29:23 to watch
In this episode of the Claim to Fame podcast, Todd Usher, founder of Tactical Back Office, shares his extensive journey through the healthcare and DME space.
What’s Covered?
Todd talks about his early beginnings as a delivery technician, his transition into management, and the eventual founding of his companies: Tactical Back Office and Tactical Call Center. He outlines the challenges and evolution of the DME industry, emphasizing the importance of adaptability and fortitude. Todd also provides valuable insights into how Tactical Back Office addresses staffing issues and the benefits of tapping into offshore talent.
Additionally, he explains the differences between actual intelligence and artificial intelligence, offering his perspective on the future of AI in healthcare. The episode concludes with a fun rapid-fire segment where Todd shares some personal preferences and future aspirations for his businesses.
Podcast Transcription
Podcast: Claim to Fame – The #1 DME Podcast
Guest: Todd Usher, Founder of Tactical Back Office
Hosts: Alex, Wayne (NikoHealth)
[00:00] Introduction
Alex opens the episode by welcoming Todd Usher, founder of Tactical Back Office. Todd thanks Alex and Wayne for having him. The hosts frame the conversation around Todd’s long history in DME, his multiple companies, and the lessons he’s learned along the way.
[00:45] Todd’s Background & Entry Into DME
Todd shares how he entered the industry in 1996. At the time, he was stuck in a cubicle doing cold calls and wanted a job that allowed him to work outdoors. A friend referred him to a local DME company where he became a delivery technician. He recalls not even knowing what a nebulizer was when he started.
As he grew in the field, he moved into management roles, joined a national provider, and eventually worked for a manufacturer – an experience he says truly taught him the business. Over the years he founded several companies: Home Oxygen Company, Easy Sleep Club, Tactical Back Office (formalized in 2019), and Tactical Call Center (launched in 2024).
[02:20] The DME Industry in the 90s
Todd describes the late 90s as an analog era. The internet was new, servers failed often, and cloud systems didn’t exist. Deliveries included heavy K-tanks and full liquid oxygen routes. Patients needed to schedule in-person time with RTs, and almost everything involved paper and manual processes. It wasn’t archaic, he says, but definitely old school.
[03:50] What Pushed Todd Into Entrepreneurship
The turning point came when portable concentrators and the non-delivery model hit the market. Many in the industry rejected the new technology, but Todd saw tremendous potential. He noticed only a few providers nationwide embracing it and felt energized by the opportunity. That excitement, combined with confidence in the technology, pushed him toward launching his own ventures.
[04:30] Lessons That Shaped His Career
Todd explains that the biggest lesson he carried into every company is fortitude. In sales and operations, he learned to take hits, stay positive, and avoid dwelling on setbacks. “Turning lemons into lemonade” became a personal philosophy that sustained him through years of reimbursement cuts and operational challenges across the industry.
[05:10] Understanding Provider Struggles Firsthand
Todd’s understanding of provider pain points began during his early years as a tech. Patients constantly requested portable oxygen concentrators, yet every provider dismissed the idea as uncovered or unavailable. Todd discovered a way to make them viable through insurance when paired with a stationary unit. That insight, saying “yes” when the industry defaulted to “no”, helped shape his customer-first approach.
[06:40] How Tactical Back Office Was Born
TBO emerged out of necessity rather than a strategic business plan. Todd describes years of eroding reimbursement, culminating in the 2016 competitive bidding cuts. Meanwhile, minimum-wage hikes in California and New York squeezed margins even further.
He found a staffing opportunity in the Philippines and hired his first offshore team member in 2016. The impact was immediate – ROI appeared the very next month. Over time, he replaced more internal positions with offshore roles, until eventually about 95% of his companies were staffed through Tactical Back Office.
[08:30] What Tactical Back Office Actually Does
Todd clarifies a common misconception: Tactical Back Office is not an outsourcing or BPO operation. Instead, it functions as a staffing partner. Providers maintain control of their workflows (billing, intake, customer service, order processing) and TBO supplies trained personnel who integrate into those systems.
Many clients start with one or two hires and quickly scale up once they see the consistency and reliability of the model. Todd jokes that he can usually tell the exact month when a client “drank the Kool-Aid.”
[10:40] Why Providers Choose TBO
While cost savings matter, Todd says the most frequent compliment TBO receives is far simpler: “Your people show up and work.” Reliability has become a differentiator in a labor-constrained industry. Todd’s own experience running a DME company adds credibility; he understands client frustrations because he still lives them.
[12:00] How Todd Manages Multiple Companies
Todd explains that he directs his time based on priority and urgency – “whoever is yelling the loudest.” Each company has its own management structure, allowing him to focus on strategy, direction, and meeting expectations rather than daily operations. He describes the role as part leadership, part firefighting.
[12:45] Tactical Call Center: The Service-Based Sister Company
Unlike TBO, Tactical Call Center (TCC) is a true service provider. It handles live inbound and outbound calls, including after-hours support, 24/7 coverage, and lead qualification campaigns. The offering serves not only DME providers but organizations across the broader healthcare ecosystem.
[14:00] Predictable Performance: What It Means to Todd
For the call center, predictable performance means fast answer times, no voicemail loops, and resolved issues whenever possible on the first call.
For Tactical Back Office, predictability comes from a deep, structured training program (often up to 16 weeks) where candidates learn EMRs, billing basics, customer service processes, and work in live environments before placement. Some clients provide their own training playbooks; others rely on TBO to handle nearly everything. By the time a worker starts, Todd says they are typically “80–95% trained.”
[17:00] The Future of TBO & TCC
Todd expects strong growth ahead for both companies. Labor shortages remain widespread, and qualified staffing is still one of the biggest challenges in DME. Because he has proven the model within his own businesses, he believes TBO will continue to help providers right-size operations and build sustainable cost structures.
He notes that some companies have been launched entirely with TBO staff and have succeeded, a testament to the model’s strength.
[18:30] Actual Intelligence vs. Artificial Intelligence
Todd shares his well-known line: “We have actual intelligence.”
He acknowledges that AI is powerful, but says it remains expensive and often impractical for small and mid-sized providers. Human beings offer flexibility, judgment, and the ability to shift roles – qualities that AI cannot yet replace. While he believes AI will play a larger role eventually, for now he sees people as the superior solution for healthcare operations.
[20:15] Todd’s Advice for Healthcare Entrepreneurs
Todd offers candid guidance for anyone starting a healthcare business. Healthcare is stable and always in demand, but it requires resilience. Regulations, reimbursement challenges, and staffing complexities can overwhelm newcomers.
He once jokingly advised someone to “open a car wash instead” because of instant payment and no DSO, but acknowledges that those who are committed to healthcare can build meaningful, long-lasting careers, if they develop thick skin.
[22:00] Rapid-Fire Round
To close the episode, Alex and Wayne run through rapid-fire questions. Todd answers instinctively:
- Pizza for breakfast or cereal for dinner? Todd chooses pizza for breakfast.
- Teleport anywhere or time travel once a year? He picks time travel once a year, adding that he actually owns a DeLorean.
- Unlimited free flights or unlimited free gas? Todd selects free flights, especially since his fleet is moving toward EVs.
- Pause button for life or rewind button for life? He chooses a pause button.
- Stuck in traffic forever or always have slow internet? Todd opts for slow internet, since at least he can reboot a router.
[24:00] Closing
Todd invites listeners to reach out through the website, and says he’s always open to connecting directly. Alex and Wayne thank him for joining the show and close out the episode.
Explore More Episodes