Analysis by Tim Rowan, publisher
This progression from general to painfully specific questions characterized this year's Home Care 100 meeting, February 6-9 in Austin, Texas. The pattern was repeated publicly in Q&A sessions with keynote and breakout speakers; it was repeated privately at breakfast and lunch tables and after hours at adult beverage refreshment stations; the questions even came up in conversations squeezed in between plays at Sunday's Super Bowl party.
Discussions about national leadership were fueled by the audience's bristling reaction to remarks made by one general session panelist. Scott Gottlieb, MD, is a resident fellow with the American Enterprise Institute, the think tank behind the U.S. House of Representatives' 60 attempts to repeal the Affordable Care Act. He had brief tenures as an adviser to the CMS Administrator (2004) and the FDA Commissioner (2003) before being recruited by the pharmaceutical industry.
Under questioning by moderator Tracey Moorhead, Executive Director of the VNAA, about the overall image within CMS of home care vis a vis skilled nursing facilities, Dr. Gottlieb resorted to bullet-point answers. "When I think of skilled nursing facilities, I think of patient care. When I think of home health, I think of fraud."
No one in the chairs or on the stage misinterpreted the silence that blanketed the audience of executives from the industry's 100 largest agencies in response to that statement. A visibly stunned Ms. Moorhead asked him to elaborate. "You want MedPAC and CMS to believe what you believe, that home health saves more than it costs," he asserted. "But you do not provide any research studies to prove that belief. Lacking the data, CMS has no choice but to judge you by the headlines, and the headlines are not so good."
This reporter asked Dr. Gottlieb if he remembered the Abt Associates study of 2008 that compared patient condition at the point of hospital discharge from the year before Home Health Prospective Pay (1999) to 2007, the most recent year data was available at the time of the study. (See "Report Shows Patients Come to Home Care After Increasingly Shorter Hospital Stays," HCTR, 8/24/09) Briefly, Abt's reading of claims data indicated that patients in 2007 who came to home care had spent 31% fewer days in acute care hospitals than they did in 1999 and were arriving at Mortality Risk Level 4 (extreme) 77.46 percent more often and Mortality Risk Levels 1 and 2 (none to mild) 15 percent less often.
"Abt learned that home healthcare, at roughly $1,200 per month, makes shorter hospital stays, at roughly $1,200 per day, possible," Gottlieb was told. "Is that CMS-commissioned study not the kind of research you say is missing? Or is the reason CMS never commissioned Abt to update the research since 2008 because they didn't like what they found?"
His reply, though unfortunately not recorded word for word, evaded the question. He mentioned Big Pharma as an industry that pays for multiple studies and suggested home care should do the same thing, provide its own evidence to CMS. This response caused another audience member to make a dash for a microphone. Teresa Lee, Executive Director of the Alliance for Home Health Quality and Innovation, reminded Dr. Gottlieb that previous attempts to submit research data to CMS have been met with disdain. "They discount the integrity of industry-sourced research," she said. "They call it 'outside information' and assume it is biased." Dr. Gottlieb stumbled through a reply that failed to address Ms. Lee's argument, merely repeating how helpful it would be to CMS if home care took the initiative to produce its own evidence, "like Big Pharma does."
Repercussions give way to conclusions
The outrage over Dr. Gottlieb's equivocation, and his suggestion that home health has the same spare cash for research as the entire pharmaceutical industry, persisted throughout the meeting until its final gathering on Tuesday morning. Artfully facilitated by Fazzi Associates' Tim Ashe, the group discussion began with a multi-faceted exploration of the urgent need to nurture partnerships with hospitals, ACOs, physician practices, and other post-acute providers. It did not end there.
With that topic as a launching platform, the executives next took aim at the need to improve our sector's image before CMS, MedPAC, and Congress. (Private duty providers generally agreed that commercial insurance payers are gradually opening up to the idea that home care saves more than it costs.) Dr. Gottlieb's comments were quoted as evidence that, collectively, we are not doing a very good job letting regulators and payers know that the overwhelming majority of healthcare at home providers are dedicated professionals doing their best to navigate through a mountain of regulations while keeping their patients at the center of all they do. He made them realize they need to sharpen the message that a handful of criminals is not representative but instead they are small, inconsequential outliers who steal a tiny fraction of the amount the rest of the sector saves Medicare, Medicaid and commercial payers in reduced hospital costs.
Ultimately, inevitably, someone suggested the group stop avoiding "the elephant in the room." Why is our image shaped by headlines instead of by a collective effort to tell our positive story in the halls of Congress and to the bureaucrats in Baltimore? With such an effort, could we polish up our brand and get regulator attention away from the handful of criminals who have infiltrated our sector? There seemed to be a consensus that the industry's collective voice would be stronger if it were one, united voice instead of a cacophony of rival voices.
So the discussion wound its way, as these discussions always do, to the third of our original questions, "Who is going to do this for us?" "Who are our leaders?" or perhaps more accurately quoted, "Who should be our leaders?" No definitive answers were voiced near a microphone but these were the questions on everyone's mind as they boarded buses for the airport. These are the questions they took home with them. Although there was no time for consensus to build around the questions, If individual private conversations are any indication, national leaders who were present for this 4-day event have the inside track.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org