Cartoon showing people experiencing burnout at work.
Resignations, no-shows & inflation, oh my!
by Todd Usher

When I started an independent health care business, I thought life would be challenging yet satisfactory in the business of homecare. I was right, but I didn’t expect the gut punches, head shots and unscrupulous tactics that came along with the industry. Some of these came as reimbursement cuts for home medical equipment (HME) in the form of PAYGO cuts and competitive bidding. Today, the industry is facing critical supply chain issues and 40-year high inflation rates.

Staffing Challenges

Still more challenges have appeared in the form of managing and hiring employees. Shortly after the COVID-19 pandemic began, the industry had to reckon with the near total shutdown of society—even though HME providers were declared essential businesses. Many employees were afraid and didn’t want to work around other people, especially members of the public with varying attitudes about safety. As the pandemic has leveled out, the industry has seen a dramatic rise in salary expectations.

There is also the phenomenon of applicants “ghosting,” or not showing up for scheduled interviews or their first day on the job. Some showed up for the first day but not the second. Others would show up, work a few days, get their testing and background and complete pre-employment health clearance—and then quit with little to no notice. Still others stuck around, but then requested an unrealistic salary increase on Day 90—or rather, demanded it. Generally speaking, local candidates have left a lot to be desired when it comes to meeting the industry’s staffing needs.

To quote a famous movie, it feels a bit like “lions and tigers and bears, oh my!!”

One Solution

In an effort to meet client needs, HME providers may need to turn to insourcing their staffing. Insourcing means hiring staff from overseas to handle key functions, such as billing, coding or first-step customer service. If this sounds similar to outsourcing, you’re right! But insourcing allows business owners to maintain control of their operations.

Outsourcing gives another company control, meaning you rely on them to achieve desired results. Insourced staff work for you directly and work to meet your key performance objectives. You should, as a best practice, know their names and faces.

Insourcing staff from abroad has been a perfect solution to a lot of our clients’ needs. Our clients report that their insourced staff are dedicated, hardworking, show up on time and want to work. A xgood number of our clients have been able to achieve their goals and maintain them over the last few years. Bad debt, error rates, denials, held sales, order production, intake, answering the phones, talking to physician offices, completing a chart so that is ready to be billed and, yes, even absences and turnover, are at an all-time low.

How refreshing it is to hire someone who not only wants to work but generally does a good job at the tasks that they are assigned to complete.

The People Business

As this article goes to press, the possibility of a recession looms. Thankfully, health care has been largely recession resistant. When people get sick, they want people who can handle complex jobs that require critical thinking and judgment. Automation has yet to master job functions like researching complex aging and collections issues. Artificial intelligence is not yet able to treat people with dignity and respect. Automated phone trees help manage calls, but there is always an operator needed to field some questions or concerns.

Health care is, at its core, the people business—people helping people. It is important in the entry levels of health care to have quality insourced people helping our customers. We have already seen it with supply replenishment, where the HME industry is moving away from automated systems and returning to having people talk to patients. In fact, some of the platforms have funded studies showing enhanced compliance with therapies when a customer is talking to a live person.

Other headwinds may continue to hamper our industry, but with their staffing issues put to rest and no longer a struggle to deal with, HME owners can focus their attention on running and growing their business. This is what we wanted to do all along; this is the fun part. There will always be challenges—especially in health care—but taking control of the largest expense line in the budget leaves all other problems manageable by comparison.

In Conclusion

My concluding thought on the matter is directed at those who took a leap of faith and those of you who started a business from nothing and are the original investor and idea maker. You nurture it and enjoy its successes and guide it when it has failures. You only want what’s best for your business so you and your employees can lead active, productive and successful lives. When this involves customers, clients and patients, you want to ensure that all are pleased with your performance.

It is vital that you always hire the right team members with the right aptitude, attitude and competence. This includes fitting into your company culture and having the drive to succeed. Anything short of that is unacceptable.

Hiring the right person will affect your business’s success or failure. It really is that simple.

Todd Usher has held various positions for home medical equipment providers and manufacturers since 1996 and is the founder of Tactical Back Office. He enjoys working on developing new business opportunities and is optimistic about the future of homecare in a post-pandemic world. Visit