Primary Matters

In Midland, Texas, population 95,000, the claim to fame is the Bush connection. It’s the hometown of President George W. and Laura Bush. And town lore has it that during their courting days, the two sipped sodas at the old Rexall Drug soda fountain.

But if Justin Rogers has his way, there will soon be something else to put Midland on the map — the home medical equipment map, anyway.

Rogers, general manager of Primary Medical Supply, and his dad Steve, a pharmacist who owns Primary Medical and two pharmacies (including that legendary Rexall Drug), are working to develop not a one-stop-shop, but a one-stop health complex.

Already, they are halfway there. In January, Primary Medical moved to a brand-new, 9,600-square-foot building designed for three tenants. One of Steve’s pharmacies moved next door; the other space will be rented to another health-related tenant such as a doctor, dentist or nursing agency.

“Then we’ll build an identical building on this property, so there will be almost 20,000 square feet on [this site for health-related businesses],” says Justin.

He envisions a day in the not-so-distant future when Primary Medical customers can visit their physician, get their prescriptions filled and arrange for home medical equipment and home nursing care in a single trip. And that, he believes, will be a terrific boon for patients because they won’t have to be running all over town for all their health needs.

It’s happening already, he says with undisguised pleasure in his voice. “[Patients] come in here, we take care of them and then they can walk right next door and get their blood pressure medication and get in their car and go home, curl up on the sofa and watch ‘Oprah.’ It’s a step saver.”

How did all this come about? The story actually begins a few years ago in August 2003, when Primary Medical Supply became a full-fledged HME provider. The company inhabited the second floor of an office building. “It started out real small, with just me,” Justin says. “It’s been a work in progress.”

Justin, a registered pharmacy technician with a background in advertising and marketing, knew a lot about the pharmaceutical business but little about HME. He relied largely on manufacturers to help him learn the ropes, and he listened to his dad’s advice about getting too big too soon.

“It was smart thinking on Dad’s part,” Justin says. “He said, ‘Let’s not get too big for our britches, let’s grow into it.’”

And that’s what they did. Slowly, Justin built the business into an almost-full-service HME. (The company does not handle oxygen.) He added three employees to the staff — and more equipment.

“It was floor-to-ceiling stuff,” he recalls.

Finally, with Primary Medical bursting at the seams in its 900-square-foot location over one of Steve Rogers’ pharmacies, the time seemed ripe to move. But Steve wanted to do more than simply lease another building.

So, with the vision of a health destination taking hold, Justin began searching for property in Midland where the father and son team could build their own structure.

He found an undeveloped, 2.5-acre parcel along a main thoroughfare with a mall at one end and a large grocery store at the other. The property was in the middle, and a little research revealed that 28,000 cars per day passed the site going either to the mall or the grocery store. One glitch: To build what they had in mind, they needed to get the zoning changed.

That proved to be but a little stumbling block. “There were so many people excited about it,” says Justin. “Everybody came out and supported us.” Newspapers and television stations picked up the story — and Primary Medical picked up some good publicity.

Construction took over a year, but when Primary Medical finally moved in, it was to a space quadruple the size it had before. “Now everybody has some elbow room.” Justin says. In addition to a showroom, there are offices, a break room and a storeroom (the company also leases warehouse space). A separate shop is equipped to repair equipment and install vehicle lifts.

The showroom itself is 1,000 square feet, and Justin has had a grand time decorating it. No cold, antiseptic showroom for him. “I wanted that furniture-store look,” he says. “I wanted something that was merchandised, that you felt when you walked in, ‘Wow, this is a nice place. I can sit down, touch and feel [the equipment], take a spin, whatever.’”

In addition to aids to daily living, he’s got artwork on the walls. A collector of vintage objects, he plans to bring in an old Coca-Cola machine. The atmosphere seems to have a calming effect on people, and so do the employees. “They smile, joke with the folks sometimes, put them at ease … There are some patients that you can just see them relax,” Justin says.

He’s seeing other positive effects from the new setting. “[The property] had never been developed, and now it’s a pretty place,” he says. “It’s neat to watch it grow … I haven’t started advertising yet, but we’re seeing more walk-in traffic.”

The new location and the destination complex concept have Primary Medical well positioned for the future, Justin believes. “I think we’re real lucky. I think we are a little ahead of the curve,” he says. “Competitive bidding won’t hit us for awhile, and if it does, a lot of the stuff I do will be exempted anyway.”

