The HME180 Podcast – Episode 6 – Violeta Arnobit from ACE Medical

Welcome, you’re listening to the HME180 Podcast. Every month, your host, Sue Chen will interview the best of the best HME retailers who are fearless, innovative, and committed to their work. On this month’s episode, our special guest is Violetta Arnobit CEO, and co-owner of ACE Medical on the island of Oahu in Hawaii.

Sue Chen: Hi, and welcome to the HME180 Podcast. I’m Sue Chen, your host, and you may be starting to hear some consistent themes on this podcast. First, our industry, HME, home medical equipment products, is vitally important to all of our lives. In fact, I would say that in any room of business owners, CEOs and industries, and I share our why and our impact, everyone would agree that the most–we have the most powerful human impact, making us the most interesting person in any room. Next, the people in our industry are truly extraordinary. Another “E” in HME. Your bold, courageous, determined commitment to help others to improve lives and to empower human ability is so powerful. My guest today is extraordinary. Violeta Arnobit, is the co-founder with her husband Terry and CEO of ACE Medical, the destination for HME on the Hawaiian island of Oahu for over 31 years. And one of the most successful HME retailers in the United States. Violeta also defines another big “E” in HME. I consider her the master educator in our industry. And her inspiration, insight and experiences are so actionable, empowering and impactful for your business and your life. Violeta, aloha, and welcome to The HME180 Podcast!

Violeta Arnobit: Aloha Sue! And thank you so much for that nice introduction. And I really, really am looking forward for this podcast in order to share a lot of insights in our industry, for we are the industry itself.

 SC: That’s right, we certainly are. So you were born in Cebu, Philippines and graduated from Cebu University College of Nursing. And in 1983, you were recruited to come to the US. And you arrived in New York City freezing cold, and with only $25 in your pocket. And you were put in a horrific and unbelievable situation. Not only did you survive, but you became an advocate for yourself and your fellow immigrant nurses in your situation. So, my first question is going to go deep and emotional. Violetta, you were so young, poor and vulnerable. Where did your fight come from?

VA: The fight came from the values I’ve learned from my parents. You cannot run away when you have challenges. You got to find solutions. Both my parents are entrepreneurs– had a convenience store and so was my grandmother. So I learned a lot from them. And my mom always tells me “have faith in God.” You always have to pray for guidance in whatever you do in life. Always follow the golden rule. Do unto others what ever you would like them to do unto you. You have to speak up and be heard. And that’s what transformed me. A challenging life coming to America. That was totally a transformative time in my life. And that’s how I started my journey.

SC: Wow, with that golden rule in your heart, but also a voice because if you meet Violeta, she comes across as just a sweet, lovely lady. But you have a lion’s voice inside of you. So when you and Terry decided to start a ACE Medical, you had very little knowledge on home health care products and equipment, even though you are already an experienced nurse. Where did you go to get educated?

VA: You will be surprised. I will never forget that my kids were young. I had a one year old, a three and a five year old. And that was how it started. I said I gotta go first of all local library and find out who’s our manufacturers. So I went to our local library and got into Oh wow. Invacare and Graham Field. So I did cold calling. And lo and behold I was responded by Pat Moore who became my mentor and so does Mike Zeman, may his soul rest in peace. He was such a good man. Both of them were my mentors in the HME industry. He told me Violeta no one’s going to teach you, you gotta come to MedTrade and be educated. So I have been to MedTrade since the beginning in 1995, and never missed one until COVID came. And that was the biggest takeaway. You know, being there, able to network, learn about the industry itself, collaborate network with CMS, learning about the guidelines, learning about the challenges, learning about new technology, new products. And then when I came back, I bring it to the community and do the, I would say, conferences and educate everyone here. So I–it is so important for me to I would say that the MedTrade conferences have brought so much value. And I think it’s important for all of us in the industry, to always be a participant, you know, be educated, because that’s the key, there are so many challenges. And to overcome those challenges, you have to have the knowledge by sharing that knowledge that you got from the conferences, allows you to be able to transform your business and be competitive and stay in business. Because otherwise you’re going to be left behind.

