Webinar Recording: Insights from Qualis' Free Evaluation Process

Hospices face a unique set of challenges when it comes to managing DME (Durable Medical Equipment). Between rising costs, vendor reliability, and ensuring high-quality patient care, finding the right approach can feel overwhelming. That’s why our recent webinar tackled these critical issues head-on—offering a deep dive into cost control strategies, clinical best practices, and the value of a free DME evaluation.

During the discussion, Al Lewis, Director of Business Analytics at Qualis, and Hall Thorp, Co-Founder & Chief Strategy Officer, broke down the key factors that impact DME utilization and how hospices can take control of their costs without sacrificing patient care. From benchmarking industry trends to working with the right vendor partners, our experts shared practical insights to help hospices optimize their DME processes.

A few key takeaways from the webinar:
✔ Utilization Benchmarking Matters time stamp: 2:03
Knowing where your hospice stands against national benchmarks can help identify cost-saving opportunities.

✔ Ordering Patterns Can Drive Costs time stamp: 8:16
Many hospices fall into routine DME ordering habits that don’t always align with best practices. A fresh evaluation can lead to smarter decisions.

✔ Vendor Relationships Impact Care Quality time stamp: 10:37
The right DME vendors don’t just deliver equipment—they become an extension of your hospice team, ensuring compassionate service for patients and caregivers.

✔ A Free DME Evaluation Can Be Eye-Opening time stamp: 13:50
Even if hospices stick with their current vendors, a data-driven analysis can provide valuable insights into cost drivers, utilization trends, and potential savings.

Hospices that rethink how they approach DME management can gain a strategic advantage, improving both financial performance and patient care. Interested in seeing where your hospice stands? Request a free DME evaluation today!

WEBINAR TRANSCRIPT

Well, welcome, everybody. Thank you for joining us today. We're excited to have you on our webinar talking about DME decision making and our free evaluation process.

I'm going to go ahead and kick things off here.

Went too far.

So we are going to be talking about a few different things today. I will introduce our team, and then we'll go into some cost control opportunities, clinical best practices, different areas of risk that when it comes to our vendors, and the evaluation process. So looking forward to getting started, and I will hand it over to Al to introduce herself next.

Hi. I'm Al Lewis. I am the director of business analytics here at Qualis.

I do a myriad of things on a regular basis, but most of the time, I am spending my time analyzing hospice DME utilization.

I create benchmarks and then make recommendations from those.

And I'm Hall Thorpe. I helped create Qualis about fifteen years ago when DME wasn't managed by management companies. We kept getting referred to as a PBM but for DME. And so throughout the process, I've been blessed to see our industry grow, and we work with great vendor partners and great hospices throughout the country.

So without further ado, I'm gonna hand it over to y'all. Thank you so much for being here today, and let's get started.

Thank you.

I'll kick us off talking about utilization management.

What Qualis likes to do is we will identify opportunities within DME utilization For cost control, that comes from the benchmarks that we have set that we see on a national basis. We get an average for, certain utilization categories of DME. And then, we we look at how hospices measure up to those benchmarks.

For example, support services are one of those.

We will look at the utilization rate for group one and group two. How is the hospice utilizing those support services?

Most of our vendors, supply a group one mattress as standard with their beds. So most of that, utilization, we can consider completely redundant. So we can make recommendations to keep that aggressively as low as possible. But, we do have a national average that we can benchmark that against as well.

And then, of course, there's group two, which is used more for stage three, four ulcers, more for treatment, versus prevention. And so we have benchmarks for that as well, to assess whether that's being overutilized.

And those are typically more expensive DME items. So that is, often one of the major cost drivers in overall DME costs for hospices.

So, when we are able to measure hospice utilization of DME against our benchmarks, then we're able to identify what's being overutilized, and we can set goals for those things. And then, for the hospices that work with Qualis, we have, controls within our system that are tools that can go in your tool belt to to, manage that utilization, to keep it low, to control it. Paul's gonna talk more about that in just a minute. But once we get those tools in place, then we also are keeping we're tracking and monitoring that utilization regularly, and we will meet regularly to review, the baseline where the goals that we've set and any progress that's being made on this. So now Hal can talk a little more about those tools that we have.

Thank you, Hall. Y'all Al is a great analyst, and she's brilliant. So it's one thing to get great data from actual utilization or from invoices.

