service and HME, she says. If they choose to take the University's mastery program, which offers advanced courses in such areas as billing and driver/delivery technician topics, “we [give them incentive] through pay increases.”

Kuller brings in manufacturer representatives for frequent training on equipment, and prefers one-on-one training when possible. “I firmly believe that people learn more with one-on-one training,” he says. “Certainly there are things you can learn from videos, but I think if you put somebody with them, someone they can talk to and interact with, they can get a good idea of what goes on.”

Memorial's Conrad uses a variety of forums for ongoing education because it is important to his employees. “We send people to Medicare and Medicaid seminars, we have consultants come in, and we send them to trade shows — not just managers but the staff as well.”

States Goertzen, “Give [employees] the tools to accomplish what you hired them for. That includes initial orientation as well as ongoing training.

“I firmly believe that if an employee understands why we have to do all the things we do, they can deal with and cope with all the craziness of HME.”

The Right Retention Policies

Once you've hired the best people for the job and provided them with superior initial and ongoing training, how do you keep them? It's a question that concerns — or should concern — every HME provider.

“When a company experiences high turnover, it has a huge impact on the business — and not just on accounts receivable,” Thomas-Payne says. “It has an impact on referral sources, documents (like CMNs) you send out to doctors, your ability to get paid, even patients who are accustomed to talking to one particular person. It has a far-reaching impact.”

Providers need to find ways to show appreciation to their employees, experts say. Certainly money helps, especially since most HME positions do not command high salaries.

“You have to keep current on the salary ranges in your marketplace,” Thomas-Payne says. “One of the things that just kills employers is when they spend all this time and money training people and they jump ship for [an extra] 50 cents an hour.”

Successful providers often pay their employees more than their competitors, but they also get more productivity from them, according to Wallace Weeks of The Weeks Group, Melbourne, Fla. “One of our clients pays 30 percent more than their competitors. They do that with bonus programs. But they get about 50 percent more than people usually get from that [position].”

Weeks advocates tying employees to the bottom line, and feels that sharing the company's financial performance is worth the risk. “It's not all about the money,” Weeks stresses. “What causes these employees to make more money is that they are given the opportunity and respect to control their destiny in an organization by making the bottom line bigger and being rewarded for it. It is driven more by the respect and the empowerment that they are able to achieve.”

Still, there may be times when even more money won't keep someone in your employ.“The hardest people to keep are those who you forgot to pat on the back once in a while,” says Feuer, adding that “the people in the front get the least amount of training and recognition.”

Goertzen says that since she instituted a comprehensive training program at Health E-Quip, turnover has dropped from a high of 19 percent annually to 5 percent. But the training program is coupled with a focus on reinforcing employees' self-worth and the knowledge they have gained, whether through increased pay for that knowledge, certificates or recognition from supervisors. “People want to be recognized,” she says.

Conrad believes people respond to a good working environment, so Memorial is focused on being a “best place” to work. “We provide a very positive, clean, up-to-date place to work,” he says. “We try to provide a very supportive leadership team and a competitive benefit package. Our ranges for positions are reviewed constantly, and people get thorough, timely, annual evaluations. We try to provide a lot of feedback to people.”

The approach appears to be working. Memorial enjoys a low turnover rate and has a lot of long-term employees, Conrad notes. In fact, the “rookie” on his managerial team has been on the job for nine years. Of 25 people in the billing and finance area, more than half have been with the company longer than five years.

Kuller's philosophy is to “pay people fairly, treat them fairly. Evaluate them. Train them. Give them the things they need to progress.”

And some perks, as well. Every Allstar driver has a cell phone with a two-way radio feature for business and personal use. Kuller also rewards employees with 100 shares of company stock when they have completed one year of service. He pays 100 percent of health insurance premiums for employees and their families, and pays an end-of-the-year bonus based on company profit.

“I share month-to-month financials with employees so they understand what's going on with the business and that their piece of the puzzle is important,” Kuller says. “They take pride in this.”

And that could be the real key to success.

Staffing Practices

Industry experts give the following advice for hiring, training and retaining the right employees for your HME company.

Hiring

• Define the overall job and its necessary tasks.

• Create a hiring profile focusing on what kind of person you want to hire, education and experience requirements, etc.

• Choose the right person for the job.

• Check references.

• Don't just fill vacancies. Hire no one if you can't hire the right one.

Training

• Train constantly.

• Train comprehensively. Make sure people understand their role in your company and how it relates to others.

• Give people the tools to accomplish what you hired them for. That includes initial and ongoing training.

• Invest in training programs, and treat training as an investment, not as an unnecessary expense.

• Give employees information in writing rather than simply telling them something and expecting them to remember it.

Retaining Employees

• Recognize good work and reward it.

• Pay competitive salaries.

• Provide opportunities for people to grow and advance.

• Consider tying performance to the bottom line so employees have the opportunity to increase their income.

• Allow people to have fun at work.

Training for the Trade

One way to bolster employee training is to tap into educational opportunities offered by buying groups, manufacturers or other industry organizations.

The MED Group, Lubbock, Texas, sponsors MED University, a series of online courses covering many aspects of the home medical equipment industry.

“The broad vision is that we have training for everything,” says Gary Schwantz, Ph.D, director of educational services. “We really are trying to build the foundation for these companies to get their people trained to a certain level.”

Most courses last from one to three hours, and costs depend on a variety of factors. But, Schwantz points out, for the approximate $195 to $250 plus expenses it might cost to send an employee to a one-day seminar, you could get 30 to 50 hours of training.

After completing basic courses, students can continue their education through mastery classes focusing on a specific course line, such as sales or master repair technician.

Another option is education through HME manufacturers, most of which offer training in the operation of their own products. Some, such as Freedom Designs in Simi Valley, Calif., and Sunrise Medical in Longmont, Colo., go beyond the basics.

Freedom, for example, offers two-day training seminars on seating and positioning at locations throughout the country. “We offer them because seating and positioning is such an in-depth practice and it is changing all the time,” says Tyler Robuck, head of strategic planning. “The seminars aren't based solely on our products; we do general seating and positioning and it's very hands-on. We bring in an actual client to be seated so they can see the process from the beginning.”

Continuing education units are offered, and the seminars are updated each year, Robuck says.

Sunrise provides in-service and custom training for its providers and also offers symposiums throughout the country, generally in conjunction with an industry event such as buying group VGM's annual Heartland Conference in Waterloo, Iowa. The symposiums, which are redesigned this year to be shorter and geared to smaller groups, focus not only on Sunrise's products but also on general information.

“We have done joint talks with other manufacturers,” says W.B. Mick, vice president of rehab sales. “The more we educate, the better off the end-user is going to be because they're going to get the best product.”

Kansas City, Kan.-based Leisure-Lift offers training videos and manuals on a wide range of topics, including servicing, marketing and getting reimbursement for the company's products. The company also provides service and sales training at its Kansas City facility, as well as on-site at HME locations around the country, says DuWayne Kramer, president.

And other HME manufacturers are hopping on the training bandwagon. Phoenix-based Vantage Mobility International this spring began its VMI Certified Mobility Consultant program, a video training series designed to provide sales training to dealers of its products.

81%
of people polled on HomeCare's Web site said that employee training will be a top priority during the next 12 months.