Success in the home medical equipment business can be defined in different ways. Some point to positive patient outcomes, others to big bottom lines. Mid Georgia Respiratory (MGR) Homecare in Griffin, Ga., aims for both.
Jack Clark, RRT, CRT, RCP, founder and principal of the 26-year old company, stays focused on his mission: caring for patients and meeting referral sources' needs.
“I seek to offer health and wellness to my patients, and by that, they will have some prosperity because they will spend less on their illness, their pharmacy bills or their physician visits,” he explains. “So, I'm a caregiver. I'm a respiratory therapist, and I practice taking care of patients with needs — I am not just an equipment purveyor.”
Clark has enjoyed a long interest in total health and wellness. As a younger clinician, he got so busy with critical care patients and 24/7 on-call status working in the respiratory disease unit, and later the neonatal intensive care unit, at a medical center that he “burned out,” he says. Not only was he exhausted, but he developed heart disease at the age of 39. After an angioplasty, as part of his recovery Clark found that when he avoided certain foods, walked, used active relaxation techniques and worked less — which allowed him to get adequate rest and reduce stress — his heart disease reversed.
As a result, today Clark coaches patients on seeking health and wellness along with management of their disease and medical equipment.
“I coach them on various things about wellness, and I place a lot of emphasis on food and nutrition because people do not understand their needs in those areas,” he says. “None of us in traditional medicine was taught much about keeping folks well; our job was to save their lives.”
Education Is Key
Clark founded MGR Homecare in 1979. Today, the company continues to operate with one location and 14 employees, serving customers in Georgia, east Alabama and north Florida. With a client roster comprised mostly of Medicare patients, the company concentrates on respiratory care, with about 20 percent of its business in other HME products.
On the day of his interview for this article, Clark had just returned from seeing a ventilator-dependent patient. He spent more than two hours at her home changing her tracheotomy tube.
“I don't get paid to change tracheotomy tubes; I get paid for the tube, but I just am not comfortable sending [people] to the doctor's office in a $500 ambulance to get a tube changed that I can change while I'm there,” says Clark, pointing out that he is not reimbursed for the service — or any of the additional services he provides. But he remains determined to accomplish total patient care, and, he says, this work ethic has brought both personal satisfaction and profitability.
MGR has respiratory therapists on call 24 hours a day who care for ventilator, oxygen and sleep-disordered breathing patients. Although Clark employs two respiratory therapists to assist in patient care, he likes to tackle the most challenging patients himself.
“On the cases that require comprehensive care, I do that myself,” he says. “I usually see patients five days a week, and I spend very little time at my office.”
The company places a strong emphasis on its ventilator program and offers patients education, coaching and counseling to prepare them for their individual course of treatment, along with an environmental assessment to ensure safety and the opportunity to communicate with other ventilator-dependent patients.
One of the tools patients receive is a series of briefs written by Clark called Ventilation Variables. The briefs range from one to six pages and cover topics such as taking a chronically ill person home, a cost guide for home ventilation, infection control targets and what to do when a power outage occurs. MGR has produced more than 50 briefs that also cover subjects including nutrition, reimbursement and equipment maintenance and care.
“These instructional pieces are for patients who are on life support and ventilation,” says Clark. “We use these on an ongoing basis.” The company also publishes a quarterly newsletter that is patient-, problem- and struggle-focused, according to Clark.
Though he believes knowledge is power, Clark is careful not to overburden patients with information or medical jargon. In fact, he often refers to these educational pieces as “cheat sheets.”
“My goal is to teach them, but I tell them I don't want them to memorize any of these things unless they're going to be of ongoing use,” he says. “I advise them that they can look up information that comes up down the road and ask them only to memorize what they are going to use frequently.”
Clark believes many of his patients suffer from a lack of information and/or ignorance of lifestyles “that may be killing them.” So he also spends a lot of time coaching patients and encouraging family caregivers on changes that can help, such as diet and exercise.
According to Clark, encouraging patients to take very specific care of themselves is what's in order today. “It's not just the specialty training skills that the practitioner is to perform. That is simply not enough to achieve wellness today,” he says.
Referrals Keep Coming
One of MGR's strengths is its reputation in the clinical community, Clark says. Over the last two-and-half decades, physicians and discharge planners have developed a level of trust when sending their cases to the company — regardless of complexity.
“People have learned that I do what I say I do, and they trust me,” Clark says. “They send me these ‘bad’ cases because they know they're not going to have poor outcomes that fall back in their laps in the form of a bounce-back admission for which they may not get paid [if enough time has not passed since discharged from the hospital].”
In some cases, Clark explains, facilities do not want the most challenging cases, so MGR receives calls to provide care for such patients. “We get calls for very difficult, complex, psychosocial cases where families have limits and require a lot of support,” he says.
Clark also says he typically loses $70,000 a year to provide care to those who cannot pay. He believes it is the right way to operate his business, and the company remains successful, he says, in spite of such financial losses.
“We accept everyone who is referred to us, regardless of the payer source,” Clark emphasizes. “So, if a referral source sends me an indigent case, he or she gets taken care of.”
Unlike many respiratory providers, MGR Homecare does not have a sales force. He tried it earlier, but Clark feels that for his company, there are better ways to market. “We were probably among the first to have a salesperson back in 1980. We hired a young therapist who did a good job with visiting referral sources. We started much sooner than most people did in going face-to-face, eyeball-to-eyeball with physicians, but we haven't done that in a long time,” says Clark.
The company has not employed a salesperson in more than a decade, according to Clark. Now, he utilizes a different approach.
“Referral sources don't want to see any of these folks because they cannot make any money if they are with us,” he says. “We are not telling them how to make money or save money; we are asking them for a referral.”
Instead, Clark says that keeping referral sources informed, educated — and satisfied — is the basis of MGR's marketing plan. “I send them educational information that I have abstracted, so they do not have to read six pages of information [to be informed on the latest practice protocols,]” he says. “I give it to them in one page, and I do that frequently enough that they remember me when they have a need.”
They also remember that his company takes good care of their patients, which instills trust and ensures a steady stream of referrals, Clark says. “In this business, you better do it right the first time, because no one is going to pay you to do it over,” he insists. “You have got to differentiate [your company] and figure out what it is you need to provide in order to sustain your referrals.”
Clark's plan appears to be working. He notes the company has survived 22 fee cuts in 26 years, most notably those from the Balanced Budget Act of 1997. “The BBA resulted in a 42 percent cut. Everybody said it was a 30 percent cut, but they didn't count the [Consumer Price Index] that you didn't get for six years, which took it to 42 percent,” he explains.
Cuts and regulatory changes aside, Clark says he will continue to do what he loves best. He cares for patients and provides them with the tools they need to improve their health and outlook — as he has since he began practicing respiratory care in the 1960s.
Clark says it comes down to “potlatch,” a Native American term that means you get more than your money's worth.
“Indians would have potlatch celebrations in the fall at harvest time because they didn't have refrigeration. They would invite all of their friends to come, and they would share their wealth with [their friends] until it was all gone,” Clark explains. “That is the way I have practiced.
“If you give people more than their money's worth, not only will they stay with you, they will send somebody to you.”
