One of a kind: The HME sales rep

Home medical equipment is an apple in a sales world full of oranges. It just doesn't match up with its counterparts in retail, real estate, finance or industrial sales, where a vendor sells to one customer. Those working in HME sales may wish it were that easy, but then it wouldn't bring the enormous level of fulfillment that comes from completing a successful transaction in what is arguably the most challenging environment in the sales field. In Eric Kline's view, its rewards go well beyond financial compensation. “HME is the best job in sales — I compare it to being a well-paid volunteer,” said Kline, CEO of Elint Technologies in Pensacola, Fla., and sales seminar leader at Medtrade 2004. “You spend your day calling on physicians, nurses and case managers for two reasons, either to help someone get better or to make someone more comfortable when they come home from the hospital. And that's not a bad way to make a living.” But as rewarding as the job can be, it just got tougher, as well as more important than ever to a company's success. As Medicare scales back reimbursement on key items of DME, and with Medicaid and private insurers likely to follow suit, if they haven't already, company bottom lines will shrink proportionately. For the independent HME provider determined to grow his marketshare and profits in this environment, an effective sales force is key. “Times are confusing for reps right now, so now more than ever HME owners need to communicate with their reps and invest in their efforts,” Kline said. “It is essential to keep them focused and motivated as they go through their day. Ultimately, it will be their confidence in their skills that will help them persevere in an uncertain future.” combating the cut5 To be sure, the pressures of Medicare respiratory reimbursement cuts are forcing companies like Binson's Home Healthcare to boost their sales forces in order to seek a higher patient referral volume. Director of Respiratory Brian Chambers said he recently hired two new reps — one came from inside the company, the other was lured away from a competitor. “We're getting spanked on oxygen and we have to maintain the cash flow we're used to getting,” he said. “The only way to do that is to expand our referral source base and market share. That has become our highest priority.” Gaining new referral sources from cold calls has become increasingly difficult in recent times, however. Physicians — especially family practitioners — have become the most treasured demographic in healthcare and their waiting rooms are now filled with salespeople of all types. Just getting past the gatekeeper is a minor miracle. But talented sales reps know how to get in the door, establish relationships with these physicians and nurture them over time. “It has become very difficult for reps to even manage their ‘A List' doctors, let alone find new ones,” Chambers said. “But the real professionals are the ones who keep close track of their doctors' lives, knowing their spouses and children's names and remembering all their birthdays and anniversaries.” Charley Ruckstuhl, sales rep for Largo, Fla.-based Custom Mobility uses a construction analogy to explain the HME rep's distinctive place in the supply chain. “HME sales reps are the connecting link to the end users, referral sources, family caregivers and funding sources,” he said. “We are the roof that covers the four walls.” Company linchpin Not only do reps serve multiple masters, the specific roles of these customers convolute the sales process to the extent that the referral source selects a product or service for the end-user and a third party pays for it. This makes the sales rep the linchpin of an often fragile alliance, and keeping it together requires velvet finesse and steadfast coordination skills. If that weren't enough, HME is broken out into several disciplines, such as respiratory, rehab and infusion, which all require extensive clinical expertise, and many reps are fluent in all of them. This may explain why so many HME salespeople have clinical designations like RT, RN or CRTS after their names, and why those credentials usually help them gain credibility with the physicians, nurses and therapists responsible for making referrals. Those with certification especially seem to connect well with referral sources, because they are seen as peers rather than peddlers. In fact, the complexities of this market often serve as a deterrent to sales professionals from other, less strenuous environments. It's rare for an HME company to recruit from outside the healthcare domain, Kline said. “Healthcare is personal, not a commodity,” said April Mason, general manager of Raymond, N.H.-based Apria's LifePlus division. “You can't sell it like you sell a copier. There has to be an element of trust. Things don't always go right in this business and when they don't, you have to fall back on that relationship.” Compassion Another characteristic the top reps share is compassion — for referral sources, patients and their families. Pam Kaehler, executive director for Mon HealthCare Equipment & Supply in Morgantown, West. Va., says that empathy is the key to sales rep David Brozik's success. “When Dave is dealing with end-users, family members and referral sources, he is so genuinely interested in whatever they have to say,” she said. “He just focuses intently on their needs and is relentless in making sure that we on the inside stay connected to that. He never lets us forget what it's like from the customer's point of view, whether it be how busy a discharge planner is, how overburdened with paperwork a physician is or how anxious a patient is at home waiting for equipment to arrive. If we let them down, we let Dave down.” A fiscally stringent healthcare climate has made competition even fiercer than usual, putting more pressure on HME providers to deliver exactly what referral sources want when they want it, added Tom Gaffney, senior vice president of sales and marketing for Conshohocken, Pa.-based Air Products Healthcare. “Money is tight in the medical industry and as a result it has changed the customer's expectations — they have raised the bar and are less tolerant of HME providers than in the past,” he said. “The issue is service, not price. Our customers don't want a simple distributor, they want a clinical manager for their patients.” Conversely, sales reps shouldn't waste time managing accounts that don't yield much business. “Have a heart-to-heart talk with those doctors and nurses who haven't been sending in referrals,” Kline said. “Tell them in a nice way that as much as you like spending time with them, you are in business and need to start seeing some referrals. That's either going to get you more referrals or will free up your time to explore new opportunities.”