Flexible Staffing

The words flexibility and focus rarely go together.
Flexibility implies change, while focus conveys
constancy. However, the HME industry is one environment
where the two are not mutually exclusive
concepts. If anything, HME providers need flexibility
in order to maintain their focus.

And what’s that focus? Working with referral partners and
caregivers to ensure patients have the care, service and equipment
they need to enjoy an optimal post-acute outcome. Are processing
claims and collecting co-pays, for example, part of that core
mission? Some would emphatically say yes, while others would
argue those processes draw providers away from the ultimate task
at hand. If that’s the case, then why not hire someone else to do it?

Now, let’s take the discussion a step further: What about clinical
staff? Could you offload some clinical tasks in order to improve
your patient and referral partner focus?

If anything, the answer depends on the provider, but if we look
at outsourcing and staffing services catering to HME providers, it’s
clear that the options for offering available to providers go much
further than just claims processing.

For several years, there has been a range of outsourced billing
services available to the market, but more recently, we have seen
the types of outsourcing and staffing options expand into many
more provider workflows, including clinical processes. Thanks to
technology tools such as cloud-based software systems and telehealth,
there are many more ways for providers to consider where,
when and how they might seek staffing and outsourcing solutions.

That’s the kind of flexibility that can foster focus. Let’s take a
look at some outsourcing and staff solutions that are currently
available to get an idea of what’s possible.

Tactical Back Office
tacticalbackoffice.com

HME staffing firm Tactical Back Office
was born out of an HME provider seeking
a new approach to creating flexible, scalable
teams for HME businesses. The company
trains and connects remote workers based
in the Philippines with U.S. HME providers
to balance their staffing needs.

“Tactical Back Office was born out of
our DME company when the rural rollout
occurred in 2016,” says Tactical Back
Office founder Todd Usher. “We took that
big 60 percent pay cut, and we couldn’t
quite pay people the $15 an hour plus what
they were demanding, so this was the next
best idea.

“We started hiring our Philippine team
and that worked out well for us, so that’s
how the idea started,” he continues. “And
then we launched Tactical Back Office with
a sleep lab locally in Fresno that took on
their first personnel, and we’ve grown from
that point.”

So, what’s the difference between a
staffing service and outsourcing? If a
provider outsources work, it pays for
remote or on-site, outsourced personnel,
or if it works with a third-party billing
and collections 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 at
the company.

However, using a staffing agency such
as Tactical Back Office, the personnel are
the provider’s employees and are managed
and administered in the usual way. TBO
still pays the employee, but it checks in
with the HME provider to confirm hours
worked. TBO also administers HR tasks
such as processing PTO, pay, sick time,
local holidays in the Philippines, double
time, and overtime.

“When we onboard them with us, we put
them through training and then we assign
them to the client,” Usher explains. “They
are not shared with any other client. … We
assign personnel directly to the client or the
HME provider, and it is their employee from
that day forward.”

As mentioned, Tactical Back Office’s
team is based in the Philippines, which
allows TBO to keep the cost of its labor
lower than what it would pay domestically.
The company trains its team in billing
procedures, HME software systems,
reimbursement LCDs, and all the skills
and specialized knowledge required to
carry out the various workflows in an
HME business. TBO’s team members work
the same hours as the provider’s staff so
that they seamlessly fit into the provider’s
operations. The only difference is that they
are working remotely.

In terms of English skills, people in
the Philippines have been speaking
English since they were in kindergarten,
which enables them to engage with other
employees and anyone in a patient’s care
continuum without problems. And if there
are employees whose English isn’t “spot on,”
Usher says those employees can still work
in back-end roles, such as posting or billing.

Having the necessary knowledge, skills,
training and language means TBO’s team
members are now carrying out a variety of
roles at HME businesses.

“A lot of folks, because of our name, think
it’s just back office, like billing and posting,”
Usher notes. “When in fact, most of our team
members are doing front office work. They
are answering the phones. They’re acting in
an operator role. They’re directing phone
calls. They’re handling resupply patients
and hospital discharges. They’re handling
hospital beds. We even have hospice folks
that are being assigned to process hospice
orders.”

