Back to the Basics

One of the major trends that is raising its ugly head is the fact that many of the leading home medical equipment companies are getting away from the mission, vision and core competencies that got them into the positions they are in today.

The years of merger and acquisition have identified the players moving into the 21st century. The scramble for managed care contracts have left home medical equipment companies without a strong customer base, and the resultant fee schedule and payment problems have made them rethink their position with the insured. Companies and PPOs that attempted to corral the managed care market are either now defunct, have eliminated contract negotiation on behalf of their membership or are entangled in litigation that will probably not be resolved for several years. The managed care demands for a one-stop shop were real, the method of delivery was practical, and the concept was sound. Because ownership of the project was different from ownership of the business itself, this one-stop shop philosophy failed. The concept failed because the nationals and PPOs underestimated the costs involved in health care delivery and accepted pricing that was not profitable--and yet they still refused to stop services.

We have improved in many areas, but we cannot let the cost of these improvements be the deterioration of our most important value to the community--excellent service.

Everyone was mesmerized into thinking that volume would make up for the poor margins. We continue to flounder as an industry, and we continue to look at competitive bidding and standards for confidentiality as the keys to success. We have become more proficient in our selection of contracts, more automated in terms of inventory control and billing functions, and more selective in taking on a customer--and we continue to ensure that the method of payment has been defined. We have improved in many areas, but we cannot let the cost of such improvements be the deterioration of our most important value to the community--excellent service. We now are seeing the results from the era of merger and acquisition, managed care, competitive bidding and the HIPPA Standards. Are we going to let the customer start feeling the effects of fragmentation, or are we going to get back to basics?

According to the American Customer Service Satisfaction index compiled by the University of Michigan, customer satisfaction has dropped since 1994 in nearly every sector of the economy, including home health care. According to the latest statistics provided by the Washington-based health care consulting firm, Polidais, the average customer service transactions per day were about 30. In another survey, 45 percent of the customer service workers said they believe that customers should be told when they are wrong, 46 percent stated that customers had to follow the rules before they would help them, and more than 33 percent preferred not to work with customers. More than 10 percent said they do not feel it is necessary to help a customer if the request falls outside the employees' area of responsibility. Is the trend to convert customer service to insurance verification and nothing more? We have made patient verification the majority of initial time spent with a patient, leaving little time to listen the patient's or customer's real concerns and complaints.

We have moved away from the trend that made us a great industry--if we initially take care of the customer's needs, we then can focus on the other issues. We now ask, "What insurance do you have?" And we say, "Sorry, we don't handle that insurance, please call someone else." The customer is not as important as his or her plan and its respective coverage. If he or she doesn't have the right insurance with the appropriate supplemental coverages, the customer is no longer welcome and is told to go elsewhere. Economies of scale resultant of the patient's coverage and respective fee schedule have caused us to forget what a patient really looks like.

We better start looking at the results of bigger is better or the tunnel vision that managed care has created in terms of our response to the needs of our customers.

Is the trend going to continue in terms of giving up on the service that made us a great industry? Are we going to succumb to the non-personal way of doing business? There is a formula out there today that reflects a company's sincerity in its treatment of customers.

The formula states that the value of the customer to that company is directly proportional to the number of phone prompts it takes to get the desired answer. Voice mail and phone prompts have resulted in the customers' questioning their value to the company. The majority of customers that call us are usually sick or have some type of diagnosis requiring certain medical treatment at home or at a facility. With some companies today, their voice prompts and their definition and direction only lead to one thing--a non-answered voice mailbox.

There is another voice appearing on the other end of the line: the voice of the caregiver. In a recent study released by the Caregivers Advisory Panel in Charlestown, R.I., 96 percent of the caregivers said they influence the purchase of health care products for their loved ones, and more than 79 percent of the caregivers actually make the purchase. Congress is starting to pay attention to this group; maybe it is time for the home health care industry to take notice as well. Many people believe that the caregiver is going to have more influence than the discharge planner in equipment selection so we better start paying attention to this customers' needs and training our customer service department accordingly.

Here's a true story that epitomizes our attitude toward the customer. A sales representative from a national company was calling on the discharge planner in an acute care hospital and questioned the facility's use of a local home health care provider. The representative stated that the local company didn't compare and the hospital should be using this national provider. The discharge planner got very upset with that comment and said, "Sit down and I will show you why I use a local provider as opposed to your company, a national provider." With that she put the receiver on speaker and dialed the representative's order department.

Customer satisfaction has dropped since 1994 in nearly every sector of the economy, including home health care.

She continued through the fifth phone prompt before she was disconnected, never reaching a live body. She then did the same thing with the local provider, and on the second ring, a live body answered her call. She then placed her order on behalf of the to-be-discharged patient. The customer service representative was professional and demonstrated to the discharge planner that her interest in the well being of the patient came first, with the insurance verification second. She then turned to the representative of the national company and said, "Now do you see why I choose the local provider?"

I do not mean to infer that all national companies operate in this manner, but is it time for all of us to look at our method of order intake and determine if it really is customer friendly. You should check out the phone system of your competition and see if you can adjust your phone to respond at least one ring or one prompt earlier than your competition. Start being customer service friendly. In some cases, particularly on weekends, you might set your ring selection to pick up after the 15th ring and it will be one ring better than your competition. Many companies really cut back on weekend coverage and phone messaging. If you think trying to get a live body on weekdays is fun, try the weekends. Why don't they just say, "Please save your time and wait for Monday?"

Unfortunately, the trends in the world today are to be less personal and make everything so impersonal. Many of you have built your business on patient services and the methods we used to promote good service. Now we just use technology to send them away.

It has been demonstrated that the way we treat our customers is a direct reflection of how we treat our employees. We must remember that the treatment of both our customers and our workers will determine if we are a true service company. I have read many home health care companies' mission statements, and most contain statements that reflect superior customer service, excellence in employee performance and teamwork. It certainly is fine to focus on many of the core competencies involved with our business, but let us not dare to lose sight of the fact and always remember that it was good service that took our industry where we are today.

This article originally appeared in the November 2001 issue of HME Business.

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