A Generational Shift Could Rejuvenate the Homecare Industry

I am truly one of the luckiest individuals to have the fortune of falling into a career in the homecare space that I love and cherish. Throughout the first half of my life, I swore I’d never have anything to do with it.

Now, it’s all I live for. Let me paint a picture of how it has changed over time because I suspect my story of taking over my family’s durable medical equipment (DME) business is not unique.

My parents were kind enough to hand me a broom when I came crawling home at age 19 asking for a job so I could pay my way through college. When life gives you lemons, make lemonade, they say. That broom led to a promotion and a set of keys to a one-ton delivery van, which I also had to use on my daily commute between home, work and school. The deliveries paved the way to a hybrid position of in-store customer service and delivery. Then our store manager left to start his own venture, and I became his replacement.

I was halfway through my criminal justice degree and itching to join a local law enforcement agency. I didn’t pay enough attention to the details that my predecessor knew about vendors, products, non-assigned claims (back to that in a moment), purchase orders and so many other things. Overnight, the script got flipped on me—but the only thing I knew to do was to roll with it.

When I finally attended my first Medtrade in the late 2000s, I learned that we were doing everything wrong. We were supposed to be doing assigned claims, not non-assigned ones. We were supposed to deliver the order first, then deal with chasing paperwork with the physician. We were supposed to do all of these things that everyone else was doing—that’s how we would scale up and grow!

A New HME Reality

Then Round 1 kicked in, and I became fascinated by watching the pilot program in the nearby Dallas region. The stories I was hearing from dealers, customers, friends and relatives were horrible. I’m not talking about the bid rates; I’m referring to everything else. We know about them because many of us in the third-party space experienced the same logistical issues:

• “I don’t have all of the necessary paperwork from the physician.”
• “You don’t qualify for coverage.”
• “It’s not a shopping mall where you just pick anything, these are your (limited) options.”
• And the list goes on.

The writing was on the wall that the competitive bidding program was very likely going to expand, despite the inefficiencies and failures Round 1 showed us in the pilot areas. I decided instead to begin shifting to higher-quality products and adding a variety of non-coded options. Who does the government think they are to tell a consumer or caregiver what they can or can’t have? Who are they to determine what is useful and necessary in someone else’s life?
I had no clue what was next, but I knew I was not going to let tanking reimbursement rates force me into providing low-grade products.

My theory is that my customer base is shopping with me for a loved one; they are vulnerable, they need education, they need their hands held or maybe even a hug. Ultimately, what they need are quality long-term solutions. I felt, and still, feel a tremendous sense of responsibility to ensure that anyone who gave us a chance would get the same service and quality of products that I’d expect for my family.

When July 1, 2013 arrived—D-Day for DME—many of us in Round 2 markets hit a new level of chaos. Doctors’ offices were finally calling me saying, “Our usual referral won’t do X—will you?” I’d then ask why and be told, “Well, they’re saying they need more paperwork. They never asked for it before.”

Enforcement was ramping up and rates took a dive, making it harder than ever to do traditional business. With no contracts, I finally felt free to start offering out-of-this-world brands and products. Gone were the non-assigned claims. Instead, we were able to give our customers the opportunity to make an investment in their well-being. Our inventory purchase orders rose—but so did our deposits, quickly enough to cover them. Plus, people wanted to shop with us, even though no one wants to shop at a medical supply store. Be honest, would you? (Come visit me and I’ll change your mind.)

Pandemic Problems

Fast forward a few years. I’m married with a kid on the way, we have a modern phone system and point of sale system with barcode scanners. Life couldn’t get any better. Then along comes COVID-19.

I had to ask my mother to stay home for her safety. I was up all night researching the latest COVID-19 protocols and searching for in-demand inventory from any vendors I could find.

This is where the shift really started for me. Now it was my turn to keep up with the monthly bookkeeping, tax payments, license renewals and accounts payables (I am proud to say we have zero days sales outstanding as a self-pay/retail operation). Suddenly, I’m the owner, administrator and showroom manager—plus a husband, an expectant father and the person responsible for my parent’s health and safety (which included providing them with lift chairs, rollators and a few basic activities of daily living items).

I had to finally admit that my mother might not return to work to do all the “boring stuff” while continuing to pester me about how expensive inventory items had become. We saw how high the cost of doing business had gone in the last three years. I took the side of the industry, knowing many HME providers were locked into static contract rates even as fuel prices fluctuated, personal protective equipment added expenses and inventory costs skyrocketed.

I chose to limit our retail pricing increases as best as I could to help minimize the sting for the families that continued to give us their business. If I couldn’t get a certain product, I had backups in mind. If no options were available that met my standards, then I’d rather do without. Quality remained critical, even as I was functioning as the customer sales representative, the showroom manager, the back-end manager, the administrator and at least playing the role of owner.

That brings me to this year. For the entirety of its operation, our business has been a micromanaged organization, and I’ve dreamed of changing that culture. I finally have a right-hand person who is helping me to do that and a relatively new team of staff who have learned over the last 14 to 26 months what makes us different from to other local businesses and how we can take my dreams to the next level.

I’m no longer working six days a week as my mother did until her forced retirement. I have become a proud member of the sandwich generation, raising a young family while ensuring my parents are taken care of in their golden years, and have shifted from business operator to business owner. I’m a father myself, and I am a firm believer that dreams that you wish will come true. Next on our radar—continued growth and expansion.

Spoiler: I don’t even like lemonade.