And how are TBO’s employees doing
out in the field? There are many longerterm
employees that have thrived since
the company first launched its services,
according to Usher.

“They are getting promoted to new
positions within the businesses or clients
that we have. So we don’t actually do the
promotion,” he says. “The clients are so
impressed with the quality of personnel
they’re getting that they call us and say, ‘I
need to promote this person,’ for whatever
role that might be. It’s usually intake lead,
intake supervisors, and senior intake
positions.

“That’s the success that we’re
experiencing, because we’re providing this
personnel, and the DME or HME provider
recognizes the fact that they haven’t
had that quality of personnel before and
they want to reward them for it,” Usher
continues. “Which is really encouraging
for us, because we get to see these people
succeed and actually get promoted through
the ranks because of the hard work that
they’re doing all on the provider’s behalf.”

rtNOW
rtnow.net

There are lots of HME service categories
that involve highly specialized knowledge
and expertise. A couple of examples of that
would be sleep therapy and respiratory
care. Both services involve clinical
staff — respiratory therapists — to be
involved in the process, not just to ensure
optimal outcomes but also to ensure that
reimbursement requirements are satisfied.
Traditionally, those workflows have
involved the RT working directly with the
patient and usually in person. However,
with travel costs, time and the limitations
of performing front-line healthcare
work during an ongoing public health
emergency, provisioning that in-person
care and consultation can get expensive and
logistically inefficient.

Enter rtNOW, which provides its team of
“tele-respiratory” therapists that help offset
that cost and complication, as well as act as
a pressure relieve valve that lets provider
clinical staff focus on more in-depth care
issues. Using videoconferencing and IT
innovations, as well as rtNOW’s remote
RTs can carry out tasks such as scheduling
new PAP setups; ongoing PAP follow-ups
to ensure adherence for therapeutic benefit
and billing requirements; and virtual
remote ventilator follow-ups.

“What we do for the HME customers is
mostly allow their respiratory therapists to
stay with the patients and people that need
them the most,” says Chuck Stadler Jr., RN,
president and CEO of rtNOW. “It’s about
keeping the resources available for those
patients who really need the respiratory
therapist in-person the most, and we can
be there for them in other more virtual-type
scenarios.

“Some of the services that we offer
HME companies are CPAP setups, CPAP
adherence programs, and the monthly or
quarterly ventilator check programs,” he
continues. “So some of these patients are
healthy patients otherwise, but they just
have questions, and they want to be able
to get them answered in quick and not
necessarily an in-person format. Oftentimes
we can get there quicker because we can be
there virtually.”

The technology backbone for this is
CoreLink, a HIPAA-compliant video chat
system that links to rtNOW’s respiratory
therapists or the provider’s therapists. The
HME provider logs into the system, enters a
patient phone number or email, and a link
that is valid for one hour is sent directly
to the patient. When the patient clicks on
the link using their computer or handheld
device, a video conference with the RT
automatically begins.

In terms of human resources, rtNOW
employs a team of respiratory therapists
with management levels and leadership
in place, to ensure that it can care for the
company’s various provider customers.

“Then we hire additional respiratory
therapists as more customers or more
volume from those customers comes on
board, and we integrate them into our team,
focusing on how we do things but also how
we do things as a direct reflection of how
our customers like to do things,” Stadler
explains.

In terms of how things get done, because
rtNOW has been doing this for a while and
is very focused on specific workflows, it
has been able to refine those processes to
ensure better outcomes. Take the company’s
adherence program, for example. The
company had its first batch of patients
come out of a 90-day program at 90 percent
adherence.

“We have a very detailed process of
getting patients set up virtually,” Stadler
says. “Every customer is a little bit different
on where we get inserted in the process, but generally speaking, we’re talking about
adherence before we can even talk about the
setup, because it’s that important to us. We
want to make sure that, if we’re going to set
this patient up with a device, not only are
they going to use it, but they’re going to feel
comfortable using it and want to use it for
not just the first 90 days, but for years to
come.”

