HQAA Blog

Steve DeGenaro

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A DME Christmas Tale

Posted by Steve DeGenaro on Thu, Dec 06, 2018 @ 03:58 PM

The holiday season is a time for merriment, good food and drink, decorating home and workplace, holiday parties, gift-giving, and cheer. It’s also a time for giving. When I visit home medical equipment companies in November and December--whether for consulting purposes or accreditation surveys—I sometimes ask about the holidays and what an organization does to celebrate the holiday season. The replies offer insight into the corporate culture and speak to the character of the companies.

I notice with great interest and growing optimism about the future of our industry that the trend seems to be increasingly about giving, sharing, and community service and moving away from the stereotypical office party of days past (think Mad Men).

I’ve heard a wide variety of customs and practices including gift exchanges, taking turns working at Salvation Army kettle drive locations, pot lucks that include inviting the patient/customers, volunteering at a soup kitchen, or simply getting together outside of work for a nice dinner together. These parties and other shared experiences serve several useful purposes. They promote a culture of togetherness and “family”—a sense that the organization you work for is more than a job, it’s a group of people working together for a common goal. They also give team members an opportunity to get to know their co-workers better by sharing a meal or a conversation at a deeper level than possible during work hours. The holiday service projects give employees a chance to work on shared projects which promotes team building. Hopefully, they are also a fun way to spend time together with co-workers to build deeper and friendlier relationships.

One of my consulting customers specializes in mobility: basic wheelchairs all the way up to custom rehabilitation equipment. They also do home modifications such as chair glide systems and building accessible ramps. They are a quality company that was accredited long before it was a requirement because they wanted the community to know their commitment to doing things right. They told me a story about their Christmas “project” last year. The Christmas project was something they elected to do in lieu of a party. The company gave them time off to do it and supported the project financially. Every employee from top to bottom, including the owners, had skin in the game and participated.

It seems that a family in their small town needed medical equipment. The driver delivered the equipment and supplies and identified several hazards around the house as he assessed their environment. He documented his findings and discussed them with the family, who said they could not afford to make many of the changes that were suggested. On a return visit, he noted that they had made some of the changes that were not particularly costly including removing area rugs and moving furniture around so that the family members with mobility problems could navigate the household.

Three generations were living in the house: a couple along with several children, and also a grandchild. The couple both had serious medical problems that made mobility challenging. They needed a ramp to get in and out of the house, and would also benefit from scooters. The husband had COPD and heart problems, which limited his ability to get out and walk; and his wife was a diabetic and an amputee, who got around in the house okay, but could not go out without a wheelchair (or scooter).

The driver mentioned the family again at an organization-wide meeting and discussion ensued. Eventually, the company decided to help the family by building an accessible ramp on their front porch/entrance to the house. They discussed plans with their home modification department and of course, the family. They got consent from the family and an estimate of material costs. The owner donated the material with the stipulation that staff would pitch in and “donate” their labor. The team effort kicked in and the ramp was built in a few days in October 2017.

In the course of working at their house, the owner was talking to the family about accessibility and decided to also make a few minor modifications in their bathroom for enhanced safety. These included grab bars in several places. The owner recounted how “making these small, seemingly insignificant improvements was easy for us—it’s what we do”. He also noted that these improvements were no big deal for his staff, but meant the world to the family.

When the project was finished, the team was so inspired by the good feeling they got and the appreciation the family exhibited that they decided to work together to get the couple scooters. The warehouse manager reminded the team that they had a “trade in” scooter in the obsolete area that could be fixed up easily. The owner bought parts, authorized repair/refurbishing, and considered getting another scooter for the couple. When he called his vendor/sales rep to ask for pricing and explained what they were wanting to do, the rep actually donated a scooter from his demo inventory!

The day before Thanksgiving, 2017, DME staff stopped back at the home to deliver two shiny scooters to a family in need. Along with the scooters, they brought a 20 lb. turkey and several pumpkin pies from a local bakery.