It's another thing to take that data and look at clinical best practices, evidence based medicine, and knowing what to order when. So just as with pharmaceuticals, you wouldn't order drugs when you don't need them or whatever. So deprescribing, of course, is is a is a common term in PBMs.

We deprescribe in some ways or make recommendations based on clinical criteria, industry best practices, what other hospices are doing. So all of that data is important, and we provide that to our clients.

However, all of that is predicated on two things. Number one, having the system to be able to control utilization. So the hospice the clinical team is in control. They're in control of patient care the entire way. The Qualis system just has to accommodate what is needs to be ordered when. So we have some protocols that can be, put in there, which makes this unusual or unique.

But another thing that's predicated on is the vendor. Your DME vendor represents you as the hospice. The patient, the caregiver can't distinguish the DME provider from you and it's showing up in cap scores. So we have to work with vendors that are great throughout the country that completely get it. So they're not Amazon delivery people or delivering a pizza. It's vendors that understand, have technicians that can communicate well and educate well and show compassion, providing life sustaining equipment to their neighbors.

And so these DME vendors are actually part of health care.

Chelsey, can we flip to the next slide, which leads us to the next point?

Absolutely. I'm gonna cut you off real quick. Before we jump to our next slide, I just wanted to pop up a quick poll question for everybody.

So do you know what your primary DME cost drivers are right now?

I will give people a second to answer that. So it looks like we're getting about fifty fifty response.

Some do, and some are a little bit less aware of what those primary cost drivers are.

Alright.

Let's keep moving on.

Thank you. Y'all those results are what we hear often. About two thirds of the folks seem to know what their cost drivers are, and they're multifaceted with DME.

One of the things that does drive cost is ordering patterns.

Most people hospices order one of two ways. Either everything is done through what we call central intake where one person primarily orders equipment, from the when when the patient's admitted or it's done in the field or a combination of the two. And so what happens with DME is where did it where did the staff learn how to best order? So it's kind of like most most folks learn how to order DME from their predecessor within the organization, who learn from their predecessor, who learn from maybe an in service.

So it's analogous to taking a photocopy of a photocopy of a photocopy. Sometimes over time, ordering patterns just get to be wrote. And what we see often, especially with with the hospices that we serve with multiple locations, is that each territory begins ordering differently. Now DNE has a geographic component and so do referral sources.

Some referral sources, especially some of the patient units, will require or strongly request certain equipment. But it's interesting that most of the time, staff don't really learn how to order DME from best practices. They just sort of do it out of out of route.

Al, can you share with us some more about information and benchmarking?

Absolutely. Yeah.

So, our benchmarking is clinically evidence based. To go back to the example that we mentioned previously of support services and, the idea that those group ones are actually redundant if the vendor, in fact, provides, group one mattresses as standard with their beds to add something to that such as an APP or gel overlay doesn't actually benefit patient care.

It's not giving them any further, support than the the mattress, which is already group one. So, therefore, we can recommend, lowering utilization of that while not affecting patient care or even improving patient care in that regard.

Thank you. So always with the hospice, you retain control. You're in charge of quality of care. So the new way of thinking or the way to view a Qualis or a DME management company is that your job is to provide the quality of care. Our job is to provide information.

And then to make that information in a in a platform that's, that's in your wheelhouse of when you like to receive it. So for example, we have utilization meetings, business reviews, where we review vendors' choices and utilization patterns and any issues that may have come up. What do we do to resolve it? What are we doing to prevent it? But the big thing is is to know that there is a new way of thinking with DME, and it can be a strategic value to hospices that manage DME differently by working in partnership with great vendors and a great DME management company, if you if you choose that.

Chelsey, do you have another question before you do I do.

I thought you might. Yeah.

Alright. Here's our second question for y'all. So do you use evidence based clinical criteria when ordering your DME?

Okay. And we are overwhelmingly seeing no. We are they are not using that on a daily basis when they're ordering.

So I will go ahead and jump to the next slide for you.

Thank you. So DME vendors that get it, are completely great. And a lot of times, they get into the same rhythms that hospice is getting in. They get into the same inventory.

This is what we add. This is what we rent. This is sort of the package that we do. It's just easy for us to get in a rut.

But just as a rut in a road creates more wear and tear on the vehicle, so too you're getting into ruts, put wear and tear on your hospice because your cost never decreased that way. One of the interesting things is that margin compression is a term that you hear a lot within hospices because revenue is fixed, but cost always seem to be increasing, whether it be labor or gasoline or reimbursement, whatever it is, stuff isn't cheaper. Inflation is a reality.

