This blogger has carped on this theme before (here's an example), but this past week has certainly punctuated the point. The Visiting Nurse Associations of America gathered in DC to consider a number of legislated and, in some cases, proposed changes to regulations governing the home care industry. Here's the backdrop:
- The recently enacted Patient Protection and Affordable Care Act significantly expands coverage and seeks to restrict the growth of health care expenditures. Some of those latter changes are immediate (e.g., massive cuts to home care) and others are more gradual (e.g., creating pilot programs designed to test changes to how systems of care are reimbursed and creating quality-based provider incentives).
- The current political climate is stressing deficit reduction and the rightward-leaning agenda is gathering steam as we barrel toward mid-term elections.
- Some opportunistic home care companies have been widely profiled (e.g., as in the referenced blog post above) for excesses and rule-bending gamesmanship that has, frankly, given much of the rest of the industry a black-eye.
- Significant positive Medicare margins have given the Centers for Medicare & Medicaid Services (CMS) reason to consider systematic "corrections" to payment methodologies.
Home care agencies who are selective in who they care for and who have been able to consistently attain 10 to 20 percent positive bottom lines can withstand a 5 percent cut. Organizations who care for everyone and who routinely reinvest funds into programs for their patients (hence the much smaller profit margins) are not going to fare nearly as well.
In DC, we had an opportunity to meet with Congressional leaders (and their staff) from the Massachusetts delegation. These include Congressmen McGovern, Markey, Capuano, and Lynch and Senators Kerry and Brown. Their ongoing support of this industry is widely recognized and most appreciated. Despite it, however, the policy direction in Washington is to aim for the middle of a lumped together pack, rather than to differentiate based on quality, performance and approach.
Ultimately, this fight is about compassion, quality and exceptional health care services for home bound and vulnerable patients. It's about doing the right thing. And... it is about dollars and cents. However you slice it, though, aiming toward the middle just won't work.