Excerpts from DC presentation

I received a few emails and comments regarding this post and the fact that I photographed (unflatteringly) a copy of my remarks for the meeting I recently attended in Washington DC. I was asked if I would be willing to share the text. Here are some excerpts (it was meant to be delivered without reading directly from the page, so I veered off at times… here are the high points):

Good Afternoon and thank you for this opportunity.

My name is Rey Spadoni and I am the president of the VNA of Boston… and I am proud to state that we are now celebrating our 125th straight year of providing care to individuals in their homes in the Greater Boston area…

For 125 years, we have provided care all over the Boston area, including in some of the toughest neighborhoods and housing developments in the city. I myself have worked in the health care industry in Boston for almost 30 years and can say without hesitation that our nurses and physical therapists consistently go to places no one else will. And we take care of everyone, regardless of their payer, or any other, status. I would prefer to comment to you here today that such distinctions no longer matter in our society, but they do. Regardless of them, however, our organization treats everyone the same. With compassion, and respect, and state-of-the-art medical care services.

Our patients are, for the most part, very sick… the average age is about 70 for non- maternal child health services and 60 years of age, on average, overall. And they are sicker now than they were even just five years ago as hospitals are increasingly getting people out of the hospital faster. At the acute care hospital where I worked, we routinely discharged patients who just a few years ago would have been considered too sick to go home. And so, sicker patients are going home and we are increasingly being called upon to go provide care to them.

I mentioned that I have been in this field for 30 years. That has included serving as an acute care hospital executive, an HMO executive, I ran an inner city community health center and worked for a large physician group practice. Those types of settings are vital to the health care system, but I can say without doubt that the provision of high quality health care services in the home helps to keep patients in their homes longer… and out of those far more costly settings. When home care is done right, it is a bargain.

The fact is that the services we provide are an exceptional financial deal for the Federal government: we provide the highest quality care… at the lowest possible cost to the Medicare program for people needing post acute care services.

And that is just what we do for Medicare.

We also take care of a lot of Medicaid clients, which is a tremendous challenge, not only because they often come to us with complex social and economic circumstances that complicate their medical care, but also because the state who sets Medicaid payment rules consistently pays us at levels below our costs…

As has been discussed, the health care reform law that just passed includes some graduated reductions in Medicare payments to home health over the next few years. These have us concerned, not only in terms of how they will impact us in the long-term and our ability to care for our elder clients, but also on our ability to recruit and compete for nurses in a very tough medical marketplace in Boston…

It has us immediately concerned because, as has been discussed, the health care reform bill rightly includes some provisions and incentives for states to stop spending as much money on nursing home care and be more creative in terms of home based services. These are goals that we support on behalf of our patients who would prefer to stay at home with us rather than be in an institution. The data is compelling: patients who stay at home longer experience better health outcomes, it costs the Federal government less, and patients’ quality of life and personal dignity is enhanced.

But as I mentioned previously, right now at the VNA of Boston, which is already a significant safety net provider for the Commonwealth of Massachusetts for people needing long term care, we currently lose… on every nursing visit we make to a Medicaid client. And the Home Care Alliance has similar data for agencies in Lawrence, New Bedford and Springfield.

I come here today not specifically to ask Congress to help make state Medicaid payers become better payers for long-term community services, though that would obviously be appreciated.

What I am asking that you understand a few things broadly, and do a few things specifically.

First, please understand that how MEDPAC characterizes home health profits and home care in general is not indicative of the bottom line for a lot of agencies such as the VNA of Boston. I hope you can appreciate that we have a different story to tell. Please know that you cannot paint all home health agencies together with one broad brush. Not everyone strives to maintain the highest standards of measurable outcomes. Not everyone goes into every neighborhood to care for patients. Not everyone cares… for everyone. But, for organizations such as ours, we simply cannot sustain any further cuts than those already proposed and still continue to do what we do.

Second, please understand that home care agencies are the solution to many of the problems of health care costs we all saw and debated in the recent health care reform effort. I mentioned previously that I have worked in the hospital, insurance and physician group practice industries and I can assure you from my own experience that home care works. That home care makes sense. That it is a very important part of the solution. Please help us to preserve it.

Specifically, we need support with the complex issue of deciding who pays for home care when someone is dually eligible for Medicare and Medicaid. Without going into great detail here, home care agencies are stuck in an administratively costly tussle between states and the Federal government on this. In your packets is a letter signed by many in the Massachusetts delegation asking CMS to fix this. If they won’t do it administratively, we need your help with a legislative change. Lisa and Congressman McGovern have been leading the fight on this… and this is one we should be able to resolve.

Thank you for this opportunity today. Thank you for your past support. I hope you will remember one thing from my remarks and that is that home care is a viable mechanism to reduce costs and to improve quality. But not every home care agency is the same. On behalf of the ones who care for everyone in their service areas, the ones who are motivated by their missions, and the ones who effectively keep people out of more costly settings… we do need your help.

Thank you.