Telehealth Clinical Evals
www.telehealthevals.com

Another example of an outsourced
staffing company leveraging telehealth is
Telehealth Clinical Evals. One of the four
services comprising ATLAS Technology
Service Group (the other three being
ATLAS Enterprise Software, ATLAS
Clinical Eval Software, and ATLAS – FIOS
Business Services), Telehealth Clinical Evals
maintains a staff of licensed physicians,
therapists, and PT/OTs that provide face-to-face evaluations via HIPAA-compliant
audio/video conferencing for mobility and
sleep providers.

For mobility, the TeleHealth Clinical
Evals team performs evals for both power
and manual mobility equipment, including
Group 2 and Group 3 power wheelchairs,
rigid frame, and K1-5 manual wheelchairs.
For sleep providers, its staff can perform
sleep evaluations, ongoing CPAP compliance
evaluations, and annual CPAP prescription
updates.

The model creates a more collaborative,
real-time process that eliminates the time-consuming,
stop-start communication
that can happen during evals, says Maxine
Paul, the vice president of Operations for
Telehealth Clinical Evals. That translates
to a much faster, more straightforward
process.

“We look at it as a team approach, where
we have the doctor and/or the therapist,
we have the ATP, and we have the patient
together on the video conference,” Paul
explains. “We can collaborate and finish
this report together and eliminate the
back-and-forth corrections. We have the
paperwork back to the provider in days.

“I’ve been in this industry a long time,
and I’ve never seen the evaluations and
deliveries go this fast,” she adds. “Most of
the providers we’re helping are delivering
equipment in under 30 days, which is
unheard of.”

Of course, telehealth really took off
during the Covid-19 pandemic because
of the need to socially distance, but the
convenience, efficiency and effectiveness was an instant hit with medical and clinical professionals, HME
providers, and patients, explains Dr. Scott Martin, MD, the medical
director of Telehealth Clinical Evals.

“… From a patient standpoint, patients adored the process,” he
says. They didn’t have to leave the solace of their home that didn’t
have COVID at the time. And it was simply a much more personal
interaction.”

Additionally, the ability to conduct the evals via telehealth offers
a literal window into patients’ lives that can benefit their care,
Martin notes.

“It’s allowed us to interview a patient and the family in their own
home and get a real concrete understanding for what that home
dynamic is like, not just for the patient, but for the caregivers,” he
explains. “Because patients are only going to do as well as the care
they have at home, and the equipment that caregivers have to assist
that loved one with at home.”

And that assessment of the home situation can go a long way into
ensuring that the home environment is optimized for the patient’s
care beyond just the wheelchair, for example. The patient might, in
fact, need a whole lot more in terms of home medical equipment.
Finally, being able to remotely connect has let the physicians and
licensed clinical professionals on Telehealth Clinical Eval’s team see
things they would never have seen before.

“We were seeing these patients for wheelchair evaluations
because a lot of them were having acute events, and at the time we
were doing these wheelchair evaluations, we saw massive needs,”
Martin explains. “There were some people literally sleeping on
mattresses on the floor, with horrible bed sores. They had no home
medical equipment, none. They didn’t have shower chairs; they
didn’t have hospital beds; they didn’t have low air loss mattresses.
Some of them didn’t have simple transport chairs to be able to get
in and out of the house.”

Naturally, those insights create all new abilities to get patients
the HME items they need to ensure they get the full complement of
care that they need.

An Expanding Universe

These are just three services using technology in new and
interesting ways to offer new outsourcing and staffing options to
HME businesses. As mentioned at the outset of this story, a whole
range of outsourced billing services paved the way for outsourced
workflows. (That’s no surprise given the immense complexity
of DME/HME billing, as well as the various workflows and
management layers attached to that aspect of running an HME
business.)

Outsourced billing companies include companies such as
Prochant (prochant.com), ACU-Serve (acuservecorp.com),
Sunknowledge Services (sunknowledge.com), Medbill (medbill.net), and MedBillingExperts (medbillingexperts.com), to name a
few. All of these services let providers outsource elements of their
claims and billing processing, and some of them help providers
outsource the management of their entire revenue cycle.

One thing is certain: outsourcing options for HME businesses
are not going away. Whether it’s billing workflows or clinical
evaluations and care, we can expect the range of options available
to providers to expand so that they can maintain and prioritize
their primary focus: the patient.