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Farewell, Bill Borne


 

Contrary to what you might think (and frankly, it surprises even me), I take no great joy in the announcement that Bill Borne has stepped down as CEO of Amedisys.  For the sake of Amedisys, it needed to happen but there would be no Amedisys at all if not for Bill.

In the early 90’s Amedisys was a very young company fueled by a handful of un-medicated junior execs with severe ADD bouncing around like Brownian motion.  There were no senior executives to set limits for us but we had Bill with his pipedream of one day being the largest homecare provider in the US.  Nobody knew what they were supposed to be doing doing but we always made it a point to be doing something.

There are certainly psychologists and urban anthropologists who study corporations and behavior.  An entire graduate thesis could be written about how Amedisys went from being an unknown agency in a southern city to one of the largest and most successful post-acute care providers in the nation to being the company with the 150M settlement and tarnished reputation. 

An advanced degree isn’t required to see that the real problem is that Amedisys simply grew up.  The values that were held close in every task and idea by the younger Amedisys were gradually replaced with Corporate cliché’s.  The practiced speeches where key points were repeated three times because the speech coach recommended it took the place of genuine communication.   

The grown up Amedisys and the grown up Bill Borne just weren’t fun anymore.  The primary outcome used as a benchmark by almost everyone in the organization was the price per share of stock.  Image mattered more than ever.  The spontaneity, imagination and creativity that drove a young company to greatness were so ingrained into the fabric of Amedisys that no one ever really noticed them.

The grown-up Bill Borne lived to please investors to keep the price of stock high.  He got so carried away with making the shareholders happy that he forgot that others had invested a hell of a lot more than money in his company.  Those of us who bled Amedisys Green didn’t think there were other options for us until we no longer had a choice.  We were well prepared – that much  I will say.

To this day, I am grateful for everything I learned from Bill Borne and from Amedisys.  I learned from Bill that I can simply blaze my own trail if I don’t like the one laid out for me.   I made friends that will last much longer than Amedisys.  I learned the difference between being driven to accomplish a mission and ambition for the sake of power.  I know from my time at Amedisys that being passionate out loud about your job is dangerous but being silent for the sake of playing nicely in the sandbox is cowardly and I have seen how ugly well-behaved cowards can be.

I am even more grateful to be gone. 

Bill Borne walked away from Amedisys this morning but he gave his company away years ago.   The shareholders replaced patients as a priority and the board of directors replaced his employees as the people to whom he was accountable. Patients are not commodities and the answer to problems isn’t terminating a scapegoat. 

The Bill Borne wanna-be that walked away this morning had but a passing acquaintance with authenticity.  For those of you who never met the authentic Bill, you missed someone important but he hasn’t been around for years. 

I wish Bill luck and love in abundance.  I mean that.    I hope he finds a little flame and sets the world on fire for a cause other than the price of stock. 

I wish Amedisys luck in finding their way in this healthcare maze.  They have the ability and resources to redesign home health and set the industry standard or put all of their energy into trying to get the stock price back up to where it belongs.  We shall see.

The 150M Settlement


It doesn’t make me feel good to know that Amedisys has had an exceptionally poor quarter and has tentatively entered into an agreement with the Department of Justice for a 150M settlement. I admit I am a little curious about the reference to The Stark Self-Referral Matter referenced in Amedisys’s press release but not overly disturbed. What disheartens me is that I am no longer surprised by the fact that when I searched the Internet for information, there were hundreds of results that all reported on the stock price.  Nobody stopped to wonder how a 150M dollar settlement would affect the care that Amedisys is supposed to be providing to patients.

Does this mean that I do not agree with the settlement? I don’t know all the details but I think that if the Federal government is going to get between Amedisys and that much cash, a legitimate question arises about their ability to care for patients and compete in an overcrowded market.

Amedisys is clear that in paying 150M to the government that they are not admitting any wrongdoing. I do not believe that they are willingly entering into this agreement because they couldn’t figure out what to do with extra cash. Not admitting wrongdoing is not the same as denying any wrongdoing. If they stayed out of the grey areas, I suspect they would be more than willing to pay a fraction of that to good defense lawyers.

While I don’t know the specifics of the settlement, I do know that it takes a lot of money to care for patients. I may find a bullet in my head in the morning but I strongly believe that if Amedisys is to pay 150M to the feds then Amedisys should no longer be afforded the privilege of billing Medicare. There is no shortage of stellar, high performing agencies who could pick up the slack and most of these smaller players would have never been given another chance by Medicare.

Alternatively, if they have been assessed as compliant and capable of caring for patients then the feds should lessen the penalty to an amount that does not interfere with patient care.