So too with DME vendors. So margin compression has hit them in a big way, resulting in a third of all DME vendors, either going out of business, being required, or stopping serving hospices, altogether. Because using your, a storefront to sell diabetic strips or focusing on oxygen or home health is easier than the service requirements of hospice. And so it's an important part to know that margin compression has hit hospices and hit DME vendors alike.

And just as there's been consolidation in the hospice industry, there's been a lot of consolidation or dropping of service with DME vendors. Some of you on this call might be in areas where they don't have where you don't have but one or two viable vendor choices, and that can impact the quality of care. It can also impact what inventory they have, available. We work with the vendors on quality of care, on how to enter a home, driveway etiquette, things like that for a white glove service, but we also focus with them on inventory and helping them get the right inventory at the right time, and helping them get the right inventory at the right time, going back to Al's analysis to getting the right high density foam mattress with every one of your beds that's ordered, and that reduces the need for some of the supplemental mattresses just as an example.

Chelsey, I think that's got that slide. Do you have another question, or can we keep going?

No. Another question for you.

So to what degree does your vendor provide compassion and patient education to your patients and caregivers?

So kind of across the board here, sometimes, most of the time is is the the unanimous decision.

Okay. Alright. Back to you, Hall.

Well, I know that Al's gonna jump in here, but along those lines, the vendors are operating a business, and some of their technicians are really good at showing compassion but not educating. Some are good at educating and not showing compassion. Some are good at both. Some are good at neither. We have to monitor that on the Qualis side.

So this your your your results are great. For those of you that have it all the time, isn't that wonderful? It's a great when it when it works, it's absolutely a blessing. So, Al, can you share with us, what the next steps are?

Yeah. Absolutely. I love the way that this is laid out. So our evaluation is free, but the analysis is priceless.

It is valuable to hospices, no matter what they decide to do in this stage. Our evaluation is, offered when we're getting to know you. But, for hospices who choose to stick with their status quo, who wanna keep shopping around, or who wanna move forward with Qualis, this, the analysis brings you value either way just to have, an understanding of what your cost drivers are, as well as any of your other cost factors. You can take keep that in mind when you're shopping around, then you know specifically what items you need to look for in the pricings that you're offered.

Or you need to know what utilization you need to work on even if you're sticking with the way things are. If you decide to come on with Qualis, that feedback becomes, goals. And we set those goals. We benchmark, as we implement you, and then we track and monitor, and we give you a regular feedback as we go throughout our relationship.

This is more of what our DME evaluation process looks like. You fill out a form and give us as much data as you can, about your DME.

We crunch the numbers. But when I say we, that's mostly me.

So I will be crunching those numbers for you, and then, we report back to you those cost control opportunities as well as clinical best practice suggestions and recommendations on vendor networks sustainability.

We also really are interested in seeing, that data that's recorded to give more feedback on understanding, DME costs. A lot of times we find that hospices think they know what their costs are, but their understanding is incomplete.

For example, if we one of the things that we ask for is for a hospice to report, what are your overall what is your overall DME spend on a per patient per day level? And a lot of times, the response that we get to that is the per diem rate that they're paying. But a per diem rate is on formulary, and it only covers formulary items, which with that margin compression has been shrinking, in what the trends that we're noticing in our industry.

So the all in per patient per day cost includes not only that per diem rate, but what's being spent on on form items that are outside the formulary.

So we dig into all of that when we, when we evaluate the DME utilization, and we can help hospices to better understand their cost.

Well, thank you. One of the things that we need, to to to analyze your data, is a BAA, and we can provide that to you. That will allow you to send us the data. If you prefer to redact any PHI within those invoices, that's great too.

And then we don't need a BAA. We I would say three quarters of the folks just prefer a BAA because we truly do get granular in analyzing what's being ordered and why it's being ordered, and then we just simply report to you the analysis. It it sounds simple for me. It's it's difficult.

Al spends hours, and we compare it with your numbers, but also I hate to use the word industry best practices. It's almost industry other practices.

And, again, DNE is regional, and part of it's driven by your referral sources, strongly suggesting certain equipment. And so we get that, but we have to work with hospices sort of where they are in their region, and we have the data to come back with with solid answers.

Thank you for going over what that process looks like. I've seen some of the results, and it's truly it just opens up your eyes to what's possible. And that's what I love about Qualis is that, you know, we don't do this just to our customers. We do it to anybody out there that wants to better their, their practice, which is amazing. So that's all we have. And oh.

