Patty Mastandrea, CEO from MedCare Equipment Company, and Casey Toomajian, CEO from Hometown Healthcare, joined us on the CoffeeTalk: Adapting to business change to share their insights and experiences during this pandemic.
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Transcript of the discussion
Q: Tell me about MedCare Equipment Company, your employees, products and markets you serve.
Patty: MedCare Equipment Company is a full service, durable medical equipment company located in Western Pennsylvania. What makes MedCare unique is we are a hospital-based DME, owning eight different health systems here in Western Pennsylvania. We have seven distribution centers, five retail stores, over 330 employees. We did a joint venture with another health system in the eastern part of Pennsylvania three years ago to see the diversity between the state. It has been very challenging to see how the pandemic has affected the western part of the state versus the eastern, which we’ll speak upon here in a few minutes.
Another thing that makes MedCare very diverse is we also have a long-term care distribution business where we try to participate with the physician offices on their office supplies. We do long-term care distribution to the skilled facilities, long-term care facilities, personal care homes, etc. We sell directly to the patient and then we also provide the durable med. We do everything but complex rehab. Our specialty is the respiratory programs. We do everything from nebulizers to oxygen tanks to ventilators, so we’re pretty complex. We take a lot of pride in managing the continuum of care and disease management with our owner hospitals and our referral sources.
I’ve been with Medicare over 20 years. So I’m proud to say this was an experience, but I’ve learned a lot from it and it will make us stronger. I think it’s going to help the whole DME industry with what the payers have done and in respect to the products and services we provide.
Q: Tell us a little about your organization.
Casey: I’m the CEO over Hometown Healthcare. We’re a 35-employee organization that focuses on respiratory home medical equipment. Recently we added respiratory care management. We have a saying internally at Hometown Healthcare that we want to make sure patients are really working their therapy and on the backend that their therapy is working. So, we are following up with them and using remote patient monitoring to make sure their adherence is there and that the outcomes that are in the physician’s plan of care are being met and managed, too.
We’re based up in Clifton Park, New York, which is two and a half hours, maybe three hours north of New York City, near the Albany area. We have two locations: our main headquarters where the home medical equipment organization is. Then about 20 minutes south, we have a local retail pharmacy. We’re locally family owned and operated.
Q: We ‘re three plus months into this pandemic: what have been your biggest surprises due to COVID-19?
Casey: I think the biggest surprise, hands down, for us is how we have not had very much of an impact at all. We have not supported one COVID patient in our patient base, and that probably surprises a lot of people because they think of New York and all the attention New York City got with the capacity issues they were dealing with and how hard hit they’ve been. But in our area, the censuses of the hospitals remained really low. Most folks were not going to the hospital unless they were really sick or had COVID. I think that allowed those hospitals to keep those patients admitted until they were fully better. So, our situation was not that we had to support COVID discharges, like I thought it was going to be. It was that we were being asked by the hospitals to provide them with medical equipment, and we did that so they could support their inpatient folks. So just really a tale of two cities in terms of what the New York City area has dealt with and what the capital region of New York has dealt with. Surprise two has to do with an internal assessment of our team and their ability to be adaptive to this crazy situation of being pushed off site, you know, 70% of our HME workforce being moved off site and being able to handle that really, really well with amazing attitudes. Those are two surprises, two really interesting things that happened from this.
Q: What are some of the challenges that this still presents for you?
Patty: Being hospital based, and with over 50 hospitals that fall under our ownership from the health system, on March 15, it was how are we going to react? COVID was new to everyone. No one knew what to do nor was everyone really prepared. So the one first challenge was making sure that we had enough PPE for our staff to protect them. Then we had to develop a plan on how we’re going to do that. But the hospitals that have ownership into MedCare were like, are you going to still have your liaison in the hospital? How are we going to get our supplies, which means oxygen to the room to expedite discharge. So how are you, MedCare, going to help us manage our patient care and all the goals we have when it was so fresh.