Just sayin……

Reducing Fraud


Everyone agrees that the industry has had enough of fraud.  In fact, some industry leaders have already declared, ‘Enough is enough!’.  I wholeheartedly concur with that eloquent and emotional pronouncement of the common values of Home Health Providers.  So lets take a look at how we can reduce fraud and cut the home health budget, shall we?

  1. Ensure that nobody gains entry into the Medicare program without undergoing a criminal history background check.
  2. Test all owners and managers according to standards set forth by The Secretary to ensure that all owners and managers understand HIPAA, coverage guidelines, compliance rules, marketing guidelines, etc.
  3. Require providers to put up a 100K surety bond and demonstrate they have the capital to operate.
  4. Mandate compliance programs or if you prefer, ‘Promulgate rules requiring home health agencies to have in operation a compliance and ethics program designed to prevent and detect criminal, civil, and administrative violations’.
  5. Do not issue provider numbers in geographical areas where there is a lot of fraud or where there are a lot of providers.
  6. Put a Cap on Episodes much like IPS.  Urban agencies will be limited to less than two episodes in the aggregate and rural agencies can go up to 3.2.
  7. Penalize agencies who do not bill for LUPA’s.
  8. Have the MACs (FI’s) perform a payment review on  a random sampling of claims in all agencies to make assumptions about the agency based upon OASIS data prior to paying claims to ensure accuracy of claims.  I am available at my hourly rate to assist agencies in this process which resembles RAC audits.
  9. Place all new agencies or agencies that acquire new provider numbers to  them on a 100% percent prepayment review of claims.
  10. Get rid of the therapy thresholds.
  11. Tighten up the face to face encounter time frame so that all patients except those who have just been discharged from the hospital must be seen within 14 days of admission..
  12. Allow Nurse Practitioners to sign plans of care.

It is possible that one or two of you are sitting there wondering how I ever became so brilliant and are willing to stand up and fully support these recommendations.

It is equally possible that some of you think I am knitting with one needle or that my IQ  roughly equals room temperature this weekend.

As such you would all be wrong.  These suggestions have already been presented to Congress by The Limited Partnership for Quality Home Health Care.   Click on the link to view the eight (8) members of The Partnership.  Is anyone surprised by anyone on the list?

In case you think that Bill Borne and his friends are just trying to mess with me, I encourage you to read their petition to congress.  It describes an entire proposed Act of Congress called the SHHIPS Act.

I have never had an act of congress – even proposed – named in my honor.  I want a Planet Wackadoo Act that eliminates stupid and/or greedy people from health care.    Better yet, what about a Put Patients First Act that prohibits determining care based  upon arbitrary numbers that coincidentally benefit the Elite Eight at the expense of the group of the other approximately 6,000 home health companies in the country?

As the week goes by, I will share my thoughts on the individual recommendations.  Meanwhile, we have a voice.  If you have any strong opinion about the SHHIP  – even if you disagree with me, use your constitutionally guaranteed right to be heard by those you elect to office

Now, go for a long walk, get some tea and clear your head.  We have work to do.

Bill Borne, CEO of Amedisys Responds


Today, for the first time, I am going to present to you factually false information on my blog.  I do not know which information is false but I have received a lot of conflicting information from various places.

The delay in posting Bill’s response is a result of the fact that Bill’s initial response did not satisfy me in that I do not understand what he means about rebasing and then staying the cuts in 2014 and how this could possibly be good for the industry.  I fully agree that there is a lot on the financial and political side that I do not understand.  But within that email, Bill writes:

My colleagues, which are not an exclusive group, are working together with the whole industry to help stay the damage by working on positive messaging. These organizations are open to anyone who wants to step up to the plate in the industry and invest their time and money.

This came after the email from Keith Myers who said that the Alliance for Home Health Quality and Innovation are not in the business of lobbying.  I took Bill’s note on ‘positive messaging’ to be a euphemism for lobbying so I contacted him and gave him a chance to clarify his position.  Bill also received Keith Myers response to my original post which stated emphatically that no lobbying or legislative activity occurred.

That resulted in a phone call from Bill last Thursday.  During that conversation, he was adamant that Keith was one hundred percent correct.  He also said that perhaps I was confused.  There are and were multiple organizations out there and perhaps, I found information about the wrong group.  It is a sad fact for me that such a scenario is extremely possible so I found the lobbying reports forwarded them to Bill.  It was not my goal to discredit him personally so I offered him an opportunity to reconcile the lobbying reports with his position.  I did not hear back from him until late Friday afternoon.  See for yourself if he explains the lobbying reports.

