This article is sponsored by Tactical Back Office. As operational pressures mount across the HME industry, providers are rethinking how they build and scale their teams. Tactical Back Office is helping them go beyond traditional staffing to unlock new levels of flexibility, efficiency, and growth. In this Voices interview, Todd Usher, President and Founder of Tactical Back Office, shares what’s new at TBO, how his firsthand experience as an HME business owner drives the company’s approach, and why the right workforce strategy will separate the winners in 2026 and beyond.
HME Business: What’s new at Tactical Back Office since the last time HME Business spoke with you in 2025?
Todd Usher: Since we last spoke, we’ve expanded into a 24-hour contact center through our TCC division. That includes equipment troubleshooting for products like portable oxygen concentrators, home fill systems, oxygen concentrators and CPAP devices.
We’re also introducing a new set of services at Medtrade this year, including provider contracting and credentialing, along with social media and reputation management. IT support will be part of that offering as well, since many of our clients are looking for reliable technical support from a trusted partner.
These are all services our clients have been asking for. It took some time to build them the right way, but we’re excited to officially launch them at Medtrade and expand how we support our customers.
What does it mean to go beyond traditional staffing in today’s market, and why is that shift so important right now?
No matter what segment of health care you’re in, filling roles has become increasingly difficult, from front-office positions to highly specialized back-end functions. Providers are struggling to staff everything from Group 3 rehab intake and order processing to technical support and equipment troubleshooting.
That’s where going beyond traditional staffing is key. We support complex scheduling for physician offices, 24-hour assistance for patient equipment issues, and now we’re offering expanded after-hours support through our contact center. Maintaining that level of coverage locally can be extremely expensive, so we help relieve providers of those costly mandates.
We also recruit globally, which includes foreign language team members, and we tailor our support based on each client’s specific needs. In today’s environment, reimbursement rates aren’t expected to rise anytime soon. That means providers have to operate within tighter margins, and labor is one of their largest expenses. Managing those costs effectively is going to be a significant driver of long-term success.
In your experience, how do local and remote workforces compare when it comes to productivity?
In our experience, productivity is consistent between local and remote workforces. The bigger differentiator isn’t location, it’s management.
We’ve seen significant variation based on a client’s leadership structure and oversight. Organizations with strong management and clear operating systems tend to see consistent performance regardless of where the work is being done. Others may need additional support, such as productivity tools or reporting systems, to help achieve their KPIs and operational goals.
What are the biggest barriers to achieving operational stability, and how can providers work through them?
One of the biggest barriers to operational stability is turnover. Constant hiring, training and retraining creates expense, inconsistency and fatigue across the organization. We experienced that firsthand before launching TBO. It was a revolving door, and it wasn’t sustainable.
That experience shaped how we built our model. Today, TBO maintains a turnover rate of roughly 1 percent, which creates a level of consistency that’s difficult to achieve internally. With stable teams, there’s far less retraining and far fewer disruptions to workflow.
That consistency matters. Our team members have been through audits, accreditation processes and complex operational environments. They bring that experience forward with every new client engagement. Instead of starting from scratch, providers gain a workforce that already understands the standards, expectations and regulatory landscape.
Operational stability ultimately comes down to systems and people. When both are aligned, performance becomes far more predictable.
How does your origin story — and your experience owning a company in this space — shape the way you serve clients today?
Our origin story matters because we’ve lived the same pressures our clients face. We’ve been on the front lines of audits, surveys and accreditation, and we’ve worked through the operational challenges required to meet and exceed industry KPIs.
Over the past decade, we’ve intentionally recruited and developed a cohesive, high-performing remote team. Every team member participates in audit and accreditation processes. We review those outcomes, learn from them and continuously refine our training programs to reflect current standards and expectations.
Because we operate inside those realities ourselves, we don’t just offer support in theory. We bring practical, firsthand experience that’s been tested in real-world environments and built into how we serve our clients every day.
What makes TBO’s system uniquely flexible when it comes to scaling with your clients’ evolving needs?
Our flexibility starts with our recruitment and development engine, which we call Tactical U. It’s a continuous pipeline of candidates in various stages of training, allowing us to scale quickly without sacrificing quality.
Tactical U is designed to stay nimble. Our teams are constantly expanding their skill sets, learning new workflows and staying current on billing updates, audits and industry changes. They also draw on the experience of our seasoned team members, giving clients access to a deep, on-demand knowledge base when they need it most.
That structure allows us to move well beyond routine HME and DME tasks. For example, a recent client acquired a competitor and suddenly needed roughly 25 team members to support data entry within an existing operating system. We mobilized within days, onboarded within a week and completed the work well ahead of the three-month timeline they had projected. There was no downtime because we had trained personnel ready to deploy immediately.
That ability to respond quickly, with trained teams already in place, is what allows us to scale alongside our clients as their needs evolve.
Zooming out, what do you think will separate the organizations that thrive in 2026 from those that struggle to adapt?
The organizations that will thrive in 2026 are the ones willing to adapt early. Those that resist change often end up continuing to struggle or eventually exiting the market.
We frequently hear from providers when they’re under significant pressure. Reimbursement compression, staffing challenges and operational inefficiencies leave little room for delay. That’s why we’ve built a system with candidates already in various stages of training, so we can onboard quickly and provide immediate relief when clients need it most.
The broader reality is that reimbursement rates are unlikely to rebound anytime soon. In fact, competitive bidding pressures continue to intensify. Waiting for rates to improve isn’t a strategy. Living within your means and restructuring your operating model around today’s financial environment is.
The providers who accept that reality, manage labor costs proactively and embrace more efficient business models will be the ones positioned to succeed in the years ahead.
Editor’s note: This interview has been edited for length and clarity.
Tactical Back Office is a remote staffing partner built to resolve operational strain and improve long-term growth. We provide pre-trained, reliable professionals who integrate seamlessly into your operations and workflow, reducing costs, increasing efficiency, and freeing leadership to focus on what actually moves the business forward. See how this works in your operation: try.tacticalbackoffice.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].