Provider Perspective
Keeping Promises: Care Medical Outlines Commitment to Service, Respiratory Expansion
Care Medical is a Georgia-based independent home medical equipment company with five branches in Athens, Augusta, Duluth, Gainesville and Savannah, which just opened in February. It has more than 70 employees and a strong respiratory business, recently bolstered by the addition of a top clinician. Further, the company rolled out a service initiative this year, articulating exactly what patients and referral sources can expect. In an interview, Jason Rogers, Care Medical president, explains the company philosophy and why the business is determined to expand, even as other companies shrink or fade away.
RSM: Tell our readers about Care Medical’s three promises.
Rogers: No. 1, we strive to say yes. No. 2, we are timely in our service. And No. 3, everyone involved will be satisfied, including the referral sources, patients, caregivers and our own employees.
Regarding the first promise, it means that we will find a way to be responsive. We find a way to say yes. It’s easy to say no. It’s hard to not say no. However, sometimes there is no way to say yes, because it is illegal, improper or damaging to patient care. But a staff person is not empowered to say no. He or she has to take it to a branch manager, and if that manager thinks we have to say no, he has to take it to a vice president or the president. Only a vice president or the president can say no. I can count on a couple of fingers how often that’s happened in about a year. We don’t say no.
RSM: How do you define timely service?
Rogers: If it’s an order for a patient being discharged, we deliver to the hospital in no more than an hour. And we do all ordered CPAP setups within 24 hours.
Timeliness comes down to empathy with patients. Patients being discharged are tired, hurting and scared, and now they have to deal with a home care company. We don’t want to be the reason they have to wait on the edge of their hospital bed and can’t go home. If you understand a little better what the patient is going through and why being slow frustrates the heck out of referral sources, it’s hard not to respond in a more efficient and more effective manner—if you care.
RSM: How do you ensure your third promise, that everyone is satisfied?
Rogers: We want to find solutions when others won’t, and we want to be timely. We can gauge success in these endeavors by observing the outcome, that being whether our patients, referral sources and own employees are satisfi ed. If all of them are satisfied, we have probably done a pretty good job of meeting or exceeding the expectations that were put in front of us.
RSM: How did you develop these promises?
Rogers: We had a series of management meetings at the end of 2009, seeking ways to specifically operationalize and communicate inside and outside the company the core principles of our company since its founding 26 years ago. We always believed in finding great individuals, hiring them and making sure they take great care of people. But as you grow from five people in a small mom-and-pop setting to 70-plus people stretched out across the state, you start to need more specifics or you lose execution on those principles. So this was a concerted effort over multiple months of meetings with management and staff to find a way to communicate the principles in a more specific manner.
RSM: What has been the result?
Rogers: Employees are excited about the promises internally, and referral sources are responding to them externally. They are easy to present, so referral sources gain an understanding quickly. They immediately click with why this is important. Some companies are very fl uffy about what they say and don’t provide specifics. But early signs are that we have struck some chords that resonate with referral sources. They are looking for the basics. Are you going to be here when I need you? Are you going to do what you say? Are you going to find solutions when it’s not easy?
RSM: So referral sources like the promises.
Rogers: Yes! We get a positive response when we talk about these things. If we are open and succinct in our communication, you get the same in response. If you are vague and fluffy in your discussion about what you do, you get a vague and noncommittal response. A lot of people aren’t clear when they say what it is they are going to do. Anyone can deliver a concentrator or a CPAP, but how are you going to do it differently, and how is that going to help the referral source.
RSM: Speaking of respiratory programs, talk about your bold move to boost clinical capability in these times.
Rogers: We had a choice. A provider faced with falling reimbursement could either start cutting back on services, cutting the cost of goods by compromising on quality, and reducing availability and presence in the market, or a provider could take the much harder and more dangerous response of working really hard for a sustained period of time to increase service, increase clinical abilities and offerings, increase the quality of products offered, and increase the geographical service area, all in an attempt to gain market share.
