The NAHC Strategic Planning Congress: Setting an Agenda for Action
April 15, 2014 09:20 AM
“We’re all a product of decisions we make in our life,” NAHC President Val J. Halamandaris recently told attendees at the NAHC Strategic Planning Congress. “The fact that you have taken the time away from your business to be here says it all. You’re making an investment in the future. You’re making an investment in NAHC and all your patients, especially the 78 million baby boomers who are going to need home care and hospice. Without us they’re not going to get what they want,” he warned. “So I commend you for choosing to be here,” he told a group made up of NAHC’s board of directors and heads of its Forum of State Associations, along with key leaders of home care and hospice.
The Strategic Planning agenda was designed to give home care and hospice a unified vision, imbue it with a fresh sense of mission, and chart a course ahead. All three are needed because life’s no beach right now for home care and hospice. The industry faces new rules and laws that pose problems for both providers and patients. “We’re being besieged on all sides,” said Michele Quirolo, president and CEO of VNA of Hudson Valley. “Unless we take time to get together and come up with an action plan, our industry will suffer. This is a good time to connect with people in all aspects of home care and hospice.”
“We need to come away with a unified plan that addresses the onslaught against home care so we can engage with our members.” And to succeed at it, “you need the most current information,” Quirolo explained. “I don’t want to read a 500-page bill, so I’m glad NAHC does such a good job of synthesizing what’s coming out of Washington, DC. The bottom line is you need to be informed. Coming to a conference like this is the easiest and best way to do it.”
To establish where DC is going, Halamandaris convened an expert panel of NAHC staff: Jeff Kincheloe, vice president for government affairs; Bill Dombi, vice president for law; Theresa Forster, vice president for hospice; Mary Carr, vice president for regulatory affairs; and Richard Brennan, vice president for technology policy. The panel discussed possible Medicare cuts, the implementation of health care reform, proposed home health copayments, proposals to pay for the SGR, face-to-face requirements, Medicaid, the employer mandate — and especially what’s on our lawmakers’ minds.
The consensus was that Congress is torn between saving home care and saving taxpayers’ cash. “The good news,” Kincheloe said, “is that there are members of Congress who see home and community-based care at the center of health care reform, so there are opportunities out there. The bad news is that lawmakers are eager to cut spending to Medicare fee-for-service providers,” like many of those in the room. “This is wonderful Washington,” Dombi said tongue in cheek. “They all tell you how much they love the home health benefit, but they don’t want to give it the support it ultimately needs. Entitlement is a dirty word in Washington today. It goes hand in hand with budget deficits. But advocates for home care are in a stronger position than those who want to do it damage. We can derail a lot of those things that are intended to do nothing more than spend less money,” Dombi pointed out.
Home care will find it harder to function if Congress acts on the president’s proposal to put in copays for Medicare home health. “The president’s proposal is probably the most reasonable of the ones that are out there,” Kincheloe said, “but it’s still egregious. It would be $100 for an episode beginning in the community if it hasn’t been preceded by a hospital or community stay. It would begin in 2017 and would apply to new Medicare beneficiaries who become eligible that year and beyond. If they go for that, our fear is they might choose to eliminate restrictions like implementation date. And of course we think it’s absolutely goofy to have to put someone in a hospital before you can give them home care.”
This attack on the home health benefit, Dombi said, “makes us feel like we’re under siege,” as does the recent rule to rebase home health by 14 percent over the next four years. The reason for the rule, Dombi explained, “is we’ve been too successful. The way MedPAC measures success is through profit margins, and their view is our profit margins are too high.” But what does too high mean in the commission’s view? “If you were to ask MedPAC commissioners what is too high, they would say anything above zero,” Dombi laughed. “They truly don’t understand what it takes to run a business. They rarely put their feet on the ground to understand that you have to make payroll, let alone invest in new technologies. Moreover, MedPAC doesn’t take into account all the accumulated cuts over the years. Somehow home care agencies manage to cope with payment reductions, so they’re testing you to see how far you can go before you break. The image of fraud and abuse is also an excuse to cut rates and make new rules. So we’ve given some constructive proposals to Congress and CMS for saving funds through value-based purchasing.”
Will they listen? CMS probably won’t, Carr scoffed as she recalled the constant complaints she’d heard about CMS. “Face-to-face is on top,” she said, “because of all the denials related to the rule. And this is a symptom of a much bigger problem. CMS is really scrambling about how to handle fraud and abuse. They’re using a lot of patchwork mechanisms, including 16 contractors who are doing medical reviews and tripping over one another. But face-to-face gets all the attention, and the only thing I can advise those of you who are out there working hard is to take it one day at a time.” And keep your eyes open, she advised. “We don’t know what they’re going to drop on us next.”
But one thing is clear, Dombi added. “Face-to face is an administrative burden beyond any administrative burden. It benefits the bad guys and burdens the good guys. But CMS has pretty much turned a deaf ear on this. We have a state of confusion about what acceptable documentation is, but CMS is absolutely convinced this rule is working because spending is down on home health. And spending is down not just in those areas they thought were risky. It’s down in all parts of the country. So it’s time to complain, and the complaints need to come from physicians. We’ve got to get the physicians to complain to their members of Congress, as well as to CMS. And maybe it’s time for us to file a lawsuit on the face-to-face encounter. We need to stand up for ourselves once again, even if there are risks involved. Sometimes you have to get punched in the face.”
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