The story of P&R Medical Connection/P&R Home IV Service (the P&R stands for husband-and-wife owners Phil and Robin Farris, or “professional and reliable”) is a classic. The tale involves an entrepreneur who saw a niche, filled it, and continues to evolve over the years to keep up with changing community needs. Along the way, the entrepreneur gained a loyal following of clientele and staff, and a sense of fulfillment for seeing his dream come true.

True to the fairy tale, this homegrown company is successful and still growing nearly 20 years after it began. In a market filled by large national companies and nearby hospital businesses, northwestern Ohio-based P&R has remained competitive by continually striving to offer superior products and service. “I was manager of a small hospital pharmacy at that time and I saw a need for this service,” says Phil Farris of the company’s origin.

Farris, a registered pharmacist, is still president of the company; his wife is its office manager. “No one in the area did home infusion at the time,” explains Harris. Since P&R Home IV Service was the only such company in the area back then, it did quite well. It fared so well, in fact, that the Farrises were eventually able to expand their repertoire. In 1998, they purchased a small existing HME and renamed it P&R Medical Connection. Today there are two locations: a 4,000-sq-ft retail store in Defiance and a 4,500-sq-ft retail store and 1,500-square-foot warehouse in Van Wert. The company employs roughly 45 full- and part-time employees, including RTs, pharmacists, and ancillary technical people. “Essentially, we are a broad-based provider, with home infusion a big part of what we still do,” Farris says. “Respiratory is the second largest aspect of business. We also offer wound care, professional apparel, mobility products, hospital beds, bilirubin lights—almost everything except apnea monitors and ventilators.”

In keeping with Farris’ professional roots, the company also fills prescription medications and does compounding. The staff likewise works with agencies to install home modification devices, such as grab bars or chair lifts. “We send out our own people to do the installation and training of the client on all of our equipment,” Farris says. “We do a tremendous hospice business with medications and equipment and deal with agencies from Toledo, Ohio, to Hartford City, Ind. That is a 120-mile radius.”

Marketing Strategy
Part of the challenge of serving an area that size is the need to get the word out. Marketing representative Bobbi Keller says that although a big part of the customer base comes from community referrals and nursing home health agencies, advertising is still a necessity for P&R. “We advertise on television and radio, and in the newspaper, and we think it is effective,” she says. “In particular, we really get a lot of exposure from our television marketing.”

Keller also gets a lot of exposure for the company by going out and building relationships with referral sources in the community. “We target home health agencies and hospital discharge planners, and we go to physicians’ offices, though that is not a big referral base for us,” she says.

P&R also sends out patient satisfaction surveys on a sample basis, and checks referral sources for feedback as well. Keeping tabs on the customer experience has helped P&R remain competitive in an often changing environment. “The nature of our competition has changed over time both since we have been in business and since we broadened our scope in 1998,” Farris says. “There are some national companies in this area like Apria and Lincare, but the biggest competitors are hospital-owned entities.

“Therefore, as we have grown from infusion to two retail sites, we have kept a constant eye on the level and quality of our service,” he continues. "We have a reputation as being the provider of choice from that service level. We are fighting for patients to have freedom of choice. Our motto is service, service, service. We can provide a level of service that bigger groups just cannot.”

Staffing Excellence
An element vital to that motto is good staffing. Farris says that, despite a not so highly desirable geographic location, he has had little trouble attracting excellent people. There also is a high retention rate among P&R’s employees. “We have been able to attract some good people with experience in the field, especially within the HME realm,” Farris says. “We try to provide incentives for our staff, we pay them well, and we reward them as best we can for jobs well done.

“However, if I need a pharmacist with infusion experience, my locale will not necessarily attract one from an urban or suburban location,” he adds. “I might be lucky to get someone from a hospital background, but often I start from scratch. Once we train, however, our people are competent.”

Farris says every P&R delivery technician is trained to handle problems that might arise with any piece of equipment, and drivers are required to attend an outside certification seminar. “I think we do a good job of providing in-house training and sending people to reimbursement seminars, and we are improving as time goes on,” Farris says. “More and more we are using the capability and products that the Ohio Association of Medical Equipment Services (OAMES) offers,” says Farris, who is on their board. “We use their Web-based seminars a great deal with our billing and pharmaceutical staff, especially to keep current with new products and so forth.”

Farris chooses different people from within the organization to be members of industry associations, such as the National Home Infusion Association, the Ohio Pharmacists Association, and the American Association for Respiratory Care. P&R also is accredited with the Accreditation Commission for Health Care Inc.

As a result of all that training, customers have constant access to assistance and support. Customers can call P&R’s staff 24 hours a day, 7 days a week, and a lead person from among the company’s pharmacists is on hand to handle business anytime. “For instance,” Farris says. “Our hospice clientele can call at 3 AM and have medicine delivered by 4 AM if they have a situation that demands it.”

Facing Challenges
Over the years, Farris has faced challenges to his business—including the one that most often plagues HME companies. “Obviously, reimbursement issues are a challenge,” Farris says. “We have faced some huge challenges with the recent Medicare legislation in particular. It is frustrating to get a referral and find out that you are not in their network or that you have to charge more money than a particular provider would who is 300 miles away.”

Farris is positive in his belief that the reimbursement situation will change—albeit slowly—and for now is focusing on ways to deal with his challenges without negatively impacting his customers or his staff. For instance, though the national company trend is to cut back on employees, Farris says P&R is trying hard to avoid that. “Offering the same level of service with fewer dollars is tough, especially not knowing down the road if we can continue providing service at all,” Farris says. “Competitive bidding is a huge fear. Even though we are significant in our market, if competitive bidding does come to fruition, that could be one thing that prevents us from existing as we do.”

Farris does anticipate seeing simple reductions in reimbursement, and he acknowledges that rules concerning eligibility among clientele will decrease profitability along the way. Naturally, after 20 years in business, he does worry how that will impact P&R. “As reimbursement goes down over the next few years, it will be a challenge to provide the same level of service,” he laments. “However, it remains to be seen what will happen. Our profits may suffer to some degree, but growth will replace what we lose.

“For now, we are ready to continue operating in the same vein,” Farris continues, noting that P&R is not currently looking to expand its scope of its services. “We will continue to improve on quality, however, and as public awareness grows, choice becomes a big issue with hospital-based competitors. We want to continue educating our client base so that they do have a choice. As a result, I see us remaining competitive and continuing to provide the same high level of service for years to come.”

Liz Finch is a contributing writer for Dealer/Provider.