With the capped rental issue shadowing the oxygen market, he’s pleased not to be involved in that sector. “I had a few oxygen patients when I first started out and I lost my shirt; I decided I’m not going to do oxygen. I think that is going to save [us],” he says.

Not carrying oxygen has not hurt him up to this point because, in his usual “get-out-of-the-box” way, Justin has formed a relationship with the local Lincare provider. He refers all oxygen patients to Lincare; in turn, that company refers patients needing wheelchairs, walkers and other products to him.

That arrangement, he says, allows Primary Medical to provide HME patients with anything they need. “It works out well,” Justin says. “Competition is good, but you have to have some professional communication.”

Still, to survive in the ever-changing, low-reimbursement market, he says, “I think both pharmacies and HMEs are going to have to diversify. You’re going to have to carve out some niche markets.”

In looking at his business, Justin researched the biggest needs in the sales area, and asked referral sources what they would like to see in the store. Now, he says, “we might not carry a lot of it, but we’ve got it.”

His main niche market in HME is adaptive aids. “What I want is someplace that if you come in and need an ankle brace, you can get it. If you need something for your home like a lift chair, something for your bathroom, you can get it.”

He has established another niche in bariatrics. “I am one of the only providers in west Texas that has a full line of bariatric equipment,” Justin says.

The innovation doesn’t end there. The company is licensed as a general contractor, so “we can build ramps, widen doorways, install grab bars and if anything breaks, we have a repair shop,” Justin explains.

Primary Medical also sells and installs wheelchair lifts. “And we work with car dealers on how to get rebates on car lifts for patients,” says Justin.

The company also works with the Veterans Administration, which is a welcome cash situation, according to Justin, and it has aligned with various other entities including hospice and the local children’s hospital.

“Our survival plan is to get out of the box,” Justin says. “There are other ways to do HME.”

Will his plan work? Will the destination health care complex pay off?

“It’s somewhat of a gamble because there’s no such thing as a sure thing,” Justin allows. “But my gut feeling is that we are on the right path.”

Primary Pointers

Justin Rogers, general manager of Primary Medical Supply in Midland, Texas, has his own ideas when it comes to building a home medical equipment business that will survive in the industry’s increasingly difficult environment. Among his suggestions:

• Get outside the box and look for new ways to work. Don’t feel you have to do business the same way everyone else does.
• Find some niche markets that will serve you — and the people in your geographic area — well.
• Build good relationships with your competitors so you can do what’s best for your patients. If you don’t handle oxygen, for example, refer your patients to a company that will provide them with good care — and ask them to refer patients who they cannot service to you.
• Do crossover training so at least most people on your team can handle several types of jobs. This helps ensure that the patient gets the best care. At Primary Medical, for example, one person doubles as the delivery driver and the service tech, one person serves as the customer service rep and also works on the showroom floor and one person is the biller and can double as the customer service rep. “It’s working together. There’s no way I can know everything or anyone else can know everything. You have to work to-gether. That team effort will pay off,” says Rogers, adding that customers don’t hear “That’s not my job” at Primary Medical.
• Remember that “profit is not a bad word in this business, bankruptcy is.” “I’m a provider first, a businessman second,” says Rogers. “I cannot lose sight that I have to take care of the customer. But there are times when I have to say, ‘Look, Ms. Jones, I have to keep the lights on.’”

Company Snapshot

Primary Medical Supply

• Full-fledged home medical equipment provider (except oxygen) with niche business in adaptive aids and bariatric products
• Family-run company with two pharmacies in west Texas
• Four employees

Pharmacy Plays Role in Federal Compounding Case

Steve Rogers’ Medical Center Pharmacy recently took a part in a landmark case that upholds the ability of pharmacists to customize prescriptions for individual patients.

U.S. District Judge Robert Junell ruled on May 25 that the compounding of ingredients to create a customized drug, in accordance with a valid prescription, does not create a new drug. In issuing the ruling, Junell rejected the Food and Drug Administration’s argument that compounding produces new, unapproved drugs that the FDA must approve.

The judge’s decision was issued in the Midland, Texas, case, Medical Center Pharmacy et al. v. Gonzales et al. The suit was filed in September 2004 by 10 compounding pharmacies — including Medical Center Pharmacy — known as the Midland Coalition.

“This landmark ruling has national implications and, while it’s a victory for doctors and pharmacists, the real winners are the millions of patients who rely on customized pharmaceuticals to live normal, active, healthy lives,” according to Bruce Roberts, president and CEO of the National Community Pharmacists Association.