With healthcare reform (HCR) and all its ramifications looming ominously over home health and hospice, how should we, as an industry, respond?
With dire predictions that many home health agencies and hospices will go out of business and Medicare patients who utilize these services will suffer, do we need to revert to the basic level of Maslow's hierarchy of need just to survive? Psychologist Abraham Maslow proposed that all other needs, motivations, and activities become secondary until the most basic physiological and instinctive needs are met (1943). But does this theory or types of behavior promote survival of an industry?
We Know for Certain That the Only Constant About Medicare Is Change
Here is a review. The Social Security Act of 1965 created the programs of Medicare and Medicaid to provide federal insurance for those over 65 and poor families. In review of legislature that has had significant impact on home health in recent years, there can be no denying that it is a work in progress.
In 1988, the Medicare Catastrophic Coverage Act was enacted to assist in covering medication and capping beneficiaries' out-of-pocket expenses. By 1989, it was believed that the costs outweighed the benefits, and the Medicare Catastrophic Coverage Act was repealed (U.S. Social Security Administration, 2000).
The Balanced Budget Act of 1997, with its change of reimbursement from per visit to Prospective Payment System to decrease cost and prevent fraud and abuse, brought predictions that half the home health agencies would go out of business (Centers for Medicare and Medicaid Services, n.d.)
The following excerpt from Aging Today in 1998 titled "Close to closure: Homecare feels the squeeze" epitomized the feelings of many. "The days of rapid growth in the homecare industry have come to an abrupt halt, leaving many home health nurses reeling. Since the Balanced Budget Act of 1997 took effect, more than a tenth of the nation's 10,000 Medicare-certified home health agencies have closed. Many more have drastically downsized and are teetering on the brink of closure, industry analysts say" (Flaherty, 1998).
In spite of the grim predictions, many did survive and many more home health agencies and hospices were created and thrived. Once again, we stare into the unknown not knowing the full impact of HCR in a hard-hit economy. Are we able to move beyond surviving to the ability to thrive?
In survival mode, thinking often becomes short term and self-centered, and most seek their comfort zone and desire predictability. But what is the cost and risk of choosing predictability and what we have done before that may no longer work? The byproduct of the decision of choosing predictability is that stagnation and routine set in. This begins the paralyzing process of short-term thinking.
In this new season of HCR, we may choose to feed our hunger to be comfortable and wait and see what happens-and perhaps be left behind. The benefits of choosing to move forward to enjoy the benefits of change may far outweigh the cost of choosing what is comfortable!!
Change has always been an incubator for new leadership and those with fresh ideas. It is clear that we are in a season of change and unpredictability of the future. Could it be that your home health agency or hospice will be a new kind of leader in innovation and quality patient care? It is time to assess where we are and prepare for where we are going. Because we are going there, whichever path you take.
In assessing your home health agency or hospice, it is important to identify the following:
* What are the current strengths?
* How does this fit with the demographics in your geographic area?
* Are there specialty areas or programs?
* What is the current case management style? Do you need to modify the management structure to better integrate into HCR?
As a consultant and accreditation surveyor, it is a privilege to see many home health agencies and/or hospices functioning well around the country and those that bring cutting-edge technology or innovative thinking to their patients.
One such agency is owned by a physical therapist who is using the latest devices as well as newer therapy techniques developed in collaboration with colleagues around the country to increase independence in patients who have not been helped with more traditional methods.
Another agency is assisting the poor of a metropolitan area with one of the highest levels of obesity in the country. They did this by assisting in opening a low-priced grocery store. This store provides affordable fresh fruit and vegetables that had not previously been an option, thereby improving the health of the patients, their families, and their community.
Is there a high incidence or prevalence of a particular disease in your geographic area? There will continue to be a need to address this in measurable ways.
Wound care, hypertension, heart disease, cancer, and diabetes are certainly some of the more common ailments that home health addresses, but what about other issues that are growing along with an aging population? These may include incontinence, balance/strength, failing eyesight, blindness, or arthritis. All of these can be addressed in ground-breaking ways. It is indeed time to reach out with the amazing science and technology that is greater than ever before and available to make a difference in the lives of our patients and thrive as a business.
Move beyond survival mode to becoming a survivor. Do this by knowing the home healthcare industry has the solid foundation of knowledge, skills, education, and specialized experience to predict, triumph over, and prevail in stressful times and deliver the quality healthcare that is so needed. Seize the winds of change and soar into the infinite opportunities of HCR.
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