September 30, 2011

To the Editor,

Last week, Reuters published an article that quoted me as calling for the government to provide home health providers greater clarity concerning reimbursement rates, in which the reporter noted that Amedisys and other publicly traded home health providers were lobbying Washington to accelerate the rebasing process. This article has generated a lot of attention, and I have received many questions seeking greater clarity concerning my comments. Accordingly, I wanted to take this opportunity to clarify my position regarding these matters.

As you may know, a report by the Moran Company from earlier this month analyzed the potential impact of CMS’ proposed 2012 reimbursement cuts and concluded they would lead to negative Medicare financial margins for 52.3 percent of all home health agencies in the U.S. This report can be found on NAHC.org.

As the Reuters article reported, it is true that several members of the home health industry have formed the Alliance for Home Health Quality and Innovation dedicated to improving the nation’s health care system by supporting research and education to demonstrate the value of home-based care. However, the lobbying efforts referred to in the Reuters article were not, as stated in the article, undertaken by the Alliance, but rather by another group called The Partnership for Quality Home Healthcare which represents more than 1,800 community- and hospital-based, non-profit and propriety home health and hospice agencies nationwide and NAHC to develop innovative reforms to improve the program integrity, quality, and efficiency of home health care for our nation’s seniors.

Amedisys supports both the Alliance and the Partnership, and has also been a long-standing supporter of NAHC, which represents all home health care providers.

We invest our time and energy in these efforts to protect patient access to home-based health care for the more than 3.2 million Americans who rely on us. In doing so, we improve patient lives and the health of the Medicare system by keeping our nation’s chronically ill seniors out of the hospital and other more expensive facility-based settings.

The point I made to the Reuters reporter is that, despite the significant cuts in 2011 and 2012, our industry continues to face additional threats from many different sources, in the form of rate cuts, accelerated rebasing and calls for the implementation of co-pays, leading to great uncertainty about the future. Without a predictable and reliable long-term source of revenue, it is very difficult for any company—large or small—to form or implement a successful business plan or make the long-term investments necessary to support a healthy, sustainable organization.

In speaking with the Reuters reporter, I was speaking on behalf of myself and Amedisys only, not on behalf of the Alliance, the Partnership, NAHC or any of my colleagues. I personally support the effort to press Washington to provide our industry with a comprehensive reimbursement plan that we can be certain will be in effect for the long term. We deserve clarity on just how far the cuts will go. We need clarity so that we can plan ahead for mission critical business decisions such as hiring talent and investing in new clinical programs. If we leave rebasing totally up to CMS, each year through 2017 we will be forced to operate in uncertainty, taking us away from investing in patient care and instead worrying about which shoe will drop next. This uncertainty is simply not tenable—for any of us, or for our patients.

In my opinion, without the type of proactive initiative being spearheaded by the Partnership, we will certainly get an additional reimbursement cut in 2012, and again in 2014 when mandatory rebasing is implemented. The intent of my statement was to have the industry endure only one reimbursement cut, that we would have a say in and that would take place now, and that would be in effect for the long term, so we can operate our businesses with some certainty and confidence about the future.

I invite and encourage all home health care providers to help our industry by being active with any of the organizations formed to help increase awareness around the work we do helping and healing people each day.

We should not be divided. We need to have a joint effort to protect home health care. Our patients are depending on us to come together and protect their access to care.

Sincerely yours,

William F. Borne Chairman & CEO, Amedisys, Inc.

As mentioned previously, there is something factually false on this blog.  I am not in a position to know if Bill, Keith or the Lobbyists in Washington are the ones who have provided factually false information.   Bill and Keith can’t seem to get their stories to correspond on whether or not the Alliance actually engages in in any political activity or lobbies.   Read Keith’s very clear statement about the Alliance here.

If you read Bill’s statement carefully, you will see that he didn’t actually deny that the Alliance lobbied.  He said, “However, the lobbying efforts referred to in the Reuters article were not, as stated in the article, undertaken by the Alliance, but rather by another group called The Partnership for Quality Home Healthcare.”   So if the Alliance didn’t take on lobbying efforts referred to in the Reuters article, what efforts did they undertake?  Here is the lobbying budget for the Alliance of Home Health Quality and Innovation for the past four years.

This is the composition of the Alliance of Home Health Quality and Innovation from their form 990 filed in 2009.