We started suddenly realizing that we had a lot of relationships that we could really partner with and say, what do you need and how can we all work together? So the relationship of can you provide nebulizers on consignment versus having your staff bring them in? Can you do doc delivery? Can you help educate our team? We started all working together more as a team than we ever had because one of the barriers we have as a DME is always the documentation you need is so difficult. We just want these patients out the door. Philosophies are totally changing. How we can work better to protect the employees and better patient outcomes? Census in our area dropped dramatically. We’ve seen a reduction in patients coming into the ERs, which we do a lot of mobility items out of there, so that all dropped. Visitors stop coming to the hospital because of one-visitor or no-visitor guidelines.
But the biggest thing is how do we treat these patients that are going to a hospital or a site that could be potential COVID, and how do we get the equipment they need home to protect them? We wanted non-COVID patients in and out quickly. For COVID patients, we did admit them but then we needed to get them home. We had 16 patients under service that were positive COVID from the time the pandemic started. So, from March 15th to last week, we had 16 but only one in the last two weeks. What impressed me the most was when we did, we reallocated a lot of our staff to home. A lot of the billing went home to work, and a lot of the customer service was worked remotely.
Our drivers, who a lot of times don’t get recognized for everything they really do, stepped up and said, “we are not afraid. Provide us the protective wear, and we’re going to take care of our patients.” The unity that came out of this between all the different referral sources and the patients has been unbelievable. With virtual setups, patients feel they’re getting more out of it. They welcome that because they don’t want to go out, and we’re getting more and more letters written from patients now complimenting us on our service than we ever did.
One thing I want to mention is I have had many conversations including with one of our biggest payers here in Western Pennsylvania and the medical directors. And I will tell you, I do believe they recognize it. I absolutely do. They have called to say: how can we change the documentation requirements to service the beneficiaries? Because through this whole thing, they didn’t want any delay in care. So, when you look at the payer’s guidelines, just to provide wound care and how home health has to be involved to make sure that they’re seeing progress in the care that they’re providing to continue to provide wound care and measurements that need to be done. The whole change to telehealth has been very positive.
Getting documentation can be challenging. They’re totally aware of that. They realize we are only a small piece of what is needed. Without that documentation that’s required from someone else, they pretty much said you’re really limited. That’s a very positive for us that we’ve developed that stronger relationship with payers because now they’re coming and saying, “how can you prevent any interruption? How can you get this patient equipment timely?” When you talk about nebulizers, we’re providing just the piece of equipment to be the transmission to get them the therapy they need. They still need the meds. So, I do think this particular payer, if this is a sign that they’re all going to recognize it, it’s going to be really good for DME.
Q: How are you leveraging new technology approaches to take care of patients and your employees also?
Casey: Fortunately, in November, just coincidentally, we had switched to a Google platform. We had gone from a server-based platform for email, communication and calendar management to this Google platform. Google has provided us with some incredible digital tools that we weren’t planning on rolling out. When COVID hit and we had to push staff offsite, having access to those allowed us to stay connected with our staff, whether it was having a Google meeting, the chat features that Google provides or an impromptu Google meeting that wasn’t necessarily scheduled but being able to emulate what would have been just kind of showing up at somebody’s office for a quick conversation. Google provided a lot of tools and getting people to use those tools was adopted well. And, I think had COVID not happened, it would have been a much longer learning curve or adoption curve for that. So that’s one piece.
We did not have though, a VoIP system, so one of the technology pieces we had to install was an Internet phone system. So, we picked folks who were working from home and had the same functionality that they would have if they were on site. That was clunky for a while, but last week, I’m happy to report that we got that done. That’s been some basic communication things. On the patient-facing side, we’re still seeing folks in our building, but the building is locked down. So, the very first technology piece we’ve leveraged is one of those video doorbells so we so we can see the patients, talk to the patients and go through some screening with them before they come in. That’s a hardware technology that we’re using with some software on the computer.
The other piece is trying to solve the problem of how do we minimize patient contact in a world where contact has been such a part of how this has run, how this has worked so well. It’s hard to do a really good mask fitting if you can’t touch somebody, but we also have to minimize the spread of infection. So, we decided to implement a virtual PAP process where we are giving folks the option to have the C-PAP or bi-level shipped to them. Then we’re using a Google meet feature to do the actual teaching and patient education. On top of that, we’ve always had this in place, but we’re leveraging remote monitoring technology to make sure that the care is being managed so that they’re actually adhering to the therapy and that the therapy is actually working the way it’s supposed to. We’re leveraging ResMed’s AirView and the U-sleep platforms, which integrates really, really well with Brightree. So, continuing to use those tools to drive outcomes has been a big thing.
