If you think your teacher is tough, wait until you get a boss. He doesn’t have tenure.
— Bill Gates
Over the years, I have had many conversations
with owners and managers in the
DME and complex rehab business about
the issue of employee retention and their
corresponding salaries. From most of
those conversations and coupled with
my own experiences, I have arrived at
the conclusion that employees in today’s
workforce expect a pay raise every year,
regardless of their performance.
That magical anniversary of their hire
date approaches, and the employee
expects an instant increase in their
salary. On occasion, I too have had that
feeling of dread wash over me like a cold
ocean wave in anticipation of letting
that employee know that they really
haven’t earned a raise based on their
In doing so, I am aware of the difficulty a small business experiences when
an employee leaves to make that extra $1 per hour somewhere else.
New employees mean lots of training, and we all know that means
time — lots of time — a commodity none of us have in abundance. A
peer recently took a class where he learned that the average re-training
of an employee costs $3,000.
A few years ago I was in just that situation, and it dawned on my
consciousness that maybe I had been going about this in all of the
wrong ways. My employee had not done a great job in the past year,
and I felt that this employee did not merit a raise. I had done the usual
manager things such as verbal reprimands and once even an action
plan, but I knew that the culture I had created made this employee
expect a raise. That’s just what was expected.
A Performance-Based Raise
This experience got me to thinking about what many smart business
managers had figured out a long time ago. Raises and increases in pay
should be performance based.
Throughout this period, I began to take a look at competencies.
What specific skills should a particular employee possess for a particular
The process seemed to be a bit more complicated as I tried to devise
a system for assistive technology professionals (ATPs). Much of their
work (excluding revenue) is subjective, particularly for an old-school,
years-removed RTS like me.
What we created was a Job Level system for all positions in the
company. Loosely defined, each employee — such as admin, tech
or ATP — would fall into a Level based on their specific competencies.
For example, an intake coordinator with no previous experience
would be Admin Level 1. This position would have a set salary. Raises
occur when the admin tests for Level 2, which consists of several exams
created by our leadership team.
A Level 2 admin would have to pass a test on reimbursement,
Brightree systems, and areas that would prove they now had a greater
skills set than they did at Level 1.
When a review occurs, we have measurables that help us understand
that this employee is now more valuable to us because they can
perform at a higher level.
Now I realize that this might not be rocket science here, and I should
have done this 15 years ago. For we now know that changing the efficiencies and performance metrics of our company will create a better
Defining Skills Set Levels for Today’s ATP
In examining the ATP system, we realized that we faced several distinct
challenges in implementation:
- If levels are affected by salary, what should we do with a Level 3
(Advanced) ATP who is currently receiving a Level 4 (Expert) salary?
- What defines the differences between the Levels?
- What is the overall goal of the system?
- What should we test the ATP on?
- Who writes the tests?
- What will this do to morale?
We chose to test the ATP with a written exam that covered several
- Products Exam
- Reimbursement Exam
- Clinical Exam
- Medical Terminology Exam
- Situational Ethics Exam
As in most businesses, the ATP also must maintain the revenue
goals for each level and maintain a respectable, pre-determined GPM
Jessica Savitch, a broadcaster, once said, “No matter how many
goals you have achieved, you must set your sights on a higher one.”
Every employee wants to know how they measure up. We are doing
our employees no special favors when we are ambiguous or unclear
about expectations specifi c to their competencies. An employee cannot
be praised for conquering a new skill if we as managers never knew of
their accomplishment. If we don’t care…why should they?
With respect to complex rehab, it is my job as a manager to ensure
that each patient who encounters Active American Mobility receives
the best, most thorough assessment that we can provide. By defining
ATP competencies based on knowledge and performance, we can
ensure that our clients are getting the best treatment possible, on all
levels. Can your ATP verbally break down the entire process required
for a patient to receive a power wheelchair through Medicare? Can he
or she do a custom mold properly? Do they maintain a GPM that you
can live with?
Then there is the whole issue of ethics. While RESNA does a great
job of illuminating the code of ethics for ATPs, there are situations that are not black and white that put your company’s reputation and
possibly its existence at great risk. That is why we have created an
ethics component to our level system. We want our ATPs to be thinking
of ethics at every eval and in every scenario.
In our organization we have a lead ATP. This is a person who already
fits into our Level 4 (Expert) category and is the most knowledgeable
about products, clinical, reimbursement/funding, and is a high
producer with good GPMs. They do ATP work every day. Who better
to serve as a conduit between ATPs in the field and our management
team? This is one arm in which we can measure competencies.
We will have our full system employed in August and look forward
to more effective employee reviews.