SC: You are a master networker, too. And I just want to make sure our listeners heard you say that you went to the library?

VA: Yes. [laughs]

SC: Yes. And that’s when you were first introduced to home medical equipment, and found in Invocare is in the library. And of course, Mike Zeman, who is, I would say, a master educator in our industry and always found the time to help others

VA:  Very nice person. Very nice.

SC: Yes. So in your journey, you early on, discovered that there is a massive gap in education when it comes to home health care products and equipment, and then the health care professionals and providers. So one can make the assumption that just because you’re a health care provider, that you know what your patients need in home health care products and equipment. Can you clear this up? And also, let’s get specific. So when it comes to home health care equipment and products, what’s the knowledge base for like, say, discharge managers, outpatient nurses, physical therapists, and hospice nurses because you’ve worked with all of them, what’s their knowledge base.

VA: Youwill be surprised, like myself being a nurse. The only thing you know nurses in the hospital, using those equipment examples or wheelchair is to transport and transfer patients. That’s it. No other knowledge about what other equipments you need in the home setting. And same thing with those discharge planners and the physical therapists, you know, they use those walkers, they use those equipments, the basic equipment in the hospital, but transforming patient’s life in the home setting is totally different. So there is such a big gap in there, and they’re just hungry to learn about it. And that’s because, as I told you, I created what we call the functional mobility assessment that really helped guide the discharge planners, and all the rest of the therapists like “How can make it–how can I make it efficient to discharge these patients from the hospital setting to the home?” So preparing them is so critical, because right now, this is another guidelines that people need to know the hospital’s guideline has changed already. I mean, the last couple years, it says timely discharge, because if the patients get readmitted within 30 days, the hospitals are not being paid. So more case managers were hired, more PTs are being done in the hospital, then transformed to home care services. So those are the things that kind of was my platform is education. And they were so excited because they said oh, I didn’t know that this equipments are necessary. So the critical assessment is so important for the mobility assessments for clients being discharged and helping those timely discharged to the home setting in medical guidelines. Two days prior to discharge, you can deliver those equipment, but preparing the family is crucial. Preparing all documentations letting them know that this documentation is critical for pre-authorization especially if you’re dealing with the Medicaid program, the HMO insurance, everywhere affect your business. Affect the quality of life for all our patients out there. So by collaborating with all those discharge planners, all the health care providers from the hospitals, it is becoming more efficient and cost-effective to become partners with them as HME providers.

SC: Yes.

VA: So think not that you’re selling equipment but providing quality care and cost effective health care in the long run for all of us.

SC: Because the forms that you shared with me which are so thorough I’ve never seen anything like this. You created these—these–it’s called a “functional ability evaluation.” And you also created a prescription and documentation form for DME supplies. And I’ve actually seen the discharge paperwork from a hospital. And it was nothing like this. I mean, it was a skeleton. And so you must have seen how inefficient and inadequate the discharge process was because like you said, the only know what a walker is like, an a commode is like in a hospital setting, they have no view of what happens when they go home. So you created this for them. And this must have been so valuable for them, because you told me that they all use this now.

VA: Yes. And feel free to share that with the rest of our HME providers.

SC: That is so generous with you, I will put that in our show notes, a copy of this, because it is so comprehensive, and it’s so in the language that the health care providers can use and understand. And the patients as well. Oh, that is fantastic. Thank you.

So you quickly realized that education and collaboration with your healthcare community, was your mission and calling, but they also needed a place for home health care products and equipment. So they needed your education and ACE Medical. Did this create a conflict of interest for you as a educator, collaborator, and also a provider?

