Old timers

Today's HME provider barely resembles the industry pioneers of the 1950s and 1960s. But somehow, despite all the change, an exclusive club of mom-and-pop companies that started out selling exam tables to physicians and lugging 100-pound concentrators up three flights of stairs have evolved and transformed their business into 21st models of success.

How have they done this?

Well, say some old timers, a family succession plan helps keep the business legacy going, though others concede their businesses may die with them. Local and regional identity with the public, established reputations with referral sources and sound business methodologies all contribute to a company's longevity; and the one universal attribute among veteran professionals is passion.It comes out in various ways, such as when Bernadine Herron talks about her team and their approach to home care.

"My management style has always been participatory," said Herron, who co-founded Hooksett, N.H.-based Herron & Smith in 1984. "My staff gets excited when we talk about our goals, improving the business and customer service. They are not threatened by trying something and failing--no mistakes means you're not getting better. We are always experimenting with something new or building upon a new service. Our role is home medical equipment, but we make sure the patient has a good understanding of why they have it. It is a unique formula that has worked for us."

Joe Ryan, owner of Nunn's Home Medical since it was known as Nunn's Hospital Supplies in Rome, N.Y., in 1970, says his passion is serving people and making their lives easier.

"One patient was terminal and had very little time to live, but she wanted to be able to go out with her husband, so she wanted a stair glide," he said. "Even though she died a few months after we installed it, it was what she wanted and it made her happy."    Dick and Sharon Webb, owners of Shillington, Pa.-based Webb Medical Systems, have stayed with the business since they took it over from her parents in 1981 and have no intention of retiring.    "We invested a lot to create this business, and we still enjoy what we do," she said. "We're not ready to think about retirement, though we are approaching that age. A strong work ethic runs in both our families."

From then to now

Family legacy has kept New Bedford, Mass.-based Enos Home Oxygen going for 59 years and counting. Richard Joseph Enos founded the company in 1951, and it is currently headed by his son, Richard Jay Enos. Third generation member Richard Jonathan Enos is being groomed to take it over in the future.Richard the second, who goes by "Jay" to avoid confusion, worked as a one-man operation in his early days--lugging heavy oxygen tanks, consulting with patients and then doing the billing.

"I was working day and night and might have had 40 patients," Enos said. "Since my son has joined the business, we now have between 3,000 and 4,000 patients. We've come a long way."

The "in-the-blood" passion that so many perennial independents show is often fueled by a devout commitment to patient service, as exemplified by Anderson, S.C.-based Bryant Pharmacy and Supply. The 46-year-old company's mission statement sums up their approach to service: "Do what you say you're going to do, do it when you say you're going to do it, do it with excellence and better than everyone else."

Over the years Bryant has evolved from being a corner pharmacy to a full-service HME company with more than 30 employees. The owners have never been tempted to sell because they are dedicated to their patients, said Vice President Giles Canter

"We believe the service aspect is what is lacking in the industry as a whole and we feel we can meet that need best as an independent," he said.

Surviving HME

Since the time Randy Wolfe got into the industry in 1976, Medicare reimbursement changes have turned HME so topsy-turvy that it is barely recognizable today.

"I can't say that I would advise anyone to get into the HME business at this moment in time," he said. "As a small business owner, I remain in because I have experience and I'm invested in it on many levels. Even though I can say that, it's still very hard to make everything work today. I can't honestly say I have a working solution for competitive bidding should it continue to move forward, and I don't think the price cuts that came out last time are sustainable. The industry is full of minefields--no one jumps into it not knowing what they are getting into."

Springfield, Mass.-based Louis & Clark Medical Equipment and Supply has its roots in pharmacy stemming back to 1965. Eugene Keane, director of medical equipment, believes there is "no secret to longevity in this industry" and that companies just need to continue focusing on what they do well.

"It comes down to knowing your business, its weaknesses and staying informed on any regulatory changes that could impact your existence," Keane said. "We continue doing what we do best in our region, keeping the relationships with our key referrals active and providing localized deliveries to the western Massachusetts region. This is still a valued service for our patients."