The one thing we’re looking forward to rolling out with the virtual PAP and the remote deliveries is the electronic paperwork that includes documentation with signatures and dates. That’s not rolled out yet, but we’ve been actually working with Brightree to talk about what our wish list would be. Some technology actually lives already within the MyForms platform. We’re looking forward to seeing how it gets built out so we can leverage that. So those are just a little bit of the things that we’re doing to leverage technology at Hometown.
Q: What have you leveraged with regards to patient care and working with your referrals?
Patty: MedCare has not opened. We closed all our retail sites and closed all our administrative offices to the outside world. Our therapists literally stopped doing home setups. We stopped doing preventative maintenance. We stopped doing portable oxygen concentrator evaluations and PMs on vents. On May 18th, we did open our three retail sites for patients to come in, one patient at a time. They have to call when they arrive to get their portable oxygen concentrator evaluation. We did start sending therapists to homes, but only for vent follow-up visits and PMs. We anticipate in August we’ll start doing PMs on concentrators again.
But where we did leverage technology is that we had all the technology in place for the phones and for people to go home and work. It was monitoring their activity because working from home isn’t for everyone. So we had to make sure that we had tools in place for taking the number of calls, ensuring the he calls were being converted into orders, and that they were keeping up with all their tasks. So that was very challenging for some of the managers to manage their staff that were working remotely, especially for the staff that did not have the time management skills to be able to multitask. But we worked through all that. We provided them tools and resources and let them know that we were here remotely. We did a lot with Teams, and we did a lot of virtual education when we had downtime. We really enhanced the process and policies and made sure all the employees knew that.
Q: As you think about your business and how you’re taking care of patients, your referral sources and your employees, talk to me a little about the largest challenger you’re still facing.
Casey: The biggest challenge for us, without question, is the sourcing of product, specifically oxygen concentrators and vents. Probably the largest concern of the two right now for us is concentrators because we had recently deployed a new vent program or the vent line itself, so we didn’t have a ton of patients yet. For the oxygen concentrators, we have almost 800 active patients, and, fortunately, we’ve had really great support from a local hospital-owned DME that’s allowed us to use some and another HME that we bought some from. We’re still being told it’s August or 14 weeks out before the manufacturer can get us product. It’s a little too tight for comfort scenario for us.
Q: What’s the new normal going to look like for MedCare?
Patty: In our new normal, we will not go back to having clinics. We feel it would be very irresponsible for us to put our employees at risk and the patient at risk by trying on different masks. We have no white paper that says there’s any good way to decontaminate that item. So, we’ll continue to provide tools and resources to our staff and also to the patients by using AirView, U-Sleep, to ensure they’re getting compliant. We’re going to engage the payers on a flow chart of when we engage the physician and the sleep lab on what ownership we feel they should have in it, especially with fitting of the mask. And we’re going to provide the patients tools that remotely they can measure across the bridge of the nose and down to the chin to ensure that we’re providing the right product out of the gate for a, fit and b, comfort, so we enhance their compliance to make sure that we’re providing the therapy the patients want out of the gate the first time.
Regarding in-home delivery, we hope to continue to do porch delivery versus in-house delivery and enhance our education available through virtual. We found patients are more comfortable with us delivering to the porch versus coming in. It’s a scary environment for patients to let strangers into their home. They don’t know what they’re expecting when they go home with new equipment, so we found that to be very beneficial. We don’t know the future of our retail. That’s something that we’re trying to figure out. Do we see patients coming back? How do we handle retail? Would we be better just to make it a focus on what we do best in the clinical areas? So those are some of the points we’re still talking about, but we’re working with our referral sources on how we can be part of the continuum of care and communicate electronically to let them know the success we’ve had with virtual setups, with the education we’re providing on compliance, and with getting them the best mask fit in a safe environment.