VA: No. Because firsthand, they’re the ones who are even requesting and asking me to come in. And I had to do a disclosure, you know, that I come here to educate guidelines on Medicare updates and changes, and not as a home health equipment provider trying to sell something. I would never come across to be like that. I want to be coming across as an educator, providing, you know, I would say, empathize, being compassionate and caring about the needs of our—sensitive to the needs of our clients, but also helping facilitate timely discharge for those patients in the hospital setting. And they are very thankful about that. And I think what speaks volumes is I’ve been also, as I said, I would like to encourage all providers to be, you know, to be members of your local healthcare organization. That’s so important, because that speaks volume of trust, like you’re not coming in yourself, not as only HME provider, but as an educator and part of the biggest organizations within your community. So the good thing about our healthcare situation comprises with nursing homes, hospitals, home health agency, pharmacy, it can be provided. So because we’re small here, so it’s kind of like a benefit for all of us, because we pretty much know who are the key players in our industry. And I challenge everyone to know who are the key people in your healthcare community. You know, who are the CEO, who are the decision makers, because those are the key people that you need to talk to, you know, to do business with. So I did not limit myself educating in the discharge planners, I ended up educating mostly even our local organizations or healthcare providers, like we have what we call the foster home, the care home, even the primary associations for physicians, I got invited to make presentations for the physicians themselves.

SC: Yes.

VA: I got invited for, even for the local union on hotels. They are your clients. It’s so important that you don’t limit yourself educating only within the healthcare professional arena. But everyone in your community needs, you know, we’re such a rapidly aging population. We are in a tsunami in healthcare right now. And we got to be part of the solution and not be a problem. So it’s important to embrace those challenges and changes that comes across our way and face it with grace.

SC: Well like I said, I said earlier, that we in our industry, are the most interesting person in any room. I can walk into any room and talk about the impact of what we make, and everyone is coming to talk to me, I imagine you are too, and that’s what you’re sharing with our listeners. Is that really your audience is everyone?

VA: Everyone.

SC: Everyone, right?

VA: There’s no limit.

SC: There’s no limit because everyone has aging parents, everyone will be faced with recovery and home health care needs. Everybody wants to recover at home.

VA: The comfort in the comfort of your home, being safe. And not only that, did you know study shows healing is faster when you are with your family members, rather than being in the hospital or so it’s so important that you bring those you know, safety equipment and a safety environment for your family. Because high risk for fall injury happens at home as well.

SC: Yes.

VA: And outside. So it’s so important to make sure, I would say, you’re home safe and ready for anything because we’re in a sandwich generation right now, you know, we have aging parents, but also, we’re caring for grandkids or other family members. So it’s so important that save from your young kids and to your aging parents.

SC: That’s right. There are 65 million family caregivers in the United States. So that is just about everybody. Wow, that’s such a great takeaway. So in a previous episode, with Jay Broadbent, we spoke about the harmony with reimbursement in retail. ACE Medical also had reimbursement and retail harmony. How did that work? And why was education the key to that harmony of reimbursement in retail?

VA: I love this area. Because from day one, you know, growing up as an intrapreneur, with my mom in a retail store, and in the retail environment, it’s always a take away like, just like, if you’re selling something that’s needed in the home, you don’t sell one thing you want to sell and make it like a one stop shop. So from day one, I had this vision of a one stop shop in our store. So literally, as soon as we open and I had a store, I made sure I created an area for bathroom equipments, how it’s set up, you know how you put the transfer bench, the grab bars, you know, everything… what’s needed in a bathroom environment? What’s needed in the kitchen? What’s needed in the bedroom? What’s needed in the living room? Things that makes everyone safe while they are walking in your home. So that was part of it, that retail comes with it. Because always remember, when we have referral or patients coming in for surgery or coming in because of a condition having stroke, they just don’t need a wheelchair. You need other equipment. So with that assessment, you will know by assessing the home environment, what equipment do they need. So I created what we call a package: a wheelchair package, a bedroom package, a bathroom package, because you provide a safe environment for the family. So a good example for wheelchair, you’re not just bringing the wheelchair for patients. That’s the means of mobility, you know, the body is built to move. And that’s your main source of transport. So how you make it comfortable? I would never sell a wheelchair without the back of the seat cushion. Because you need that stability.

SC: Of course.

