Leading today, sustaining profitability
by Miriam Lieber
September 8, 2017
In his book Traction, author Gino Wickman precisely summarizes successful companies: "Successful businesses operate with a crystal clear vision that is shared by everyone. They have the right people in the right seats. They have a pulse on their operations by watching and managing a handful of numbers on a weekly basis. They identify and solve issues promptly in an open and honest environment. They document their processes and ensure that they are followed by everyone. They establish priorities for each employee and ensure that a high level of trust, communication, and accountability exists on each team.”

There’s no question that in today’s HME environment, status quo is insufficient. Rather, thinking outside the box for ways to garner revenue and generate profitable business is what will sustain providers through the deepest reimbursement cuts in the history of HME.

While market volatility and health care reform generate a fickle and erratic sensibility inside HME companies, one thing that can be controlled and managed is efficiency in internal operations. That requires a robust and solid foundation of leadership.

Sharing a Crystal Clear Vision

A clear vision means that everyone in the HME organization understands the mission of the company and its philosophy. Everyone should know where the company is heading and the direction it is going to take.

In many HME companies, especially in the past, serving the patient regardless of who was going to pay was the mantra. When I consult with companies where this still rings true, I find orders without proper documentation and innumerable denials because the staff is told to take the order regardless of payment. While benevolent—and historically a philosophy that worked—today this makes an HME company insolvent.

To sustain profitability, a complete order with necessary documentation should be solidified (with little exception) prior to dispensing product. To do this requires the right mix of employees.

Right People in the Right Seats

A primary focus in every HME company is making sure you have the right people in the right seats on the plane. The reason why this is universally significant is that in the past, the seats we needed to fill are not the same seats we need to fill today. Specifically, the knowledge we needed in the past was technical but not as analytical as we need today. A business mind was nice to have but not essential to make ends meet.

Today, when a referral source sends an order with third-party insurance information, it is not necessarily a straightforward plug-and-play plan. Rather, it might be an insurance plan that is administered by a third party, it might be a Medicare or Medicaid replacement/managed care plan (HMO), the patient may have switched plans in the last month, it might be a plan for which you are out of network or another hurdle.

Insurance verification today requires a deeper probe into the type of plan, rules and payment terms that cover the patient whose order is at stake. Whereas several years ago, the insurance could be entered, an online check administered and an order fulfilled, today this same exercise may require multiple phone calls and a more analytical undertaking to determine exactly what portion of the bill, if any, insurance will pay. Therefore, a discerning and analytical thinker is required to fill the role of insurance verifier today. This is just one among a myriad of job functions that have changed during the last several years.

Pulse on Operations

Finding the right person for a position is not as simple as it once was in an HME business. Equally, if not more, important is to watch and manage a handful of numbers consistently to ensure progress is made and to avoid errors/payment denials. For example, to measure and monitor insurance verification as indicated above and to measure denials associated with choosing the wrong insurance—innumerable metrics help you stay on top of potential operational issues. The same is true for all job functions within the HME organization.

To do this you will need one, two or three metrics/KPIs (key performance indicators) for each department that you measure on a routine basis (see sidebar of metrics/KPIs). For instance, many HME companies set a goal to work denials within 48 hours. They assess performance by generating a report of all denials that management reviews with staff at the end of each week. This tells them who exceeds goal and who needs remediation. The same is true for other functions in the organization, such as a goal to confirm orders within two days of delivery. This requires paperless deliveries and seamless inventory. These are a few among a multitude of ways to measure staff performance.

By engaging staff to determine the most pressing issues and establishing a way to prevent the errors and measure against them, you will likely gain more buy-in and staff will want to meet the new performance standard. If accepting orders without sufficient documentation on hand is a common error, use staff to establish a template that requires intake personnel to answer a series of questions that check for the appropriate documentation prior to sending the order to the next department. Specifically, for a Medicare oxygen order, a required question could be, “What previous treatment was tried?” (Include a drop-down menu of possible answers.) When this required field is left blank, you will know that an error was made.

Identify and Solve Issues Promptly

Discovering issues in an honest and transparent environment is the key to improving processes and outcomes. Meet regularly with staff, after goals are established, as a forum to discuss progress (percentage of goals achieved) and how many errors are found. It allows you to nip errors in the bud and create solutions promptly, before these matters grow out of control. If denials are received and you find trends, you can more easily and promptly determine the fix and prevent recurrence by retraining staff. When improvements are made, celebrate the wins. In an open and honest environment, staff will be amenable to modify behaviors and/or processes if the approach is constructive and helpful as part of process improvement.

Document Processes

One of the most common remarks I hear from HME staff is that training is poor, and there’s no established documentation for process and protocol.

Even if you initiate a training protocol, without documentation, employees are left with inconsistent information and ways of doing things. By documenting each process, staff can refer to the written document as a reference point. Further, it can easily be updated as changes occur. Documentation should be accessible via a shared file minimally and optimally; if it could be included as part of your billing software, even better. In some cases, rules can be built in to the software and accessed during intake. This effort will require a dedicated resource to author the documentation and to maintain it. Depending upon the size of the organization, documentation is the role of the training department. In other cases, it is delegated to someone within a specific department.

Priorities for Each Employee

In addition to a job description and list of tasks to accomplish, prioritize the list of functions/responsibilities for each employee so they can easily reference what must get done on a regular basis. Objective and concrete, this type of documentation is a way to inform the staff of their most important obligations. In the billing/collections department, prioritize how denials will be worked and how many lines/claims should be worked. Some companies have a top 10-20 accounts to work during the week/month. This gives staff a gauge for how much they should expect to get done in priority order.

Trust, Communication, Accountability

The final, and in my opinion, most important point of author Gino Wickman’s statement is to elicit trust and integrity through communication and accountability. If you invest in staff, they should be engaged. If they understand what is expected of them and they agree to it, they should be motivated to perform. Open communication enables employees to feel included in the company and deserving of information that impacts them, their team and the whole business.

As Jim Huling, Chris McChesney and Sean Covey write in their book, The 4 Disciplines of Execution, “People disengage when they don’t know the score.” Alerting staff to changes in the operation with enough time to learn how they will impact their job, for example, is one way to keep people engaged.

Using your small group of core employees to disseminate change and model behavior you want others to emulate builds a group of employees who want to perform as their supervisors/leaders perform.

The better the group and individuals, the better the company. A leader is only as good as his or her team. These two statements show that leaders who credit their staff for their success are those who model leadership behavior and communication skills.

Leaders who set objective expectations with accountability measures as described above, incite trust and integrity organically throughout the business.

Loyal employees build loyal customers and the company becomes a business others want to have an opportunity to work in, do business with, or use to serve their loved ones. What better testimony than a loyal and dedicated staff that strives for excellence despite reimbursement cuts and audit frenzy. Who could ask for anything more?