On the Alliance’s 2009 Form 990 signed by , an IRS document required to be filed by all non-profits, the second page states, as attachment 2:  (bold lettering mine)

2009 was a transition year for the Alliance.  The Alliance has reorganized its working groups to address:  research, education of policymakers, internal and external communication, memberships, relationships with other professional organizations, quality and technology and innovation.  It also established working relationships with key policymakers at CMS, MEDPAC and other public and private organizations.  The Alliance has also held educational sessions for federal officials on the value of the home health benefit.

My understanding is that lobbying is an effort to gain political influence.  Truthfully, there is nothing wrong with that.  When a group of passionate people who openly state their purpose and do their best to persuade policy makers to make changes, the results can be amazing.  Going back to that little form 990 again, we see that simply joining a group does not give you an opportunity to facilitate change.

The Alliance shall have two classes of members:  once class of members with voting rights and the other class without voting rights.  Only members with voting rights may designate a representative who shall be eligible to be elected as a Director (it being understood that not all voting members shall be entitled to have a representative to serve as a Director).  The board of Directors may establish different dues categories and member designations in each class and shall otherwise determine all other rights and obligations of the members.

The Alliance also had to list its board members on the IRS form 990 in 2009.  This is taken from the IRS form 990 which exempts this organization from paying taxes.  Keith Myers signed the form.

Bill Borne Chairman and President
Ron Malone Vice Chairman
Val Halamandaris Secretary
Bill Yarmouth Director
MikeBayada Director
Chris McInnis Director
Keith Myers Treasurer
  • Once you get answers to some questions, even more arise.  Those that come to mind immediately are:
  • How can the lobbying reports be reconciled with the statements Bill and Keith made?
  • Is there a meaningful difference between ‘establishing working relationships with key policy makers at CMS, MEDPAC and other public and private organizations’ and lobbying?
  • Bill states the Alliance is open to all.  I have a whole lot of emails from home health agencies all over the country who state they never heard of it until last week.  If it is open to all, how much does it cost to join?  How much does one have to pay for voting rights?  What did the current members pay and is that public information?
  • Does NAHC have voting rights?  If so, on what scale?  If the voting rights of NAHC are proportional to Amedisys and LHC representatives, it stands to reason that the entire industry is not being represented proportionally.  If so, the name of the organization should be changed to, ‘Alliance of Really Big Home Health Companies’ .
  • If any topic arises that NAHC could be outvoted on by the large corporate entities, NAHC doesn’t belong in the Alliance, period.  That’s Julianne’s opinion.  No one else’s.
  • Do the members of NAHC know that their organization is part of a small group of very large players chaired by Bill Borne?
  • How much of NAHC’s membership dues went to pay the dues for being a member of the Alliance?
  • Bill proudly states that the Partnership for Home Heathcare represents more than  “1,800 community- and hospital-based, non-profit and propriety home health and hospice agencies nationwide and NAHC ….”  If you add up the number of agencies owned by Amedisys, LHV, Gentiva, Almost Family,Bayada and the VNA, I wonder how close the total is to 1800?  NAHC has 33,000 members according to their literature.   Which ones did NAHC choose to support?
  • Why is the Alliance for Home Health Quality and Innovation not listed on the NACH website under the affiliated organizations page?
  • Oh, and can somebody tell me who the Partnership for Quality Home Healthcare is?  The  information I know for certain is that they have a very large lobbying budget.  Nowhere on their website is the name of a manager, director, contact person, etc. mentioned.
  • Would the Avalere study emphasizing the benefits of home health have been more credible if the members of the Alliance hadn’t have paid for it?  It is understood in academic worlds that conflicts exist but conflicts of interest do not discredit a study nearly so much as the non-disclosure of said conflict.  By hiding behind the cover of the Alliance, a very expensive study was paid for by the largest home health care companies in the US.  I think that is relevant information.

As interesting as these questions are, nobody owes me an answer.  It is the agencies who compete against the larger publicly traded companies that need answers.  It is the 3,3000 home health agencies who are NAHC members that deserve to know these answers.

I encourage your comments.  However, since this is my domain, I could be held responsible for anything  published here.  I will withhold any comments that are overly insulting to any one individual or that make accusations that I cannot independently verify.  My goal is not to ‘attack’ any one individual or company.  My goal is to alert you to the fact that we have a limited number of large organizations, including NAHC that are making decisions for us all.

We have a ton of stuff to get done in the next couple of months in order to prepare for 2012.  But as far as this blog goes, it’s time to turn our focus back to what really matters.  We have to take care of our patients and keep them out of the hospital.  We have to endure cuts in payment but we will not compromise care.  We are nurses and given a roll of duct tape and a paperclip, we can bandage wounds, perform emergency tracheotomies, kill germs, and keep our patients quiet so we can provide the covered skill of teaching and training.

Attention: Bill Borne, CEO Amedisys, Inc.


Dear Bill:

I read with great horror a Reuters feed in the Baltimore Sun  this morning in which you made a statement to the effect that you along with Louisiana Home Care Group and Gentiva think it might be a good idea to accelerate the pending payment cuts to Home Health Providers.  You are on record as saying that such acceleration would give you the opportunity to exploit the ensuing financial devastation of smaller, privately held agencies with the ultimate goal of purchasing up to 53 percent of them.  You made an extremely salient point that is no fun to wake up and see your stock prices plummet and spoke of a strategy that involves sudden death to MY clients to possibly lift an overhang on the stocks.

I worked with you when you picked up shifts at the Baton Rouge General CICU 20 years ago.  I went to work for Amedisys Corporate when we were the proud owners of 5 provider numbers.  I was there when Amedisys got kicked off NASDAQ because of insufficient cash and Assets.  And I was there when the small fish bought the big fish, Columbia.  To be honest, up until this morning, this has always been a source of pride for me.  I learned a lot at Amedisys and I am grateful for the opportunity to have worked for you.

So, riddle me this, Bill.  Did Reuters somehow misquote you?  Were your words taken out of context?  Did you forget to run your opinion by your PR department?  Because let me assure you that I am so not impressed.

The industry as a whole is facing serious challenges but my clients are more than capable of handling them unless the three largest publicly traded home health care companies put pressure on CMS to hurt them.  It seems like you want CMS to lower the cost of acquisitions for you.  What a brilliant idea.  I want CMS to make being stupid a diagnosis that adds to the payment for a patient so you can be admitted and treated by one of my clients.

Make no mistake, if I believed that the Amedisys way is the best way to take care of patients, I would be out there brokering deals with my current clients right now.  But that isn’t the case as the numbers show.   The graphs below show a couple of my clients’ performance in comparison to Amedisys and LHC in areas where you coexist.    I limited the comparison to hospitalization rates because reducing hospitalizations is the greatest benefit offered to patients, families, communities and our payor sources.

Baton Rouge, Louisiana Hospitalization Rates

Houma, Louisiana Hospitalization Rates

Birmingham, AL Hospitalization Rates

I assure there are many more examples but my goal is not to say that my clients outperform you and leave you in the dust.  In the interest of transparency, I also have clients with a much higher hospitalization rate.  My purpose here is to illustrate that my clients are more than capable of holding their own against the ‘big boys’ in our industry in the only outcome that really counts – hospitalizations.

Of course, there are more than numbers to consider.  My clients hire a lot of nurses that have previously worked at Amedisys or LHC.  While I appreciate your need for standardization for management purposes, it is frequent that Directors of Nursing and Administrators are merely figureheads on paper that are given job descriptions resembling recipes.  This approach limits creativity and the ability of the nursing staff to take into consideration the particular strengths and weaknesses of their field staff.  When the most important decision they make all day is whether or not they should call Corporate it is unreasonable to expect them to be able to gracefully deal with more serious challenges like federal investigations, etc.

I can’t help but notice that your personal annual compensation package is greater than the annual revenues of many of my clients.

William Borne/Chief Executive Officer

2006 2007 2008 2009 2010
1,350,758 3,669,021 4,381,190 3,247,024 2,185,698

I do not begrudge your wealth.  The way I figure it, Bill, is that as smart as you are, you are not smarter than me.  Ergo, if you can do so well then so can I.  I would feel worse if you were chronically broke after working so hard and I do recognize the fact that you worked very hard.

What I find so offensive is that you used to be a CEO of a company that took care of sick people in their homes.  What pisses me off is that I remember when you were a nurse.

Unless you were seriously misquoted, it would seem that somewhere along the way you have evolved into just another corporate fuck-up motivated by greed and stock prices.  I feel like holding a funeral for the Bill I held in such high esteem for so long.  I hope you always remember that victory at the expense of others is a merciless taskmaster.  It is an honorable aspiration to do grow your organization by giving superior care.  It is pathetic that you prefer to build your organization by wishing harm to your competitors.  Little boys kill ants in jest but the ants die earnestly.  The ants in your world are my clients and countless other smaller providers just like them and I work just as hard for them as I ever worked for you.  Consider that.

You may not know this but my office is now less than a mile from your corporate headquarters.  It is next to the first Corporate Building that you and I worked at together on South Sherwood.  I am upstairs in suite 300 and would love to give you an opportunity to clarify your outrageous statements.  Call me at 225-253-4876 if you want to schedule a time to talk or email me a response.

julianne

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