Stopping Medicare cuts, ensuring Medicare Advantage beneficiaries have good access to care, passing groundbreaking hospice legislation and bringing homecare into the forefront are all priorities for the newly-formed National Alliance for Care at Home, said CEO Steve Landers.
“We’ve got to start improving access to home health care, and the way that we do that is we end this march of payment cuts that are being set forward by Medicare,” Landers said at the Alliance’s Homecare and Hospice Conference and Expo, which was held in October in Tampa, Florida.
The event was originally organized by the National Association for Homecare and Hospice (NAHC), which merged this summer with the National Hospice and Palliative Care Organization (NHPCO) to form the new group. The expo included a handoff from NAHC President Bill Dombi to Landers.
The new organization plans to highlight the patient and family perspective to advocate for home health in Washington and beyond, which Landers called a “life or death issue.”
Landers said the new alliance has the opportunity to have a stronger voice, and that he will add his own clinical perspective to his leadership and conversations with regulators and legislators.
“I'm also a family caregiver and have my own personal experiences with homecare and hospice that have instructed how I think about these things,” Landers said. “There is every opportunity here to get stronger, to try to make a bigger impact. … We need to find another way to tell these stories, to somehow get somebody to listen.”
This will require getting frontline workers, patients and their families into the offices of decision-makers to tell their stories, Landers said. It may entail additional partnerships with state associations to focus on local advocacy, as well as sharing data from studies that show the positive outcomes in-home care has on patients’ lives.
The alliance has automatically enrolled members of both legacy organizations, but Landers said that for renewals or new members, participants will be required to sign an attestation that says they have a program in place for quality and compliance, that they monitor the Office of Inspector General’s expulsion list and don’t take referrals or staff from organizations on that list and that they strive to participate in Medicare’s quality reporting programs.
“In order to make a difference on behalf of our members and make a difference on behalf of the people that need care at home, we have to have as credible and high integrity of a voice as possible,” Landers said.
Landers spoke before the results of the election were known or the final rule on home health payments was released by the Centers for Medicare and Medicaid Services. But even then, he said it would be important for advocates and providers to work for the long haul.
“We've got to wake ourselves up … and just keep our energy up, keep our voices up," he said. "So many people are depending on us, and they're hidden. The people that depend on home health and hospice care programs—they're hidden. They're sick, they're in their homes, mostly. Their families are stressed. … We’ve got to keep the volume up and keep telling the story.”
Dombi Says Farewell
During his final general session at this year's expo, NAHC President Bill Dombi reflected on his nearly 40 years in the industry. He began as a litigator, hired to take on a suit against the Medicare program for arbitrarily denying care. Ultimately, the case—Duggan v. Bowen—rewrote the Medicare home health benefit.
"It’s not perfect, but it was a monumental move forward," Dombi said.
This case was also the beginning of Dombi’s tenure at NAHC. After promising his wife and family that they’d stay in Washington just three or four years, they ended up staying 37.
In that time, he said, his accomplishments included:
- Creating the Medicare Hospice Benefit: Today, one out of every two decedents have used hospice in the last 12 months of their life, which is a large increase since its launch.
- The growth of the Medicaid program: The program went from having no home services in 1965 to being the largest home health program in the world.
- Increasing access to care for pediatric patients, those receiving private duty nursing, the severely disabled and the elderly.
- The transition of making hospital-at-home care permanent in Medicare.
- Ever-growing technologies and improving the focus on in-home care.
- Several lawsuits that Dombi led at NAHC against private insurers and others, to ensure that specific patients—including several with amyotrophic lateral sclerosis (ALS)—weren’t arbitrarily denied the coverage they needed.
"That’s where my heart, my soul is; that’s where my aggressiveness is born, representing those very vulnerable people," Dombi said.
He also made a range of predictions and hopes for the future of in-home care, which were focused on a shift in both health care and the culture at large.
"I see the future—whether it be one year, five years or 10 years—when we see a whole transformation of health care where the minds, hearts, operations, payments and everything else are focused around a homecare direction," he said. Not everyone can or should receive care at home, he said, but it would be the ideal default before someone is hospitalized or moved to a nursing facility.
Additionally, his hopes for the future include:
- Nursing school curricula that focus on in-home care.
- Physician education including care at home.
- A time when the head of the Centers for Medicare & Medicaid Services (CMS) or the Department of Health and Human Services (HHS) has a homecare background.
- Technology visionaries, such as Bill Gates and Elon Musk, working on homecare.
- Every State of the Union and presidential debate includes discussions of in-home care.
Speakers at this year's expo also acknowledged Dombi’s role in rebuilding the organization as “NAHC 2.0” in the 1990s and helping shape the future of home-based care.
“Bill is a person that’s always looking forward,” said Denise Schrader, vice president for Mosaic Life Care. “That’s why I call him transformative.”
Additionally, they credited him for helping get the industry through the COVID-19 pandemic, pushing for personal protective equipment and other assistances for in-home care workers, including lobbying to allow non-physicians to certify for home health.
“Without Bill’s leadership, I truly believe the outcome of the pandemic would have been very different for home health,” said Mary Myers, retired president and CEO of Johns Hopkins Home Care Group and a member of the NAHC/NHPCO transition board.
