Punishing the Solution

A collection of thoughts regarding the recent cuts to home health services:

I met a brand new mother whose son had just been discharged a day or two earlier from a high tech hospital neonatal ICU. The infant, born prematurely, suffers from serious heart defects and respiratory problems and has survived three complicated operations already. His eager, loving mother gingerly and anxiously held her baby, unsure and worried. Then the nurse confidently and reassuringly took hold of the child and weighed him on the portable scale she brought into the home. She placed a small stethoscope that she had warmed with the palms of her hands over the child’s tiny thumping chest and carefully examined him with skill and poise. After a few minutes, she turned her attention to the mom. The visiting nurse instructed her on how to care for the child and then, before we left together, showed the mother how best to hold him, teaching her that holding him often was best.

And then there was the elderly man who lives alone in a third floor apartment building. He felt bewildered and overwhelmed when the hospital staffer read his complicated discharge instructions and asked him to sign the triplicate hospital forms. When we entered his home the next morning, the physical therapist I accompanied, before he did anything even remotely resembling physical therapy, reviewed the discharge papers and carefully and clearly explained them to the man. And when we left forty-five minutes later, I marveled at the transformation I had just witnessed - a transformation where despair and confusion gave way to anticipation and hope.

Not-for-profit home health agencies, such as the Visiting Nurse Association of Boston, do not construct sprawling medical complexes and we do not purchase multi-million dollar technological marvels. The wares of our trade are exceptional clinical skills and limitless compassion…. all brought to the one place most of us want to be – not a high cost institutional setting but our own homes.

The recently passed health reform law rightly focuses on improving access to care and curbing the high costs associated with providing that care. Unfortunately, the home health industry has experienced substantial reimbursement cuts in the process. The logic holds that there are home health corporations and agencies that have been able to generate vigorous financial margins, thus suggesting that the Federal Government has historically overpaid for services. But organizations such as the VNA of Boston have never been motivated by the quest for financial margins. We began 125 years ago on the waterfront in Boston, seeking only to provide care for those who require our assistance and today we are the largest provider of home health care services in the region for those in need regardless of ability to pay. The VNA of Boston does not turn anyone away and our 125-year track record of doing so will never help us to generate vigorous financial margins.

We are preparing for over $2 million of cuts to our reimbursement, challenging our ability to continue to meet our mission and to remain viable. More importantly, the reimbursement cutbacks pressure the one segment of the health care industry that can unquestionably demonstrate that we are the most efficient and best health care investment for taxpayers. A typical four-day hospital stay can cost over $20,000 while a typical three-week visit from a home care provider will cost far, far less. In Massachusetts, 28% of all home care patients will ultimately be readmitted to the hospital during their home care treatment. By investing in state-of-the-art information systems, creating intensive training programs for our staff, and developing clinical centers of excellence in diabetes and cardiopulmonary disease and others, VNA of Boston patients are readmitted at a rate of 25%. That three percent difference applied to large populations can result in billions of savings annually.

Recent Federal payment decisions have left us besieged and distressed. If organizations such as ours do not survive, patients will be forced into more costly settings. The infants, mothers and seniors we care for today will not fare better without skilled and compassionate home care.

Access to care and reducing medical costs are worthy goals. Visiting nurse associations have been devoted to these goals for decades and, in our case, for over a century. We have not been the problem… we have been the solution.