Kim Gordon, RN, uses her nursing skills to anticipate customers’ needs.

Compassion brings many people to the health care profession. But health care is also a bottom-line business, and compassion can be challenged as well-meaning providers jump through bureaucratic hoops and through financial hurdles. It takes uncommon persistence to keep up the good fight—to focus first on the people in need, to administer to the balance sheet later. Is such a lofty goal even feasible in today’s regulated, profit-driven climate?

At Providence Medical Equipment, a DME branch founded in 1986 by what is now one of the largest health care agencies in Central Texas, the answer is an emphatic—and empathetic—yes.

For Providence it begins with a mission statement created in 1904, when the Providence Health Center was founded with the help of the Daughters of Charity, a religious order with a long history of sponsoring social services. Providence has since expanded into a diversified health care network, including a full-service medical center, nine clinics, and the home care division under which Providence Medical Equipment operates. But through all the years and growth, the mission has remained the same.

“Our mission is to serve each individual as we would serve Christ Himself,” says Kim Gordon, RN, service coordinator for Providence Medical Equipment. “You hear it from the moment you are interviewed and hired throughout your employment here,” she says. “We always talk about how we are here to meet the needs of the individual, to serve the underserved, and to become the voice of the voiceless. That permeates the entire institution. We have a very clear understanding of what our mission is.”

Unfortunately, the best intentions often falter without the tools to make them reality. At Providence, the core spiritual values are reinforced with continuous hands-on education and training. Providence also works closely with the community it serves to find solutions and resources where other providers might stop short. Most important, Providence Medical Equipment has a staff of 19 dedicated, knowledgeable individuals who overcome those hoops and hurdles, day in, day out, to serve their customers.

Teach Them Well
Employment at Providence begins with a 6-hour orientation class called Mission Possible. “Everyone who works here comes in with a compassionate heart—I don’t think you would be in medical care unless you had that,” Gordon says. “But I think we take that raw ingredient and really mold it. We discuss meeting the mission and how we can best serve clients every week, every day.

“When I was first here, I thought, ‘How can this business afford to do that?’ But the director said, ‘If the client has the need, and we have assessed that need, then the money becomes an item to be considered down the line. The client’s need comes first.’”

Pam Dulock (left) stresses teamwork when serving 60 to 100 customers daily.

After orientation, the learning process continues with weekly staff meetings, guest speakers, and outside educational programs. Whatever is learned is taught again. If staff members attend seminars at a trade show, they return as teachers to share the information with their co-workers. If an employee excels in a particular area of operation—financial reimbursement paperwork, for example—he or she is asked to bring others up to speed.

“We have people who specialize, but we do a lot of cross-training and many people are able to do more than just their assigned positions,” Gordon says. “They understand the beginning to the end of how the business works. We spend a lot of time in orientation and meetings to ensure our employees know the questions to ask clients so that we can get the information needed to provide comprehensive care as opposed to just products.”

Patients, Products
A significant portion of Providence’s clients can not easily afford the medications and HME that have been prescribed. Many fear they will have to choose between paying their health care bills or their electricity bill, Gordon says. As part of the Providence mission, customers are treated first and foremost as patients in need of care, no matter how confused or destitute they may be. And that means far more than handing them a sales receipt at the end of a transaction.

The Providence DME has two RNs (Gordon and director Judy Hendry) who can recognize—even anticipate—a customer’s medical needs far beyond equipment, things that might go unnoticed at many other HMEs where RNs are unavailable. If other needs are identified, Providence helps guide the patient through the proper community channels, be it a clinic or a social service worker. “Because of our medical training, we are able to pick up on some problems when people walk in the door, and help them with appropriate products,” Gordon says.

Outside the facility, Providence’s drivers become the RNs’ eyes and ears. On every delivery, they show how the equipment works and ask the customer for a return demonstration. “We make sure they are comfortable with the equipment and it is appropriate,” Gordon says. “If our driver technicians have any indication that the client is not in a safe environment, or has some educational needs or medical or monetary needs, such as not being able to afford medication, we go back to see what other areas of care they need. Most [providers] are probably making certain that the client is safe and understands the use of the equipment, but I think we have a distinct [niche] in making sure that people are plugged into other community resources.”

Providence Medical Equipment retail supervisor Pam Dulock and three co-workers serve 60 to 100 walk-in customers a day in the 5,000-sq-ft retail area. “We all work as a team,” Dulock says. “We look at the patient as an individual when they walk through the door. We try to help them as much as we can with the resources we have.”

That is no small feat when one considers what any given day might bring to a HME. In the case of wound care—not exactly a profit niche—it can take an hour to set up a single patient. “We do not make a lot of money on wound care, and we have to go through so much to get it covered by Medicare, from home care assessment to documentation,” Dulock says.

Because of reimbursement hassles, Dulock believes that many HMEs have turned their backs on retail services and lines. For example, she says that only two of seven Waco-area HMEs carry colostomy supplies. “To me, they are getting away from the patients,” Dulock says.

Providence still carries colostomy supplies and other products that they lose money on. “We do a lot of things that Medicare does not even cover our costs, and other stuff that Medicare does not pay for well,” Dulock says. “I guess in the long run, patients come back to us for the other [products] that we can make money on because we cared so much from the beginning. It is a chain reaction: You help one person and they tell two people.”

There is no secret to staying in business while providing product at a loss, Gordon says. “We are expected to be inventive and creative in meeting people’s needs. We certainly look to see what we can do to keep costs down. We have a budget, and we are expected to operate within it. A portion of our budget is allotted for meeting charity or indigent care. As for other HMEs, I know there is a focus on bottom-line profits. That, of course, is a concern of ours—you couldn’t stay in business if it was not. But it is certainly not our No. 1 objective.”

Profits and rewards are two very different things, of course. “We get personal with our patients and they become part of our family,” Dulock says. “If we don’t see them in a month, we call up to see if everything’s OK. Sometimes they just stop by to say hello.

“You see all these companies struggling to make it in the HME industry—they keep looking at the bottom line and I think they need to look further. You do get compensated.”

As industry consultants encourage DME providers to concentrate on more lucrative lines and “safer” privately insured clients, Providence sticks to its mission. The consultants might be right about many things, but Providence isn’t wrong.

Aaron Smith is a contributing writer for Dealer/Provider.