In the DME storefront, hanging on a wall above their license, a copy of the Supplier Standards, and a picture of the store on the day it opened hangs a Christmas card with a beautiful note from the family and a picture of the couple with their children and grandchild visiting a huge outdoor Christmas light display. The card reads, “Made possible by the generosity of a company made up of some of the most caring people we are blessed to have in our lives.

Incorporate and emphasize giving in your holiday traditions, and you’ll be richly rewarded with a great feeling of satisfaction that is better than any gift exchange or party. And keep your eye on the ball: despite the tough reimbursement climate and the many challenges that face our industry today, most of us got into this line of business and work because it was a caring profession. Keep caring no matter what!

HAPPY HOLIDAYS everybody.

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Topics: Business Practices, Customer Service, Quality Care

DME Policy Manuals

Posted by Steve DeGenaro on Thu, Nov 08, 2018 @ 10:28 AM

Many in the home medical equipment industry equate policy manuals to their accreditation inspections. And of course, these bulky tomes are certainly a large part of the accreditation and survey experience for every DME. Policy manuals serve as the road map for how work gets done within an organization, a set of rules for the organization, and the document that defines the structure, function, and philosophy of the organization. Let’s look at what a policy manual should contain and how it impacts not only accreditation, but also the overall day-to-day operation of an organization.

A well-crafted policy manual should contain not only policies, but also procedures. Think of a “policy” as a guiding principle, used to steer an organization in some direction. A policy should also define or describe a course of action that is to be taken. “Procedure” is the steps to be followed to accomplish whatever the policy described. The steps are spelled out so that the organization’s staff can accomplish a task in a consistent manner. The policy is the what and the procedure is the how to.

Policies and procedures may be contained within the same document or within two separate documents. They can be hard copy, old-school paper in a binder or electronic files stored on your organization’s hard drive. The key to the success of your policy manual is that it is accessible by all staff and well understood and followed. Since the manual is considered a set of rules, the staff must be aware of the rules and where the rule book is stored, so they can use the manual on an on-going basis to refer back to when questions arise.

DME policy manuals are sometimes written by the staff and management of an organization. Other times, home medical equipment organizations will purchase a template, which uses boilerplate policies and procedures. Both can be used effectively. If you write your own, include the staff that actually has to live with the policy and utilize the procedure as you craft the document. If you use a template, be sure to customize and personalize the policies and procedures so that it accurately defines the principle and the steps to be followed in the procedures. Change the template’s verbiage to match your actual practices, not the other way around.

Written policies and procedures that are required by law and regulation, payer requirements, or accreditation standards include:

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Topics: Business Practices, HME Accreditation Requirements, Quality Standards, Compliance, HQAA Accreditation, Patient File Requirements, Employee Training, Renewing Accreditation, Patient Privacy, Materials Management, Personnel Files, Avoiding Deficiencies, Quality Improvement, Complaint Process, CMS, Billing, Clinical Practice Guidelines, Emergencies, Disaster Preparedness, Customer Service, Marketing, Safety Officer, Competence, Warehouse, Oxygen, Delivery, Clinical Respiratory Services, Showroom, Retail, Quality Care, Security, HIPAA

Hepatitis B and DME Personnel

Posted by Steve DeGenaro on Mon, Oct 08, 2018 @ 09:27 AM

New employees who apply and secure jobs with durable medical equipment companies are often surprised to find out that they are being offered vaccinations to protect them against Hepatitis B.  In fact, some new employees find it unsettling to learn that their new job offers this “benefit” because of increased exposure risk to this dreaded but somewhat misunderstood disease.  Let’s dispel some myths and lay out the basic facts about the disease, its prevention, and why healthcare workers are being offered this vaccination.  

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Topics: Business Practices, Delivery, Clinical Practice Guidelines, Personnel Files, Employee Training

Are You ‘Any Willing Provider’?

