Problem Solvers

Taking HME's Talent Pool International

HR costs can be a problem for HME businesses. One provider that has launched a hiring agency might have just the right solution.

Staffing is a primary concern with HME providers, particularly given that they operate in an increasingly competitive marketplace and one where there are winnowing reimbursement and declining revenues. Providers need to pick carefully about what they spend their money on, and in that regard, staff expenditures quickly come to the fore.

One company that has introduced a new service that hopes to help providers in that regard is Modesto, Calif.-based Tactical Back Office ( which aims to help providers tap into back-office staff resources in the lower-cost labor market of the Philippines for tasks such as billing. That might sound like outsourcing, but it’s not, says Tactical Back Office co-founder Todd Usher.

“At its simplest form, it’s a staffing agency, or if you think of a temp agency or an employment agency, it’s the same thing, but it’s utilizing our Philippine personnel to provide the staffing providers and the HME community needs,” he says. “It gives complete control back to the provider.

If a provider works with a third-party staffing company, it might pay a premium for on-site, outsourced personnel, or if it works with a third-party billing company, it might pay a percentage of revenue collected. If there are staff issues or anything like that, the provider works through a point person. However, using a staffing agency such as Tactical Back Office, the personnel are the provider’s employees and are managed, administered, and compensated in the usual way.

“You can take control of your billing again or take control of your staffing and intake process, and there are people that report directly to you, and they follow your guidelines, your training, your policy, and procedures and try to achieve the KPIs that you set forth,” Usher explains. “They’re your people.”

In terms of savings, Usher says that the HR cost efficiencies gained depend on factors such as reimbursement cuts mixed with a providers’ state compensation averages and laws (for instance, his state of California will soon see a minimum wage of $15 an hour). That said, he says, “your costs savings ends up being between 50 and 75 percent, depending on where you are in the country.”

An Entirely New Take

Sound unique for the HME industry? Usher says it is. He and his wife originally developed the idea with their provider business, Home Oxygen Company, and the approach took off from there.

“I have not heard of an employment agency like this, and quite frankly, it was strongly encouraged by some of my friendly competitors to let them in on the deal,” Usher noted. “That’s what was the birth of Tactical Back Office. We started by helping out some of our friendly competitors up and down the state, and we started to grow. So the business came into its own at that point.

“Actually, there is a sleep lab down south from us that I was speaking with who is a friendly competitor, and he was curious,” he adds. “I explained to him what we had done the last couple of years, and he was very interested in following suit, doing the same thing. The idea was really enacted at that point of hiring personnel strictly for hiring out to other companies, DME, sleep lab, billing centers, etc.

For Janet Bailey, operator and co-owner of Fresno, Calif.-based sleep lab Sequoia Sleep Diagnostics Corp., Tactical Back Office rolled out services just at the right time.

Insurance companies funding sleep diagnostics are increasingly requiring pre-authorization, but billing companies don’t frequently offer pre-authorization services.

“So we were having our own administrative staff do pre-authorization, which can be very time-consuming,” Bailey explains. “So you can have one person in the office who’s dedicated to making pre-authorization requests, and you’re down an employee.”

To solve the problem, Sequoia hired staff through Tactical Back Office to hire new staff to take that burden off its existing staff to free them up and focus on core competencies.

And there are added benefits: “Another real benefit is that we lack the office space for additional administrative personnel,” she says. “So this also eases the burden of having to provide a physical workspace.”

Dispelling Fears

Offsore staff sounds like a “natch” after the fact, but the idea can take some explaining. In particular, Usher says some providers might have some initial trepidation over moving staff roles to workers in the Philippines. It helps that his provider business was the testbed for this approach, he adds.

“There are some comfort level issues when I initially talk to people, and I think it is quickly dissipated, if you will, as soon as I share my experience,” he explains. “Nothing we’re doing, we haven’t tried ourselves.

“We started this over two years ago, and it’s been pretty successful for us,” Usher adds. “I just share our experience and what we have done and not done. We have explained to future clients that this is a sure-fire away to save money.”

If some discomfort remains on the provider’s part, it’s usually concerning any potential language barrier, according to Usher. However, he adds a quick conference can abate those fears.

“I get one of our folks on a video conference through Zoom or Skype or Microsoft Teams and introduce them to one of the team members [at the provider],” Usher explains. “Once they realize that it’s like talking to a neighbor and it’s very clear English and very clear understanding of English, we’re signing up folks immediately afterward. That gets rid of any fears of offshoring or anything like that.”

In terms of getting started with hiring remote staff through an agency such as Tactical Back Office, there aren’t many nuts-and-bolts to deal with when it comes to implementation, thanks to the fact that so many HME systems are cloud-based.

“They’ll remote into our local server and work within that environment,” Usher explains. “Whether it be Office 365 for email or chat or video conferencing, or Brightree or any of these other cloud-based services, they will utilize those things locally with their own equipment. We provide the voice over IP systems and the web conferencing equipment. It’s pretty simple. That’s really all that has to occur.

“Whatever they’re able to take care of in an HME or other business they can handle virtually because so many of the operations are handled on the cloud now,” he continues. “They can even access our servers are on the cloud. They don’t need to be here in the office to handle any of the tasks.”

This article originally appeared in the October 2019 issue of HME Business.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.


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