VA: If you are riding a Handi-van, you need the positioning belt. You need a wheelchair extension handle because you know, when you’re weak, you need a longer handle. You need a wheelchair tray to prepare and put your food. You need a wheelchair bag when you travel, you know? You need a cup holder. So make it a setup in your store to have all of those.

SC: Yes. And doesn’t that follow your golden rule? Do unto others as you would have them do unto you? Isn’t that the treatment you would want if you came into the store?

VA: Yes, treat them like your family. I mean, how would you like to be served? And how would you like envision yourself if–God forbid,–you’ll be in that situation? You want something accessible. Something remains your independence and dignity.

SC: So when it comes to then communicating because some of those items are covered by insurance. But many items are not so then you give them the whole package of packages, and then you communicate and educate them on what’s covered and what’s not.

VA: Yes, definitely. And safety is priority and knowing that they’re safe with that, you know, rather than incurring more. So by preparing them with an environment of safety, it allows them to be independent, but not only that: accessible. Especially when they’re being left alone at home, you know, and they’re preparing their meals, so they need to have those tray or a cup holder, you know, or a wheelchair bag when to go out in the community. So those are things that I think it’s so important for everyone that you’re not just delivering one item. In a walker, there’s a walker tray! There’s cupholders! There’s walker bags! There’s Walker skis! Don’t give them tennis balls. walker skis, you know, make it a nice Aloha–I would say an Aloha walker bags. No don’t give like a black bag! And I love it, Sue, because you made such a big innovation in the industry. I love the colors and everything that you put in for NOVA. So I’m such a fan of NOVA products because I tell people, when I get older, I will need to have something that will match my personality. And I can change anytime with the colors that you created in the industry. It’s just amazing! We just love it.

SC: Well, you’ve always, you’ve always encouraged me with the style and the colors. And when I went to visit you, you’re like, “My store is so beautiful because I have NOVA Products!” I love that. So that harmony did change, though. And in 2019, you hit a breaking point and you made the decision to quit insurance, you went 100% retail and you said goodbye to insurance. Were you scared or worried?

VA: No, I wasn’t scared. I think there was a turning point. I became fearless. I had it, I said to myself, I’m not going to be at the mercy of this insurance company, who is trying to take over and run my business. Being in an island, the cost of doing business is higher in the whole nation. Shipment. I mean, our shipment is almost 1/3 to ½ cost of my purchase order. So those are the biggest challenges. And they don’t understand that. And people right now knowing that a lot of people understand the cost of living here in Hawaii, so expensive. And so people know, well, if I don’t get my equipment, my insurance, but I want to keep my mom in the home setting, they’re willing to buy it. You know, I mean, they’re not hesitant to buy anymore knowingly that they are keeping your mom at home because you know why? Nursing home are more expensive! You know, being such an island.–and Hawaii is such what we call an “ohana environment”. They want to care for the family members at the home setting. And so that’s when we came in to really help with assessment. Honestly, when I first started, I go to the home and do the assessment.

SC: Wow.

VA: They had these big challenges. Let’s say a patient being discharged was a quadriplegic and being called by Queen’s Hospital saying, “Violetta we need your expertise. We had this patient who has a quadriplegic and needs the specialty equipment.” I come in, I made the whole assessment, family trained from the hospital setting all the way to the home, and even help them find home health care agencies.

SC: So you are the one, you are the one that would go into the homes and home assessments.

VA: Yes. And then I train my staff. So always remember, you are not the company. It’s your staff are the pillars. So make sure that when you do your continuing education, educate them first. Because you want the answers from what you educate is consistent with your staff, knowing what you’re training out there.

SC: So when you were telling me about how the customer experience has when they come into your store, it’s a one stop shop, you go and do the bathroom package and the bedroom and kitchen, you do the whole assessment. Say that anybody who walks into your store, if you’re not there, that your any staff member is going to give that customer the same experience.

VA: Yes.

SC: And how do you achieve that?

