Thoughts on OT and the Home Mod Industry

Home modifications by occupational therapist (OT) based on principles of universal design and accessibility.

Universal/accessible design of the home from an occupational therapy and a construction perspective. This blog is part of a quest for cool, convenient, functional design that makes life safer, easier, and as maintenance-free as possible. It's about the lifestyle.
  


Perspective of OT home mod market and where it is going from a 12-year veteran.  Backstory in the next 4 paragraphs, skip down to get to the point.

I started my business 12 years ago as a construction company specializing in aluminum rental ramps.  I was renting aluminum ramps for $400-$1300 per month, good money but then the big boys got in the game drove the prices down and took over.  I still rent aluminum ramps but not anywhere close to what I was doing before.



Case managers found out I was an OT and started hiring me to do OT home evaluations.  It was a specialty field and not too many OT's were doing in depth home evaluations, business grew and Barrier Free OT was born.  In Michigan we have auto no fault, which pays for OT home evaluations but doesn't require the complicated billing practices of health insurance so it was easy entry.  Over the past 10 years since Barrier Free OT was born the home health agencies and large case management agencies have gotten into the game and hired OT's to do home modifications and now the small business owner, me, is competing against large hospitals, home health care agencies and large case management companies.

I have always enjoyed business and making money by my wits.  I became an OT so I could work in the schools and have my summers off to develop a business.  I have been frustrated with OT because I feel like in this profession it is very difficult to have a business that makes big money.  I think that is because healthcare is so structured there are too many barriers to entry.

In 2015 after my husband got laid off of his job and his health was too poor to return to work and I suddenly had to come up with an extra $160,000 per year. I decided to get serious.  I had been working for almost 10 years on my businesses and they just weren't taking off like I had hoped.  I wanted to figure out how to make OT business work, AIM BIG (Accessibility Independence Modifications Business Interest Group) now called HMOTA was born.  I started to talking to other OT's that were in this space and found they were having similar issues.  The only ones with successful businesses were doing it with home mod evals, but were also lecturing or were builders like me.


Basically it boils down to this.  Up until this point:
  • Home health care didn't know how to bill for the kind of home modifications people really need, it didn't fit the billing structure.  
  • Auto no fault realized the cost savings in having OT's or PT's do home evaluations for accessibility and have been paying the going rate for those evaluations.  But there are big companies now entering the game.
  • Workman's comp is a little behind auto no fault but they are ahead of health insurance.  They don't play by the health insurance rules so small OT business can pick up a few cases here and there, but the cases are so geographically scattered it's difficult to build a business on.


Market now:
  • Health insurance is beginning to look at home mods as a way to cut costs, they are just getting serious.  
  • Workman's comp is ahead of health insurance, they know they have a need but they don't know how to solve that need.  Workman's comp isn't interested in dealing with a bunch of small businesses, that's too much work finding them credentialing them and processing each of the new businesses, they want a one stop shop.  
  • The big boys are starting to take notice but they don't know where to find OT's or what to offer.  Nothing has been defined in the home mod market.  They are starting to hire OT's and pay them the standard OT wage to do the evaluations.  That will knock us little guys out of the game unless we pull together.

We got a leg up on PT's because we already have our HMOTA group and people are able to find us.  We need to rally our forces and capture this market so we can grow our profession and grow our businesses.  We need to capture the workman's comp market in our own way so that we don't have to work for large companies and we can get paid as business owners not as employees.

I struggle with this.  I want to support our profession and grab the market not only away from PT for OT's but also for OT small business so bold OT's can influence and grow the market and their businesses and OT doesn't have to be an 'employee' profession where big business gets rich off of us.  My businesses are doing well so I'm spending money to support others but in order to really rock this world we all need to throw down the gauntlet and take over, but I hate to ask.  That's stupid, this isn't my dream alone it's our dream and it will take us all to make this happen. 


So these are my thoughts.  We have several strong leaders in the HMOTA group, but we aren't organized to really disrupt the industry.  Part of our issue is that we have many members each with great ideas but pulling in different directions.  I think we have the same ultimate goal but there are many obstacles that we need to get over and we are all stumbling on the same things we just have different ways to get over them.  We need to come together to solve these problems. 
 
In order to really disrupt the market we need:
  • Marketing, but not OT's marketing.  OT's hiring a marketing professional but OT's developing our message.  We also need to learn more about the big players in the workman's comp market and how to access them and fulfill their needs.  
  • We need contracts.
  • We need to set our prices for our members and what their reimbursement is for services so we can get paid enough to have successful businesses.  Thank you to Kathy Subasic and the processes committee for defining the process and the different areas to get paid.
  • We need continuing education to keep our skills strong and meet licensing requirements.
We need money to do this.  Issues:
  • We lost a lot of work from the national contract because we could not fill the jobs.  We need to grow our membership and fill the jobs so we can keep our contracts and make money. 
  • We need to develop our app to make the home evaluations cost-effective, consistent and accurate.  We don't need to reduce our rates when our timeliness improves, we need to spend more time growing our market. 
  • If our members are going to be working on this if possible they need to get paid.
  • Marketing.
How to bring in money:
  • Subscriptions to HMOTA, at $5.00 a month the money that will be coming in is nominal.
  • Home mod jobs for members a percentage of the job goes to HMOTA for marketing and growth.
  • GoFundMe or Kickstarter, let's find a crowd to fund us.  We need solid goals for where the funding will go. 
Let me know your thoughts. 

Let's swing for the fences.  If you're a home mod OT or COTA and aren't already a part of HMOTA please join us here:  https://hmota.net/home-modification-occupational-therapy-alliance/



No comments: