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Homecare vs Homecare

There is much philosophical talk about being divisive in our healthcare.  I don’t have a problem with being divisive.  This is my website and I can write what I want.  I am the senior editor – make no mistake. 

I do hold myself to certain standards, though and I think I may have fallen short on Monday and understated NAHC’s position on the Caps Limitation bill.   What I wrote was that both NAHC and The Partnership denied involvement regarding the introduction of the bill. 

In a nutshell the facts are:

NAHC – The organization that represents home health care and hospice on a national level has spoken out against the caps.   This is exactly what Bill Dombi of NACH wrote to me:

We do not support the episode cap and, in fact, have actively conveyed our opposition to Senate and House members.

The Partnership – A group of publicly traded homecare companies, plus a few stragglers, originally drafted the language in the bill but denies knowledge of how it was introduced.  This is what Eric Berger of The Partnership wrote in an email to me:

Like others throughout our community, the Partnership views targeted program integrity reform as a preferable alternative to further across-the-board cuts or the reimposition of cost-sharing that would impact innocent beneficiaries and their compliant providers. 

There’s only one sentence but if it were clinical documentation it would result in a denial.  Here are just a few of the questions it raises:

  1. Who are the ‘others’ in our community?
  2. Targeted Program integrity reform is what exactly?  Capping episode limits based on an arbitrary number determined by people who have never laid hands on a patient? 
  3. If there are innocent patients and compliant providers, does that mean that there are guilty beneficiaries?  Is that where the problem lies? 

As I stated in a post last week, there are some people who simply cannot write.  I cannot dance, remember?  The next email I received late Sunday night left no doubt about the position of the Partnership.  Again, from Eric Berger:

As for the Partnership’s plans with respect to this bill, we will not be taking any action on it — our total focus is on the rebasing and face-to-face regulations that pose a significant threat to our community. 

Initially, I was not going to make a big deal about this.  My concern is the bill itself – not The Partnership.  The members of The Partnership pay serious money to be a part of the elite group of companies that pay for lobbying efforts designed to benefit their companies.  Whether you like it or not, I do not believe there is anything illegal about it.   

So while it is very true that both NAHC and The Partnership deny having anything to do with the introduction of the bill, their positions on the bill could not be further apart.  I think that my original post would have been better if I had highlighted these differences.

Because honestly,  while I believe Eric Berger when he says The Partnership had nothing to do with the introduction of the bill, I worry about  his documentation skills.  He’s like a nurse who leaves the vital signs section blank and states the patient is stable.  We assume the nurse forgot to document the vital signs but it may be that the patient is dead.

10 Comments Post a comment
  1. Christie #

    your first post on this really sent me reeling. A member of HCAF(the Fla association) posted about it the very next day with a call to action. By the afternoon, HCAF posted the following to it’s members:Members,

    It is great to see you taking notice of meaningful legislation that is being filed which would have large effects on the home care industry. I would like to take this opportunity to assuage some of the very reasonable fears of this bill.

    In speaking with the legislative affairs department of our national organization, NAHC, we have learned that this bill has zero chance of moving through the process and being passed. While we oppose any measures to be filed which would bring harm to our industry, we wish to use our resources to best influence policies that are more likely to have a direct consequence on home health.

    Leaders in the U.S. House of Representatives have assured us that this bill will not be allowed to move through the process. In addition, the current gridlock in the U.S. Congress prevents most legislation from passing, meaning changes occur almost only through rule-making.

    As always, we applaud our members who are willing to contact their legislator and let them know how they feel about policies that affect the home care industry.

    You may look up your legislator and their contact information at our website here:

    If there is any additional way that I can help or provide information, please do not hesitate to ask.

    With Best Regards,
    Christopher Lipson v Director of Government Affairs and Member Advocacy v Home Care Association of Florida (HCAF)

    While I fully intend to follow this closely, I know how busy you are with all the audits right now and hoped this might alleviate some of your concerns. Please keep up updated as to what you hear.

    October 16, 2013

    • I had heard that the bill had about a one percent chance of going anywhere and I was going to leave it alone after the first post but I really needed to clarify NAHC’s position.

      My position is similar to yours but a little focused on the patients themselves. If I honestly believed that there was a better alternative to home health, I would sing it’s praises loud and strong. I am naive enough to really believe in the nurses taking care of our patients and smart enough to know that we, as an industry, are not living up to our potential. We never will as long as we are the subject of such intense scrutiny.

      I do not believe that the two representatives who introduced the bill got together at lunch and came up with an idea that matched The Partnerships proposal without any input from home health. I really get my socks in a knot when an ‘anti-fraud’ bill is a thinly disguised law that benefits some agencies at the expense of others without regard to whether the agencies involved are fraudulent or not. So, whoever put this bill in front of the representatives is on my list.

      I did hear a rumour that the federal government was shut down now that you mention a gridlock. It sucks to have the zoos closed. Other than that, I haven’t really missed it.

      October 16, 2013

  2. I think you make a salient point Julianne. There is very little solicitation of input, opinion and data from home health executives or their state associations. Congress, CMS, and MedPac look to NAHC, the partnership and lobbyists for their direction when proposing legislation and changes for regulation and reimbursement. They need to get in the trenches and see what our nurses, therapists, and aides really do on a day-to-day basis. Extraordinary effort and improving outcomes and patient satisfaction. The numbers are changing and in the right direction. By the way, the government is about to open the zoos again Julianne…happy days are here again.

    October 16, 2013

    • Happy Days, indeed!!!

      You are right, of course, but I would add that communication is two ways. One of my favorite jobs is working with a software vendor. I love it because they don’t speak nursing and I don’t speak tech. It’s a challenge to articulate what I think should be in a program in such a way that the software peeps hear what I am saying. In the same vein, nurses should not wait to contact their associations, congressmen and MedPac to ask them for information. They should offer it whether it is welcome or not.

      Christopher Lipson just posted a link where agencies can contact all their legislators. I think it would be a fine idea if all the agencies invited all the representatives and senators to go on a home visit. Gonna be in Lafayette on Wednesday?

      October 16, 2013

      • I agree Julianne. We will begin the process. I stay in touch with one member of MedPac that Lisi and I met in Baltimore at Johns Hopkins. He is almost always voting in favor of our patients interests in home health. He is now in Austin, Tx and has about a year left on the Committee. See you at the zoo.

        October 16, 2013

        • I will be in the primate section.

          October 16, 2013

      • Software vendors:
        I had to cackle – I speak nurse, and I speak Geek, and most of those that you would speak to as a non-IT person speak neither. So don’t feel bad about it. Invite your vendor out on a visit, maybe they’ll learn something.

        Hey, maybe we should all invite Bill and the other suits in NAHC to come out and go on a visit too. No offense to those of you who are not suits. And who answer our tireless questions. We really do love you.

        My big boss, he’s an MD not a nurse, commented that those of us who work in the field but don’t see patients, can lose site of why we became health care providers in the first place.

        And those of you in Texas, please invite Senator Cruz to go visit someone who is alert, oriented and total care and would not be home without their Medicare benefit 🙂

        Sorry, got way off topic here.

        October 16, 2013

        • I hope your boss gives you a bump in pay for being bilingual! You deserve it.

          Mr. Dombi has been invited by me to go visit patients. I think a day down the bayou would do him a world of good. He might be a little overwhelmed by the quiet respectful demeanor my cajun folks show him. Since they do not wear a suit unless a close family member has died, they will all feel really sorry for him. I’m sure he will come around eventually. Then I will send him your way to brush up on his spanish skills and we might as well teach him how to inject insulin to all those diabetics you have. Funny how the number of episodes and the percentage of diabetes are both doubled in those areas the partnership has identified in TX as being fraudulent. Of course, it is the same area where they cut off people’s heads so maybe the feds are worried about decapitations instead of capped episodes in that area. Seems strange that they cut off heads when we gave them all those guns in Fast in Furious but I digress. I sure would like one of those rifles, though.

          It is admittedly easy to lose sight of why we do this when we no longer care for patients directly. I do make it a point to go on visits with my clients but the one of the best things in the world is Thursday nights. My office is on the third floor of a building that has a hospice on the lower two floors and we share the conference room across the hall. On Thursday nights, they have the bereavement support group. It took them a very long time to figure out I didn’t actually work for the hospice so they come on in and visit before they start. It is more fun than you could imagine. One gentlemen sells Avon which I hate but Mama’s church ‘shut-ins’ (as she calls them) love it so they are all smelling good these days. Mama regularly asks me what can be done for these people. They get a nurse for a little while but nobody is helping them get out of bed and such. It is heart breaking.

          The grown children of one her friends wants to put her parents in an assisted living facility. I explained that would be nice if they enjoyed bingo but they wouldn’t get the kind of help they needed there. Mom’s friend has had two knees and a hip replaced and her husband is not able to leave the home or do anything for fear of her falling or having to go to the bathroom, etc. while he is out. If she doesn’t get help at home, the only alternative is a nursing home. I told Mama’s friends to borrow against their house, live large with 24 hour help and die leaving a ton of debt to their grown children. I’m like that sometimes – practical.

          I think you should invite Senator Cruz to go visit a patient who is in the bed post THR with a hx of a CVA and explain to him that the claim was denied due to fraud – the MD didn’t write down HOW the total hip and stroke made it difficult for him to leave the home. Just saying……


          October 16, 2013
  3. Diane Wells, RN, HCS-D, HCS-O, Dir. of QA #

    If NAHC and the “PArtnership” are for us then who is against use? They don’t seem to really represent Homecare at all. The big wigs have forgotten their patients, that is if they ever worked in the trenches. There is nothing so satifying than to see your patient start to regain what they have lost by illness.Hope springs back into their life. this is what makes home care so wonderful to do. Those in Washinton and elsewhere who make the rules have never experienced being sick and unable to do for themselves, but they sure can make those who do loose hope .Rules and regulations are fine but when they have become excessive they burden those who need the care the most. This cap on episodes is one that is really uncalled for. People are not machines.Each patient has different needs. One may only need an episode, but their are others who need manydue to foley catheters, and otherdiabetics with no willing and able caregiver to administer the insulin. The people in washington and those in CMS who actually write the regulations based on the law need to get out of their IVORY Towere. for once , no for all time.

    October 18, 2013

    • Diane,

      I think that NAHC and The Partnership are at polar opposites on this particular issue but you bring up some very valid points. I agree with everyone who says that everyone in Washington needs to solicit the advice of clinicians when it comes to patient care. But communication works both ways.

      The thing is, unless you take care of patients on a daily basis, you can’t begin to understand what is involved, what isn’t involved and what a profound difference we make in the lives of the elderly in their homes. And two of the ‘big wigs’ have worked in the trenches – Bill Borne and Keith Meyers both started as field nurses. I keep that in mind and make it a point to go on visits often because I never want dividends and the needs of investors to come before patient care. But Bill and Keith and the rest of the partnership do not represent us.

      Bill Dombi, I believe, is a lawyer. He works for a National Association of home health providers and he is paid to represent you in Washington. If I had to guess, he couldn’t change a tegaderm to save his life but it would be fun to see him try. On the other hand, we cannot do what Dombi does. I could no sooner navigate the political channels of Washington than I could navigate a space shuttle but again, it would be fun to try.

      From what I gather, regardless of what Bill Borne told me in the past, NAHC is not presently involved in any way, shape or form with the partnership. His job is to represent home health and that means you and your patients. How can he do that unless we all take the time out of our day and tell him and the others at NAHC what really happens on a visit? Just like I cannot know how to get the attention of a senator, he doesn’t know how frustrating it is to have your hands tied because a patient refuses to get better or exacerbate and there are no alternatives for the patient depending on where you live.

      But you can tell him. And so can everyone else who reads my blog. People who don’t read my blog (unenlightened as they may be), can also contact NAHC.

      Your politicians are ambitious people. They love publicity because it furthers their cause. Invite them to ride along with you to see a patient. Take pictures (with all appropriate consents signed)and write it up for your local newspapers. All of us need to send the message that when agencies are pummeled into the ground by excessive rules and regulations, old people suffer.

      October 21, 2013

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