National HME CEO Ingram: Building Hospice Partnerships Boosts Quality, Efficiency

Last week hospice durable medical equipment provider National HME, Inc., appointed Andrew Ingram as CEO after nearly 12 years in senior leadership positions at Encompass Health (NASDAQ: EHC), along with more than 30 years in hospice and health care leadership.

Previously the executive vice president of operations for Encompass Health’s home health and hospice segments, Ingram helped the organization’s hospice service line to generate approximately $200 million in annual revenue throughout 85 locations across 18 states. Prior to Encompass Health, he served as regional vice president of operations at home respiratory and medical equipment provider Apria Healthcare.

Headquartered in Irving, Texas, National HME provides technology-enabled hospice medical equipment (or HME) management services. The company serves thousands of hospices throughout more than 50 locations across the United States.


Ingram recently sat down with Hospice News to discuss his transition from a hospice provider to a hospice service vendor and the outlook for building business relationships, technological advancement and the field’s shrinking workforce.

What led to your transition from providing hospice care to providing hospice services, equipment and resources?

It really goes back to the way that I’ve worked with the service providers at Encompass Health and the relationships that I had with them. They were more of a partnership than a vendor relationship. Although we had contracts, we didn’t do the traditional [request for proposal (RFP)] approach. We evolved with the relationship, and it was a trusted relationship. Cost is always an impact, but at the end of the day it really came down to the efficiencies of working with a trusted partner. Basically, we worked collaboratively and proactively to make each of us better and be supportive of each other. That’s kind of how I had the opportunity to come over to National HME.


What I wanted to bring to the organization is that kind of a relationship where we’re both in the same foxhole together. The service provider is focused obviously on the clinical care, the staffing, retaining their staff, training other staff and the deliverable there. As a medical equipment provider, National HME is focused on making sure that we’ve got the provider’s backs, that we’ve got equipment out there when they need it, and that they can trust us to always be ever vigilant in that regard for a great service experience. It’s really an honor to be able to partner with folks who I know how tough their job is because I’ve done it. It’s not falling on deaf ears. I think they get a better sense of empathy of how difficult it can be on the other side to now know what the needs of hospices are specifically.

What will be your most important focus as the new CEO of National HME?

My focus is really going to be around the people that we employ and trying to build and continue to build upon the culture that we have, which is a culture of excellence and inclusion, and investing in our folks with training, education and also career opportunities for them. I’m a huge believer in promoting from within, so that’s one of the things that we’ll really be focused on and hopefully our people will be appreciative of that and our retention will be high. As a result, our results to the actual hospice providers will see the difference.

The pandemic is having reaching impacts throughout the hospice industry. What are some of the ways COVID-19 has been impacting the business of hospice care and service providers?

The biggest issue has been how fragmented the health care system is overall. Acute care hospitals kind of operate in their own silos, inpatient and rehabilitation hospitals operate in another silo, and home health and hospice providers are in silos — even primary care physicians are in a silo. One of the things we talked a lot about at Encompass, and I’ll continue to have those discussions here at National HME, is how do we get everybody in the same foxhole, because it is now coming down to more population management. My takeaway is, how can we all manage the aging population throughout the entire continuum of needs like acute care, home care, end-of-life and hospice care?

What is your perspective on the shifting needs of hospice providers and how hospice service providers can step in to fill those needs?

There needs to be a much higher level of collaboration. On the provider side, you look at disease stages and the comorbidities that patients face, and all of those drive different equipment needs or different therapy needs on the servicer side. Providers need to have that information and access more proactively rather than the traditional way of ordering when needed.

It’s almost like having a fast-ship program, where you have a patient that you’re admitting into care and we’re there very quickly [with equipment] so that you’re able to get that patient started and lower the stress across the board and to the patient and their family. When you can make the overall stress in the environment go down, everybody feels better, and that’s really what hospice care is about. It’s about having a good end-of-life experience. The beautiful thing about hospice that I learned from being on the provider side for so many years was the value we bring to those at the end of their life.

How is technology shifting the hospice industry in terms of delivery patient care?

Patients want to be taken care of in a setting that they’re comfortable in. Ideally, that’s their home. With the advancements in technology, equipment, different therapies and a more mobile workforce, there’s the ability to really be in touch with so many diagnostic tools out there. You have the ability to monitor a patient remotely and respond to them in real time if they have an exacerbation or decline. You can do that through the equipment, through monitoring technology and apps on phones and tablets. I continue to be amazed at how much health care has changed through the years and where we’re going with it. The “Star Trek” days are going to play out to be real.

Even with simple video conferencing, a picture’s worth a thousand words. You can check on patients in the home and ask how they’re feeling today, get a quick blood pressure or some vital signs and put their mind at ease till you check in the next day or whatever that cadence is. The advancements in technology are going to provide a lower cost setting for patient care and going to extend the reach of our limited resources when it comes to clinical staffing.

What advice do you have for hospice providers and how they could improve partnerships with vendors?

It really comes down to the collaboration with all your constituents and all your partners, including your employees. As far as in the hospice industry and looking at it from the provider side, you want to work with partners that bring value to your hospice program, ones that make it easy for you to do business with them — that’s a valued service. Obviously, it’s a transactional relationship, but there’s more to this than just a price. It really comes down to, do we take soft costs off the table for the provider and do we make it easier for them to do business with us? In any service company, your biggest expense is labor. I we can make it easier for them to leverage the labor spending that they already have and get a little bit more incremental productivity out of their workforce, then it’s a far, far better return to deal with a provider that can do that for you than it is with one that gives you a cheap, cheap price.

We’re focused on the service that we provide and on the reliability and the quality of the equipment that we put out on patients. We’re really focused on the technology to make it easier and more connected interfaces with the [electronic medical records (EMRs)] that hospice programs are using so that doing business with us is very, very easy and rises above so many dollars per transaction, and that’s similar to how I managed it at Encompass. We retained most of our vendors for a long time, and we did that because we had an agreement that we need you to be successful and in turn you’ll help us be successful. And it worked.

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