Codependency and the HME Operation
Running your business efficiently and managing employees work together for the best outcome
by Miriam Lieber

Operational efficiencies and managing employees go hand in hand. In fact, you can’t have one without the other. Regardless of the automation initiatives you employ, you will always need employees. To achieve operational efficiency, your employees need goals and accountability measures. Let’s explore the codependent relationship between operational efficiencies and management, both of which require the employee.

Operationally Sound HME Companies

What does an operationally sound HME company look like today? It certainly does not look like the HME provider of five years ago, or even two years ago for that matter. It is the company that is constantly looking for ways to improve its overall efficiencies. It is the company that focuses on goals and achievements, and is relentlessly focused on raising the bar. For example, one company I recently visited is working on a management action plan and setting new benchmarks for their employees to improve collections. In that vein—among many different improvements—they are measuring (and segregating) denials from A/R collections. They are working to ensure they collect the bulk of their monies in less than 90 days, resolving all denials by week’s end and maintaining their A/R greater than 120 days at 10 percent of all A/R. This is best-in-class performance. To do this, they are divvying up tasks by skill set.

This same company is using senior leadership to help guide the staff to perform their functions and meet or exceed their goals in all departments. For example, they are playing back recorded calls for customer service staff to hear their tone of voice with the customer and to audit for superior service. The results will be used to benchmark customer experience as part of ongoing performance improvement. The leaders’ presentation styles and collaboration with staff is the key to gaining the buy-in needed to meet necessary targets. The driving force is motivation to set and achieve goals, recognition of a job well done, identifying holes in the process that need reinforcement and behavior others want to emulate. This personifies the making of an excellent and cohesive department/company, which is the leaders’ real charge.

Ownership Mentality

With buy-in and strong leadership, the HME organization gains “ownership mentality.” How many of the employees care enough about the business that they go above and beyond the call of duty to complete their work? How many staff members treat the business as their own? In today’s world, this is a rarity and not simple to find. Although you do not need more than a handful of core leaders in the company with this mentality, you definitely need role models for others to emulate, as mentioned above. Without this leadership persona, staff morale will wane. Focusing on positivity during an otherwise tumultuous time is paramount to the overall success of the business.

When you spot a stellar leadership moment, stop and praise it. Highlighting and singling out for this reason creates enthusiasm and stimulation for more positive behaviors. For example, at a recent meeting with an HME company, one staff member was concerned with the company’s overall collection performance even though her role was designated as customer service and front-end supervisor. When I asked why she was so concerned with the A/R, she indicated that she wanted to know the reasons why payments weren’t made so that she could ensure her team was doing everything in their power to bring in the bottom-line dollar. Although it could have been misconstrued as meddling in others’ business, she was exhibiting ownership mentality. This is the same person who identified inventory and logistics issues that she solved, all as a customer service supervisor. The company was receiving complaints for being out of stock on equipment. She worked hard to formulate a solution; she proposed the solution and it worked out great for the company. Specifically, there is now a manager who handles this role and executes it to perfection. Again, this is a model employee who identifies a problem, finds the best possible solution and executes it. Now they can measure against it, and complaints are currently a nonissue.

Do you have employees who accept responsibility for fixing problems that are in the company’s best interest, not necessarily within their immediate scope but impactful nonetheless? This is the type of person whose behavior you should recognize and praise.

Automation’s Impact on Staff

As much as core employees’ exceptional leadership behavior is important for your overall success as a company, automation is also a catalyst in driving profitability. This is the case because operational efficiencies are maximized via software initiatives that both expedite processes and measure against goals. For example, by implementing to-do lists directly from your software, you can identify errors and measure items such as the number of denials worked and the reason and person responsible for the error. You can use this information to train from mistakes and track the number of denials resolved that result in increased cash. This type of initiative should help to improve productivity and prevent recurring intake errors.

I recently noticed a company that would not use the internal eligibility check in their software because of the charge associated with it. The result was numerous denials for ineligible patients. It would have been much less expensive to pay on the front end for internal eligibility checks rather than fix the denials on the back end. Despite the expense of implementing new automation initiatives, the return on the investment should more than outweigh the cost.


While you use your software to bill and get paid, you also use it to measure productivity and meet bottom line expectations. For some leaders, accountability is the impetus behind their employees’ motivation. For other leaders, it is their weak spot—they are unable to hold staff accountable for their work. Still others will set goals, begin to measure against the goals but stop short of the consistent measures and comparisons to previous months’ results that illustrate progress or highlight areas that need improvement. Clearly, when a staff member knows what is expected of him or her and can quantifiably measure to know if he or she meets the expectation, there are no surprises; rather there is increased commitment to perform and meet the expectation. For example, in one HME company, we engaged staff in a goal-setting exercise by asking them how many accounts they believed they could work per day in the A/R for which they were responsible. Based on their own expectations, goals were then established.

After tweaking the goals for a month or two, we decided to post results and created some healthy competition among the teams of collectors. Inevitably, the lowest performers were offended and became belligerent when they learned their marks were posted for all to see. The highest achievers were more than pleased to see their names at the top of the list. In Gino Wickman’s book “Traction,” he sums up this same notion perfectly, “Wrong people in the wrong seats usually resist measurables. Right people in the right seats love clarity. Knowing the numbers they need to hit, they enjoy being part of a culture where all are held accountable. It creates an esprit de corps with everyone pitching in to make the company a success because right people want to win.”

Employee Behavior: Management Tone

As summed up in the previous section, employees who are in the right positions with the right expectations and responsibilities will perform to their maximum capabilities. This begs, however, for the right leadership to guide them. It is sometimes hard to remember that tone comes from the top, and—as a leader—if you are not engaged and/or you create negativity or tension, your staff feels it and typically behaves similarly toward coworkers and supervisors. To get buy-in and respect, you must model the behavior you want to see in your staff. If you witness someone conducting him or herself in a way that is unacceptable, you must have the difficult conversation and be clear about what occurred. Use it as a learning experience to prevent its recurrence. I often ask the person what they would do differently if they had the chance to rewind and redo the action.

For instance, when a department leader decided to take vacation right when a big software initiative was being implemented, staff felt slighted. They did not know if they should take the implementation seriously because it was not important enough for their leader to be there. Further, they were unclear of how the change was going to play out and felt, at best, skeptical and anxious at worst. Once the leader returned, they were questioned about how they thought the project was unfolding. When the leader realized it was going to take longer than expected and the staff was not feeling so excited about it, the leader admittedly confessed that leaving during the transition period was a bad idea. Without having to ask, the leader mentioned that if they had to do it again, they would not have left during this pivotal period. The leader later apologized to the staff and stated that they would be re-implementing the start date and the leader would be there to help after-hours and on weekends until the project was complete. As a result, staff felt as if the leader owned the problem, solved it and was completely engaged going forward. This vulnerable human side of a leader is critical for staff to see. From then on, the staff established a great rapport with the leader and respect was renewed.

As you can see, leadership in an HME company plays a compelling and crucial role in the organization. Not only is the leader responsible for operational efficiencies and sound decisions made to enhance performance via software and automation, but also the core group of leaders delivers the tone, pulse and energy to the employees. Negative energy spreads negativity swiftly, and a positive culture is motivating and invigorating for staff seeking to succeed.

This requires goal setting and accountability measures, both of which should be tracked and reported via data found in the software. Posting results and rewarding those with exemplary results creates inherent competition for those who strive for excellence. And we all know that success breeds success. In the codependent relationship of operational efficiencies and core leadership, if balanced properly, bottom line profitability will improve, and the HME company will be poised for the next big change. The trickle-down effect on employees will enable you to thrive now and into the future.