This takes a lot of effort, time and investment, and it has to involve salespeople, clinicians, new employees and new management roles. Every facet of our business is engaged in this new effort. One part of this for Care Medical was finding someone with clinical expertise in a variety of settings and sales experience. We found that in Darlene Weeks, RRT, vice president of sales and clinical services.
Since she joined us in October 2009, she has quickly brought a wealth of experience to take our clinical abilities with respiratory to the next level. We are making a better-coordinated effort around clinical care for patients, including compliance checks and improvements, and follow-up after delivery. We are also developing programs for disease state management and co-morbidities. We are seeing a lot of excitement within the company and getting responses from physicians and the medical community.
RSM: Like you said, it’s a dangerous move to add clinical staff and ratchet up your clinical abilities right now.
Rogers: It’s expensive, and we are swimming upstream. Providers around us aren’t typically doing that. They are typically going in the opposite direction. Sometimes we get quizzical responses, but it’s what’s good for the patients and for the referral sources. And we believe if we act in a way that is beneficial to patients and referral sources, there may be bumps along the way, but in the end we are going to win their business and their loyalty. But it is a very different philosophy than those who respond to the difficult climate by cutting services and other expenses. We don’t treat service as an expense here. We treat it as what we do.
Since Darlene arrived, we have seen an infl ux of orders for CPAPs and oxygen. It’s a little early to say how much our business has grown. I will have a better idea in a couple of months. But the respiratory purchasing behavior of our company, which is a leading indicator, has changed. We have definitely increased purchasing of equipment for oxygen and sleep.
RSM: So you’ve gotten more business and achieved better patient compliance as a result of the respiratory program. But what about the threat of competitive bidding?
Rogers: Atlanta and Augusta are in Round Two. All that we can do right now, beyond what we are doing to grow and strengthen our business, would come down to fretting. And I see a lot of people unproductively fretting about this. It’s not that I don’t worry about it, but I have limited resources of time and effort. The best thing to do is spend them on constructive purposes.
I’ve been active in the Georgia Association of Medical Equipment Suppliers and the National Association of Independent Medical Equipment Suppliers, and I worked on the American Association for Homecare’s New Oxygen Coalition that attempted to reach a consensus proposal for oxygen reform. Competitive bidding is going to be a disaster that unfolds in front of us. I’ve called it the “coming bloodbath” for a while now. I am absolutely behind the effort to get co-sponsors for the Meek bill, which would remedy the problem, but there are some really powerful foes amassed who want to see competitive bidding charge ahead.
RSM: So look to the future. What do you see?
Rogers: Everyone at Care Medical has worked hard for a number of years to prepare for the coming bloodbath. We are positioning ourselves to have the opportunity to pick up the pieces. I am excited about the future of my company; I am concerned about things that are beyond my control. And I’m deeply concerned about a lot of other providers who are going to be caught up in the coming bloodbath. They are already caught up in the demolition of the 36-month oxygen reimbursement cap and other inherent unreasonableness.
RSM: Inherent unreasonableness—that’s a great term.
Rogers: There’s a lot of inherent unreasonableness in the wave upon wave of regulation and policy change coming from CMS and Congress. There is often a kernel of valid point, but they go off track when they try to make policy and implement it, becoming punitive along the way. For example, we need to improve the compliance rates of CPAP users, but doing that comes with an unreasonable degree of burden for a provider. And regarding the oxygen cap, how do you put a system in place that requires continued care, but provides no reimbursement? And what about the pittance for a service call that doesn’t even pay the gas and labor time for the drive much less the time with the patient? We should be striving for more than visiting our oxygen patients’ homes once every six months. I understand Congress’ desire to save dollars, but there’s a way to go about it. It’s not the way they are going about it. Ultimately, access to care will become a critical issue.
This article originally appeared in the Respiratory & Sleep Management April 2010 issue of HME Business.