Nope. Went too went too fast. There we go.

That's all we have, and we wanna open it up for questions. So what what questions can Hall and Al answer for y'all today?

Oh, I see one popping up.

So how do you choose which vendors you work with to serve the hospices?

Yeah. I'll I'll answer unless you raise your hand to answer it.

Our choice we we work with vendors throughout the country.

Vendors would always rather deal directly with the client directly. They understand our model. They seem to prefer Qualis because we don't compete with them. We're never gonna open bricks and mortar on them.

But our vendor is is really your vendor choice. It's vendors that you want us to work with. We reach out to those vendors. So, for example, when we analyze the invoices, we would never proactively reach out to someone in that market.

Normally, we serve folks in your market because we serve hospice throughout the country, but there's, the occasional state where there just hasn't been where we serve before. And in that case, we would never reach out without your permission. But, typically, you tell us the vendors you like working with. We look if they're already in our network, and if they're not, we get them in our network.

So you drive the vendor choice that they have to be willing to contract with us. One thing that makes us unusual is that if you have a patient coming on board that's been renting equipment from another DME provider locally, we like as long as that vendor has the right insurances and accreditation acceptable to you, we will contract with that one vendor. So you have the choice whether you wanna use the sort of the Qualis preferred vendor in every county and then our secondary or the existing, vendor that's serving your patient.

Another one popped up. What if I only have one good vendor in my area?

Yeah. Okay. I'll I'll just double that. Again, margin compression, there used to be more vendors in every market. We love a primary vendor in every county, and at Qualis, we break things into counties and at least one great secondary because free enterprise works with you having a choice. What's happened in some markets is that there might just only be one DME vendor. That vendor often will work with us.

Our job is to work hand in hand with the vendor to serve you. So you're our client, and we mutually, along with the vendor, they add value in ways that we can't, and we add value in ways they can't, both to serve you, to to to maximize the value of every dollar you're spending on DNA.

So we're we're used to this. We we can work with just one.

Hey. Are there any other questions out there?

One area that we're seeing I'm gonna jump in, Chelsey, if there's a question, but even if there's not, one area we're seeing, there's a lot of personal injury lawyers that are now kind of getting into hospice and to the d and e space or to to drugs and, you know, exactly why was this item ordered and why. And so having a justification of that, is becoming more important. We look at that. We cover all of that.

One of the things that we would do in analyzing your data isn't just looking at what you're ordering, but also rendering an opinion of vendor strength in your area. Because what'll happen is we we hear a lot from vendors.

That call us to say, hey. I wanna get out, or I wanna sell, or I wanna buy, or even a hospice that may say, hey. I wanna get in the DNE business. We are constantly becoming a hub of what's going on in DNE. And so one of the things that we like to come back to you at is what's the vendor risk of you and your market? You know, if there's only one or two, are we hearing anything? Those are the kind of things that we like to offer, as part of our analysis that I didn't mention before.

That makes complete sense. Okay. I have another one that popped up. What are the top trends you see in your evaluations?

Okay. Al, that's you, but I can jump in. But you go. Yeah.

I'll start, and you can add to it.

Let's see.

And I use a previous slide to guide me.

Tops top trends we see are cost drivers being, a a handful, maybe, of certain categories. We already mentioned support services, a group one and group two.

Kind of related to that are cushions, not just for the bed, but for chairs as well, can be overutilized, and those are often becoming more and more nonform items.

Oxygen utilization, kind of the practice of just ordering oxygen, for almost every patient or even every patient, instead of being more intentional with how that's ordered, or utilizing high flow instead of, regular flow when that's, sufficient.

Electric lifts, those are sometimes facility driven, but manual lifts we find, do the same work and, electric lifts would be more based on the caregiver than the patient that needs to be lifted. So and then sometimes brand names. Just use utilizing brand name GME because, because the name recognition when, the the product itself is, not necessarily superior to others.

Yeah. Al, a lot of that is similar to to deprescribing within within drugs going from a gin a brand name to a generic. There's certain things within d and e that they can go from a brand name to something that does to say that has the same efficiency.

One of the things that Al mentioned was oxygen. I wanna go back to to supplemental oxygen is what we refer to it as. So oxygen concentrators are iconic to our industry, and sometimes they're just ordered out of rope, without the pulse ox, or without some evidence, some basic criteria for it. And if that's what the patient and plan of care calls for, that's fantastic.

