Sourcing Your Best HME Employee

You've hear of outsourcing, but have you heard of insourcing? There's a difference and a unique approach to HME staffing might be just the flexible option you need.

I started as a delivery technician for a local HME company in 1996. I worked very hard, got lots of overtime, and looked for opportunities for advancement. After a couple of years, I started to promote and eventually was assigned to manage a region of branches. I soon left and did a short stint at a national HME provider, then joined the sales team of an international manufacturer.

After opening our DME company, we hired, grew, received contracts, and had a solid foundation. Then the bottom started to crumble with regular cuts to reimbursement, competitive bidding, and finally, the death knell of the rural rollout. At that time, we laid off some employees, most of our sales team, and managed our expenses — barely.

It was not until we hired the first remote team member that we started to notice a difference. We decided to “insource” and not outsource. What is the difference? We did not “farm” out our backend functions or hire a service to take care of a certain task. We hired remote personnel directly assigned to our business from a third party. They are not shared or sourced from a pool.

The “insourced” team members report directly to us every day, eight hours a day, 40 hours a week. We developed a relationship with them, got to know their strengths and weaknesses, their capabilities, and their desires to succeed. Like any other employee in the past, we know the capabilities and unique skillsets of our team. When we outsourced, we only knew a “point” person and had no idea who was working our accounts. They were nameless and faceless. With insourcing, I know who is working for us, and we hold them accountable accordingly.

The difference was not just our expenses for payroll but was also the professional work ethic exhibited by the team member. We hired a second remote person, then a third remote person, and moved on to our entire operation between two branches and a sleep diagnostic lab we opened a few years later. The level of commitment, loyalty, and willingness to learn; the ability to achieve a high level of results; these things had not been seen in most of our previous local-based staff. The behaviors exhibited by our previous staff were “put in your eight and hit the gate.”

Previously, we saw little loyalty or commitment. “WIIFM” (What’s in it for me) was the common attitude from local workers. However, with the remote team, we’re now achieving our KPI standards and have quickly excelled to meet our KPI goals. They did this by showing up every day, on time, and wanting to achieve the praise of their supervisor. This had not been the case previously. I was astonished at the insourced team’s level of professionalism in the workplace and the desire to work with our patients and satisfy all those they meet.

The cost savings to our labor pool was evident within the first month. We saved more than $500,000 after the first year of making this transition. Looking back, I do not know how we had any semblance of success without our current team. They have become an integral part of our day-to-day operations and continue to achieve a high level of success in all departments; intake, customer service, billing, clinical, logistics, bookkeeping, and now management.

It has truly transformed our business into a company we look forward to working with a team willing to strive for more. The wonderful team mentality, along with a strong desire for customer satisfaction, is commonplace with everyone on the team. This has undoubtedly kept me in our industry. The remote team also encouraged our remaining local team members as they now have a strong support team surrounding them. It seemed to raise the entire level of professionalism and work ethic among all team members.

Over the last few years, I have noticed the HME industry is behind the times in this arena. Many national corporations have been known to have an international workforce, especially in the tech industry. Additionally, I have learned that many healthcare companies, such as payers, have international workforces. Some National DME companies have had international workforces for years, coincidentally since 2016! I see exactly why. It brings our cost of doing business down to a level where the sting of reimbursement cuts does not hurt as bad and can make things in our industry a little more palatable.


  1. Team members are assigned to you full-time and not shared with any other business.
  2. Team members are competent and trained.
  3. They are easily integrated into an existing operation.
  4. Cost savings are immediate and substantial.
  5. A good resource to scale your business and have a talent pool ready for onboarding.


To find out more about insourcing, visit or watch its YouTube channel at

About the Author

Todd Usher is the founder of Tactical Back Office Inc. Usher started in the HME industry 25 years ago, in 1996. Holding many positions for local, regional, and national providers and manufacturers, he helped his wife start their own HME business in 2008. They have since opened other companies that complement healthcare and enjoy working with vendors and providers throughout the United States.

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