
Corey Smith at HME Business FUTURE.
While labor shortages were among the key issues to make headlines during the COVID-19 pandemic, home medical equipment (HME) providers have always faced challenges to recruiting, training and retaining enough local talent to run their businesses efficiently.
The 16 months since the end of the COVID public health emergency in May 2023 have confirmed what most HME providers already realized: Labor challenges are here to stay.
“That’s been our experience,” said Corey Smith, client sales executive for Tactical Back Office (TBO). During the HME Business FUTURE conference in August in Nashville, Tennessee, Smith discussed how TBO was actually ahead of the pandemic’s labor shortage curve thanks to strategies TBO founder and HME provider Todd Usher put into play in 2015.
“Our sister companies were faced with a rural rollout at that time, as well as reimbursement cuts happening in conjunction with wage increases,” Smith noted. “Minimum wage was going up to $15 an hour at the same time. There was already a revolving door of staff, and it just got worse. And so [these strategies] were created out of necessity — and throughout the pandemic, we thrived.”
Familiarity with the HME process
TBO created a remote staffing business that it now supports other health-care providers — HME suppliers, of course, but also home health businesses, for example.
Key to the success of TBO’s remote staffing model is the company’s extensive experience in the HME industry and its familiarity with health care in general.
“When we started out with this model, we first needed a proof of concept,” Smith said. “I imagine most of our clients also want a proof of concept that this will, first and foremost, work with their staff.
“So we started out with one [remote staff] person, and we wanted them to do what we most urgently needed: getting CMNs [certificates of medical necessity] and working on our CMNs. And then we said, ‘This is working out great. They’re showing up on time. They want to work, they’re ready to work, and they want to learn more about our business. What else could we use them for?’”
Another successful example, Smith added, was collecting documentation. “They chased facilities that needed to send us additional documents for the prescriptions,” he explained. “But most of what we’re doing today wasn’t our idea. We don’t dictate the rules of what our clients can and cannot use the staff for. We follow their lead, and most of what we’re doing was brought to us from clients, partners or friends in the HME industry or home health industry.”
One TBO client needed a dispatcher: “We had a client that was having a hard time with constant communication between the drivers, between the patients’ homes, between the referral sources, whether it’s hospice or traditional DME [durable medical equipment], to just keep everyone [updated] about where the product is, where, when the driver can be expected to be there, updating the driver if something changes. And it’s worked out well.
“If it can be done remotely, we’ll find a way to get it done. Another example is respiratory therapists. We have a lot of respiratory therapists that we can prepare remotely to do compliance follow up, to do CPAP remote setups in situations or markets where that’s allowed.”
Making remote workers part of the team
TBO puts its remote workforce through intensive, provider-specific training. But then TBO encourages providers to integrate remote staffers into their local teams.
“The most successful clients treat these staff members like an extension of their team,” Smith confirmed. “They’re dedicated to you. They work your hours. You dictate what they do on a day-to-day basis. You build in redundancies. You cross train them.
“We use the term ‘insourcing.’ This isn’t just a model where we say, ‘Hey, we prepared a person to do intake for you. So you need to have them do intake.’ Well, what if you have someone go on maternity leave in your billing department or CSR area? You can cross train this [remote] person, or you could have this person now pick up the slack so your staff isn’t pulling out their hair. People get sick, people go on maternity leave, people take PTO. So these [remote] people are yours. And if you treat them like they’re an extension of your team, they’ll do a wonderful job.”
Asked if remote staffers would ideally be included in, for example, your weekly Monday morning meetings, Smith said, “Absolutely. Get to know them. Everyone has likes and dislikes. Get to know what their strengths are. Some of them are more proficient in certain areas than others. Some have more understanding of new, complex tasks, such as working a Medicare report. Coach them and treat them like you would a local staff member.”
Remote staffing tailored to specific needs
Smith added that when looking for a remote staffing partner, providers should ask what training remote employees will be given.
“At any point in time, we have 120 to 250 staff members at the ready who have already been through approximately eight weeks of our training,” he said. “So today, if a provider comes to us and says, ‘Hey, I need a person help my intake department,’ or ‘I need a person to help with prior authorizations,’ we have people that have been close to eight weeks in training with us.
“We’ve shown them general orientation, making sure they’re showing up on time for training every day, that making sure that they’re asking good questions, staying alert, retaining new information. We’re introducing them to HIPAA and letting them know what’s a CPAP, what’s DME, what is Medicare? How do private insurances differ from Medicare? What’s Medicaid?”
Smith said TBO also trains remote employees on popular business systems. “We’ve already shown them Brightree. We’ve already shown them NikoHealth, [Computers Unlimited’s] TIMS, if our clients are using TeamDME. We’ll get them acquainted with those operating systems. You tell us what you need. You interview [the remote employees], and you have to approve them. They onboard with you and you treat them like you would any other staff member.”
Taking control of HME staffing
Remote staffing can be a way to improve business efficiencies and benefit everyone from local employees and managers to referral partners, funding sources, and patients.
“What I see on a continual basis is clients will have good employees, but they’re fearful of what happens if their biller they’ve had for 20 years retires,” Smith said. “What happens if they need to hire someone else? It’s hard to find people with experience, let alone to be able to afford whatever the hourly rate is. In California, McDonald’s is paying $20 an hour now, starting out. So how do we afford to pay somebody $25 an hour when you have to add 30% for benefits as a business owner?
“I think this is something to start considering for those that haven’t thought about this option. You can start with one person.”