All of the oxygen goes through grueling regular season contests and after the playoffs...the championship. shortly thereafter the team is selected. THE OXYGEN ALL STAR TEAM!!!!!!!!!!! Did the FDA have to set up trials and approve O2?
After working as a hospital pharmacy manager for 10 years and founding two home infusion companies, Mike Kuller, RPh, became regional vice president of Apria Healthcare before founding Allstar Oxygen Services in Concord, Calif., in late 1999. In 2004, we were ranked the fourth fastest-growing private business in the San Francisco Bay area by the San Francisco Business Times. By 2008, Allstar Oxygen Services had weathered numerous Medicare reimbursement cuts and shifting risk between medical groups and managed care payers, and had grown to $2.5 million in annual revenue. About half of our business was home oxygen, a little less than half was CPAP and the rest was DME. But by mid-year 2008, we recognized that the Medicare reimbursement cuts coming in January 2009 — including oxygen patients who would cap after 36 months and the 9.5 percent across-the-board cuts — could be devastating and put us out of business if we didn't do something. So we began an analysis to develop a strategic plan. I gathered the company managers together in July, and we had a brainstorming session. Fifty-eight percent of our reimbursement was Medicare, so we were looking at a pretty significant exposure. Of our 600 oxygen patients, roughly 24 percent of them would cap in January. We were looking at a top-line revenue loss of 14 percent at the first of the year, so we needed either to grow our top line or cut out $25,000 to $30,000 in monthly expenses, or a combination of both. At that point, we had 17 employees, a 40-day DSO and a 6 percent net profit. We came up with a number of ideas to help grow our top-line revenue: We would push overnight pulse oximetries to drive more oxygen patients. Our two sales reps agreed to call their hospital discharge planners on Saturdays to see if there were any patients we could help take home. Our customer service reps would begin a “would you like fries with that order” campaign to remind our referral sources we also provided DME. When our delivery techs were in the hospitals delivering equipment for patients going home, they would seek out the discharge planners to ask if there were any other patients we could help them with. And finally, we would pursue three managed care contracts we had not been successful in obtaining. Looking at the expense side and where we could cut was much more challenging. We decided not to replace a delivery tech who had left and instead have the logistics manager become our third driver. In order to operate with fewer drivers, we needed to invest more heavily in nondelivery oxygen technology like transfill and portable concentrators. We also decided to eliminate a part-time respiratory therapist position and schedule as many of our CPAP mask fittings in our office as possible to create more efficiency. We froze everybody's salaries. At the first of the year we would switch to a less expensive health care benefit plan with a higher deductible, and increase the employee percentage from 20 percent to 30 percent. Since the new plan was cheaper, the employee's cost didn't change much, but the company's portion went down.
The employees in our company are like a small family, and it was extremely difficult and emotionally wrenching when we announced the decision. We talked to the individuals privately and then told the rest of the staff. This was one of the hardest things I've had to do in owning a small business, and there were tears flowing all around, including mine. We gave the two employees 30 days of severance pay and worked to help them find jobs before the holidays began last year. Then, because of having fewer employees, we had to cap everybody's vacations at two weeks and pay them out the additional, since we had little overlap for coverage. The economic meltdown started in November 2008, so after the New Year began, people settled in to our new philosophy of doing more with less. Surprisingly, morale remained quite high. Fortunately, we had invested in a paperless scanning system, and this created a lot of efficiency for us. We had also agreed to become a preceptor for a local career college, taking in unpaid medical assistant externs for six weeks at a time. With our workflow reorganization, our billing and collection department began to bill Medicare daily rather than three times a week. At the end of the second quarter in 2009, we analyzed our results. We had been successful at signing one additional managed care contract. We now had only 13 employees, a 23 percent reduction.
