Hospice DME contracts rarely end because of one bad delivery. They end because, at renewal, the agency's director of operations has a vague feeling that "things have been slipping," and the supplier has no numbers to show otherwise. A quarterly business review (QBR) fixes that. It gives both sides a shared set of facts, surfaces problems while they're still small, and turns renewal into a formality.
Here's how to build one that agencies actually want to attend.
1. Agree on what "census" means before you show a single number
Most QBR arguments are really definition arguments. The agency's census and your active-patient count will almost never match, and that's fine, as long as both sides know why.
- Agency census is usually patients on service with the hospice on a given day, whether or not they have equipment.
- Active DME patients are patients with at least one item currently in the home or facility.
- Billable patient-days depend on your contract: per-patient-per-day, per-item, or a hybrid.
Write the definitions on the first slide and keep them the same every quarter. If the agency counts census at midnight and you count at delivery, say so. Track the ratio of active DME patients to census over time. A drop can mean the agency is sending equipment orders elsewhere.
2. Deliveries and pickups: volume and mix
Show totals for the quarter, broken out by type:
- New-admission deliveries
- Add-on deliveries (new items for existing patients)
- Exchanges and repairs
- Pickups after death or discharge
- Pickups of individual items no longer needed
Split by urgency (routine, same-day, STAT) and by setting (home vs. facility). The mix tells a story. A spike in STAT orders may point to a gap in the agency's admission workflow, not just a busy quarter. Pickup volume matters too. Equipment left in a home after a death is a cost to you and an uncomfortable moment for the family.
3. On-time percentage: define the window, then report against it
"On time" means nothing until both sides agree on the window. A common structure:
- STAT: delivered within X hours of order
- Same-day: delivered by end of day when ordered before a cutoff
- Routine: delivered within the agreed scheduled window
- Pickups: completed within X hours of request
Fill in X from your contract. Report on-time % for each category, not just a blended number. A 96% blended rate can hide a 78% STAT rate, and the STAT rate is the one the agency's on-call nurses remember. For every miss, keep a short reason code (driver availability, wrong address, patient not home, item out of stock) so you can show it was handled, not just counted.
4. Proof-of-delivery rate
Proof of delivery (POD) protects both of you: you get paid, and the agency has a record if a family or surveyor asks what was in the home. Report:
- POD capture rate: the percentage of deliveries with a signed, timestamped POD
- Exceptions: deliveries missing a signature, photo, or serial number, and how long they took to resolve
- Pickup confirmation rate: the same measure, applied to pickups
If your POD rate is below 100%, show the trend and the fix. Agencies will forgive a gap you've caught. They won't forgive one they find themselves.
5. Per-agency billing that reconciles
Billing disputes are where contracts quietly die. Give each agency an invoice that reconciles to its own census and orders, with:
- Patient-days or item-days billed, by patient (using whatever identifier the agency prefers)
- Start and stop dates for each item, tied to the delivery and pickup records
- Credits issued and why
- Disputed lines still open, with their age
The goal is that the agency's billing contact can match your invoice to their records without calling you. If you serve several hospices, keep each agency's data separate. Never show one agency another agency's numbers, even in aggregate, unless you've both agreed to it.
How to run the meeting
Who attends. From the agency: the director of operations or administrator, someone from clinical leadership, and billing. From your side: the account owner and your operations lead. Keep it under 45 minutes.
Send the packet 48 hours ahead. Nobody should see numbers for the first time in the meeting. Use a one-page summary with the five sections above, plus an appendix.
Agenda:
- Definitions and headline numbers (5 min)
- What went well, with one specific example (5 min)
- Misses: on-time, POD, and billing exceptions, each with root cause and fix (15 min)
- What the agency is seeing: new referral sources, census changes, staffing, new facilities (10 min)
- Commitments for next quarter, with owners and dates (10 min)
Bring the misses yourself. The most important habit in a QBR is putting your own problems on the table first. It builds more trust than a perfect scorecard.
End with written commitments. Send a short recap within a day: what you agreed to, who owns it, and when you'll report back. Next quarter's QBR opens with that list.
Make the data easy to pull
Most suppliers skip QBRs because pulling the numbers takes days of spreadsheet work. DME Engine tracks orders, deliveries, pickups, POD, and per-agency billing in one place, so your QBR packet is a report, not a project. It's $200/month for 10 users.
Book a 15-minute demo at dmeengine.org and we'll walk through what a QBR packet looks like with your own workflow.