But we are seeing a movement within hospices that are wanting to manage that utilization differently because the nasal cannula tends to tend to dry out things.

Soon as it requires a patient to have more morphine because it creates anxiety. Those machines can be warm. They're loud. The residents sometimes are small. So what we're seeing is a trend in our industry where some hospices on admission are saying, whenever you want an oxygen concentrator, it'll be here that day, that next day, whatever that looks like. But educating the patient and the caregiver on the front end of saying, you know, let's wait on the on the oxygen concentrator.

Just let's see until your pulse ox dictates or you just may want one. We're seeing it, and hospice is historically just ordered it because, traditionally, it's been part of the formulator.

But as utilization of those items decreases, we analyze that, we work with the vendor, and it can result in cost savings to our clients. So, again, that's just information that we share. We share which hospices are doing it, how they're going about it, and we're seeing it move the needle, selectively with some hospices that wanna pursue oxygen concentrator utilization.

Okay.

Another one for you. I was hoping that you'd be providing clinical guidance decision trees on this call. Can you provide any documents?

Yes. Can you say blank or on call? I didn't hear the last part.

Can you provide any documents?

Do we provide those?

Yeah.

Absolutely. Yep.

Great. How long does it take to get up and running with Qualis?

I love these questions. Mhmm.

We prefer sixty to ninety days. So once someone signs with Qualis to start but everything is different for every hospice. And so if you're in a market where we are already, you know, serving multiple people and multiple vendors, it's just easier in some markets for us to onboard.

So the thing that holds us up a lot of times is an existing agreement that that you might have with a DME management company. The DME vendors are normally much more willing to work because they understand they still want to serve you and they we would work with you. So it takes us if we get your data, it'll take us about ten days to return the data with answers. But if you're interested in Qualis, I would love the opportunity to share more or find out what timing works well for you. Traditionally, sixty to ninety days, but it really is specific to the hospice.

Think we've got time for one more. But before we do that, I wanted to throw up one last poll question. You know, I love them. So just wanna know if you would like to receive our free DME evaluation, and we can get the form over to you and get that working.

Give that a second. And then, Hall, I will tee you up for the next question.

How does your how does your system handle urgent or stat orders?

Yeah. The definition of stat is your definition. Most hospices are four hours. Some are two.

The stat is different than routine or scheduled. Our system allows you to order stat, of course. The vendor then acknowledges it in real time, and the orders worked. So your definition of stat is our definition of stat.

Our contract with every vendor is unique for every client, but that's we can share with you what's normal, but, yeah, everything that's placed within Qualis system is routed in real time to the vendor. The vendor acknowledges it. So everything is date and time stamped, and stat orders are just part of serving hospice. One of the things that's interesting is that we watch, orders based on frequency.

And what's happened a lot with hospices is your vendors have been so slow to to deliver or even pick up that sometimes we can watch orders that become more stat. They're just simply stat because they're frustrated with their vendor not working orders, timely. And so we watch that, and we work with the vendors, and we do action plans with the vendors.

But stat and hospice is is critical, and vendors serving you have to honor your window.

Perfect. I I have I think those are all of the questions.

Oh, no. One more. Do we have the flexibility to switch vendors if we're unhappy with service or pricing?

I love y'all's questions. If the yes.

That's the beauty of our model. Again, we like a primary vendor that you and I select mutually select and, hopefully, if someone's serving you well in your market, and then at least one good secondary vendor in Erie County because free enterprise works and it allows you to choose the vendor that's best serving you. People change over time, and the vendor is only as good as that warehouse manager, those customer service people, and the technicians. And so we our job is to work with the vendors on getting them good, but also allowing you to have the flexibility to to switch.

One of the things is there's a big net trade conference right now in Dallas, and that's the d and e vendor industry. And so when we go to those meetings, a lot of the sessions are telling the vendors, get your clients using an ordering platform that's specific to you because then they can't lead you. And that's the sawiest shit. That's like hostage service.

So we love having, what we call vendor we're vendor agnostic.

We don't have a preference of vendor except those that you like or the ones that serve you. And so we our system accommodates vendor choice.

Awesome. Well, I think those are all the questions. If there are any others, we're always happy and around to answer those.

Thank you, Hall and Al, for sharing your expertise with us today.

Enjoyed it. Always fun.

Absolutely. Alright. Have a great day, everyone.

Thank you. Bye bye.