VA: That’s what’s important for me that as soon as I get back from the conference, I share that with my staff. We right away, we have our staff meetings weekly and say, “Hey, by the way, these are the things that I got out from the conference. And these are the new products.” So bring in the product, show them how it works. And same thing with what are the guidelines, documentation checklists. I download all those documentation checklist. I’m so anal about documentation. The Bible of the industry is the CMS guidelines. And it’s on cms.gov. It’s on your fiscal intermediary arbiter. It’s Noridian, Aetna, Humana, WellCare. We need to know the industry. You need to know about policy and guidelines. You need to know about fraud and abuse. I discuss that it’s important for all of us to operate your business with honesty and integrity and transparency. Otherwise, you’re not going to stay in this business.

SC: So you were one that’s educating your staff?

VA: Yes.

SC: Well, that leads me to this point I want to make. And when you’re running a business and raising a family, and you mentioned three girls, but I have to share that your—

VA: Four!

SC: Four daughters, right? When you first started ACE Medical your oldest was five, but you had one more later. So you have these four daughters. And so you’ve got to prioritize your time for the best ROI for your business and yourself. ROI goes both ways. So your time has to have the greatest impact for your target and yourself. Because it’s equally important that your time invested brings you value in the form of experience, insight and wisdom. And over the years, you kept gaining more experience, insight and wisdom. And I call that double–double ROI. And so you become the Chief Education Officer, I’m a Chief Education Officer, too. Because it’s your priority and where you spend the majority of your time. That’s the double ROI. I mean, you are the one going into people’s homes because you gain so much information from that experience. And that’s why you keep doing it. So then you can then teach your staff. So today, decades later, you truly are the master educator because of all the time, and energy and passion you put into it. So for a dealer or pharmacy hearing this and wanting to do more with education, and their referral sources, and the healthcare community overall, how do you suggest they get started?

VA: Product knowledge is the most important thing before you can get out there. As I told you a quick experience how I was so gung ho, I was such a new HME provider, and I just like, “Hey, I’m gonna make a call on this rehab hospital.” It’s almost like a slap in my face when they said, “Do you know your equipment? Do you know what you’re selling?” And I was like, shocked, and I said, like, “Whoa, I never got confronted like that.” But that was such a challenge for me. And I said, so take the challenge as an opportunity to learn and grow. So I told to this therapist, “Like, I gotta be honest with you, I don’t know much about the equipment that I am carrying right now. But I’m willing to learn. And once I’m learning, I will come back. And I’ll make sure I’ll give you the rest of the equipment’s specification.” And she said, “Okay, I’ll give you the chance.” And we became good friends, lifetime friends and invited on her wedding. So, it’s so important product knowledge, you know, you can never leave that behind to your staff. It has to start from you.

And number two, then educate your staff. You know, as I’ve said, they are the pillars in your company, you know, so when you’re not there, they’re there for you to, you know, take charge.

From there, build relationships as well. So being involved in the communities to volunteerism is one big thing for me. So I volunteered to do health free education for Home Safety. So I go to daycare programs, or nursing homes at one point, they would even videotape and then present it for the rest of the nurses in this nursing home. So they look forward, I kind of schedule what I call a continuing education programs for nursing homes, hospitals, physical therapists, discharge planners, home health care agencies. So I have like, a monthly schedule to make sure I do in services at least three or four times a week, when I first started.

SC:  Wow.

VA: I did that. I was lucky to have my mom live with us and help take care of the kids, and that was a takeaway from me, having a good support system. And same thing with my husband. Jerry was, I would say, was my lifeline to help me, you know, raising the kids, but also making sure that–it’s a hard balance, running a business and running a family. But it can be done when you have a good support system at home as well as at work–at your workplace.

So it’s so important to volunteer, but also give back to your community. You know, so when you get back, they will remember you. So that’s so important. And I was just lucky because of the things that I kind of being part of the community, I got appointed to become part of the board of directors, in fact, on our local Hawaii Pacific Health for nine years.

SC: Wow.

VA: I got appointed for that at the hospital level. And then I get appointed now as Board of Regents at Chaminade University, and advisory nursing board, as well with the School of Nursing. So I think it’s so important to give back, but, but also to realize that you grow and embrace those challenges and transform yourself professionally, and focus on those growth.