Posted by Steve DeGenaro on Thu, Sep 13, 2018 @ 11:08 AM

In July 2018, CMS made a rather important announcement: that effective January 1, 2019, after the current bid schedule expires December 31st, 2018, any Medicare provider can supply durable medical equipment and supplies to Medicare patients/recipients.  This will likely continue until the next round of bidding takes place, which will be at least a calendar year later.  This rule revision, known in the industry as the “Any Willing Provider” provision, is something the industry has talked about since competitive bidding began. “Wouldn’t it be fair,” one provider I spoke with posited, “if they {CMS} settled on a bid amount and opened it up to any credentialed, accredited, licensed DME to provide equipment and services?”

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Topics: Marketing, Retail, CMS

Re-inventing Your DME

Posted by Steve DeGenaro on Fri, Aug 10, 2018 @ 10:33 AM

People have thrown around the words “re-invent,” “re-imagine,” and “re-purpose” in regards to their career, their life’s goals, their outlook, and their businesses quite a bit in the last decade.  It is considered chic to reinvent ourselves—in both our personal lives and our careers and businesses.  And it’s becoming more and more useful and important to do that in our DME businesses today.  Reimbursement changes (and by “changes”, we almost always mean “cuts”), as well as technological advances, coupled with the changing styles of consumerism, how people shop, and the fact that customers are willing to pay for an increasing amount of their healthcare all make the environment ripe and ready for change!  

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Topics: Marketing, Customer Service, Business Practices

Death, Dying & DME

Posted by Steve DeGenaro on Wed, Jul 11, 2018 @ 12:11 PM

A cousin of mine just passed away a few months ago after a long illness.  He was fortunate to be able to spend his last few weeks at home with the family and friends he loved around him, either looking out the window at his beautiful backyard or some days, on the back porch.  “Fortunate” is a relative word: he was in his early 50’s and should have lived a lot longer.  On the other hand, after weeks in hospitals and long term acute care (LTAC) facilities, he (and his family) were grateful that he was able to spend his last days at home.  During those last weeks, he tapped into the durable medical equipment industry more than most people do in a lifetime.  

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Topics: Customer Service, Oxygen, Delivery, Quality Care

Ongoing Staff Education in Your HME Organization

Posted by Steve DeGenaro on Tue, Jun 05, 2018 @ 03:12 PM

Education is the passport to the future, for tomorrow belongs to those who prepare for it today” ……………Malcolm X

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Topics: Employee Training, HME Accreditation Requirements

Isn’t All Ventilator Care ‘Clinical'?

Posted by Steve DeGenaro on Fri, May 11, 2018 @ 03:53 PM

HQAA fields quite a few questions about ventilator care and whether or not the care is “clinical” in nature or non-clinical.  It may be helpful to clarify some points about ventilator care and review the definition of clinical respiratory services. 

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Topics: Ventilator Unit, Quality Care, Clinical Practice Guidelines, AARC

Emergency and Disaster Preparedness

Posted by Steve DeGenaro on Wed, Apr 04, 2018 @ 10:15 AM

The last year has given us several natural disasters.  We’ve seen “Nor’easters”, major fires, hurricanes, floods, and mudslides, which left major highways destroyed and communities completely isolated.  It’s been a rough year! 

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Topics: Disaster Preparedness, Emergencies

A Brief History of Home Oxygen Therapy

Posted by Steve DeGenaro on Tue, Mar 06, 2018 @ 09:27 AM

Mathematician and author Vernor Vinge popularized (and named) the notion that technological change grows exponentially.  He called the phenomenon “exponentially accelerating change” and wrote both scientific articles and popular culture fiction about the concept.  We have all heard statistics thrown around; such as the fact that your child’s IPOD has more capability than the computer on the Apollo mission that landed on the moon in 1969.  Or that we’ve developed more technology in the last 25 years than in the previous 10,000 years.  

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Topics: Oxygen, Delivery