SC: Yes. And it sounds to me that product–once you have product knowledge and you have that confidence, and you have the customer or patient experience, then you have the confidence to go out to really any platform, and to be an educator and an advocate for people. And so product education, it sounds like is the key to getting started. So that’s a great starting takeaway for our listeners.

And so gosh, our time has flown by so quickly as I knew it would when we chat. Two big takeaways and wells of inspiration from this conversation is one: be the master educator in your community because education equals advocacy, expertise and empowerment. And we have learned this from you today. So get out there and work with your referral sources do in-services, do home assessments and be out in the community. And the second takeaway is love your relationship with change. You’ve had a very long, healthy and dynamic relationship with Mr. Change. Share with us how you keep this relationship strong and healthy.

VA: Okay, always remember: self-care. So important, okay. So even, as I’ve said, make those challenges become opportunities for education, and learning new things. So learning is continuous, it never ends. So I always love to learn new things. So when there are changes, embrace them, you know, be fearless. So always think positive amidst challenges, you know. And I would say like, with embracing challenges, you learn to uncover your hidden strength from there. And not only that, you have to surround yourself with good people. And always think positive. You know, try to ward yourself with negative thoughts. When you start doing that. Get out on your chair, go take a walk, go run, do yoga. So I’m an avid runner, I run marathon, I’m proud to say I finished the New York Marathon, the Honolulu Marathon. I did Napa, and I’m doing my third San Francisco marathon, the end of July.

SC: That is AMAZING, Violeta! And the thing is that you are a younge person, be we all kind of know that you have had your business for years—

VA: I’m not young! [laughs]

SC: So that’s what I mean. I say it in air quotes that you’re young. That’s tremendous. You’re constantly pushing yourself mentally, emotionally, and physically.

VA: Yes. And it’s very important, you know? The only way for you to take care of others is you have to take care of yourself first.

SC: Rule number one.

VA: And everything falls.

SC: You have to put on your oxygen mask first before you can give it to somebody else.

VA: Yes.

SC: So how does the future look like for you and ACE Medical. My goodness… it has been a journey for you and your family.

VA: Well it’s succession planning. So I’m hoping my daughter #3 who is getting married soon with a husband who is—a husband to be who is also an entrepreneur. We kind of talked about it already. So I’m hoping that the next journey for ACE Medical is for them to transform to the next level. More on e-commerce, but not only that, keeping what I have right now so I have another company that really kind of—I do case management, so I have a contract with a local state program, so that’s so important for me as well. So because we call it program that doesn’t sunset because we are a rapidly aging population, and the need is bigger and greater more as all of us will be in that population. So it’s important to I would say mentor the new generation.

SC: That’s such a wonderful takeaway. And thank you for that inspiration. I want to give you a big mahalo, Violeta, for being extraordinary and inspiring in our industry. And I know our listeners feel the same way and I’m going to be sharing your incredible assessment forms with our listeners today so that you can really see these amazing tools and use them in your own quest of being a master educator. I also want to thank our listeners for listening this podcast. This is number 6, and f you like this podcast, feel free to rate it and also give me your feedback. You guys know where to find me. And then lastly, I just want to thank you for all that you do, Violeta, and everyone listening to this podcast and remember, that you are the most interesting person in any room. Alright, thank you and take care!

Sue and Violeta continue to chat. Here is 45 seconds of bonus content.

VA: Be fearless. You know? My mom told me, like, “you never know until you try.”

SC: You never know until you try. That’s right. And trying always seems scary until you’re in it, and you’re like, “Oh! This isn’t so bad.”

VA: Yeah, yeah! Because how would you know if you don’t try? And hey, you learn from your mistakes. If you fail, hey, bounce back! Be resilient. So for me, it’s really interesting sometimes because I feel like I wouldn’t be here if I didn’t have those challenges came across with me growing up and even coming to America. I was by myself, Sue. Landed in America, with no one except, like the other people who are not your family, and starting a new life. It was like, scary. But you know what, I wasn’t scared.