If you ever thought one person couldn't make a difference when it comes to HME legislative issues, consider William Deary — and be inspired.
Deary is the CEO of Great Lakes Home Health and Hospice in Jackson, Mich. He is not a mover and shaker in the industry, he says, though he does belong to industry organizations. He doesn't hold any leadership positions in those groups and isn't known on “the Hill.” Instead, he focuses on operating his business to ensure that Great Lakes is carrying out its mission: “To provide superior quality health care in the home.”
But when Deary heard of the Deficit Reduction Act and a provision in it that requires HME providers to transfer ownership of oxygen equipment to the beneficiary after 36 months, he sprang into action.
“The provisions were extremely onerous and not well thought out,” he says. He was gravely concerned that beneficiaries, many of them elderly, would be unable to ascertain whether oxygen saturation levels were correct and concentrators were in good working order, thus placing them at risk for complications and, possibly, even death.
So he sought out Rep. Joe Schwarz, R-Mich. “I thought, ‘When a physician sees what is in this bill, he won't be able to support it,’” Deary recalls.
He was right. After hearing Deary's concerns and studying the oxygen provision, Schwarz didn't support the measure. But it passed anyway. “I called [Rep. Schwarz] the day after the bill passed. He explained to me that he had serious concerns about the oxygen cap, and he committed to looking for a legislative fix,” Deary says.
Three weeks later, Schwarz's office called him back. They asked him to come take a look at a bill the congressman had drafted to see whether it made sense from a provider's standpoint.
The bill, the Home Oxygen Patient Protection Act (H.R. 5513), calls for overturning the DRA oxygen rental cap and allowing Medicare beneficiaries to continue renting their equipment to patients indefinitely, leaving ownership and servicing in the hands of their HME providers. Deary says he found it “well expressed and concise.”
“[Rep. Schwarz's] comment was, ‘How can you expect a 90-year-old grandmother to become a respiratory therapist the day that the cap expires?’” Deary says.
Schwarz, an ear, nose and throat surgeon, has since credited Deary with making him aware of the provision and inspiring him to author the bill, which is backed by other physicians in the House. As of this writing, H.R. 5513 is still in committee, but it is gaining momentum as new co-sponsors continue to sign on. At last count, the number was 48. And in August, a companion bill was introduced in the Senate by Sen. Pat Roberts, R-Kan. (see page 12).
While he does not know what the outcome of the bill will be, Deary is gratified by Schwarz's swift response and attempt to right a wrong. “We have a physician who believes something is wrong and took proactive measures to get this fixed. The [DRA] was not well thought out. He brought [the new bill] back and said, ‘This is going to help our patients,’” says Deary.
The Right Response
If you look at the evolution of Great Lakes from its inception as a home health agency, it's probably not surprising that Deary reacted as he did to the DRA. He's used to responding to patients' needs.
The company started in 1994 when Deary's wife, Cheri Lyn, came back to her hometown of Jackson to help with a relative, who was ill. Cheri Lyn, a nurse, soon realized that no home health care was available in the town.
So the couple pulled up stakes in San Antonio and moved back to Jackson to start Great Lakes. They had no idea how successful it would become.
“If you took a look at our business plan when it was mature, Great Lakes would have 25 employees,” says Deary, almost chuckling. “We have 450 employees now, both full-time and part-time.”
That growth, he says, has “all been market-driven.” Great Lakes started out in home health care. Patients who went on to hospice didn't want to lose their nurses, so the company branched out into hospice care.
“We started providing HME to control expenses on hospice, and doctors familiar with our work saw that they were signing scrips for hospice patients and wanted us to provide equipment for their other patients,” Deary says.
So the company expanded again into general HME. It is now a full-service provider with six locations in Michigan.
Along the way, Great Lakes has achieved a reputation for quality care. It has received the Michigan Medicare Quality Improvement Organization's Award of Excellence for improving care in the home health setting and was named the Michigan Small Business of the Year for 2003.
Deary himself has been honored as an Ernst & Young Entrepreneur of the Year and named a finalist for the West Michigan Entrepreneur of the Year award.
“I'm extraordinarily fortunate to share my wife's passion with her,” Deary says. “She was the one with the passion for patient care. But I didn't like the business model; it didn't make any sense. We've never really operated our company along traditional health care business models.”
Deary says Great Lakes operates on a customer service model. “Someone from Great Lakes visits with every patient before they leave the hospital so we know their needs. They are trained by the therapist in the hospital with the [equipment] they will use in their home. We've planned accordingly so if someone lives in a manufactured home, we know they will need different equipment.”
Such predischarge coordination is costly and is not reimbursed. But Deary believes it is necessary and the right thing to do.
“It reduces or significantly eliminates post-hospitalization anxiety,” he says, noting that each patient knows who is going to deliver the equipment (and in some cases, even the name of the person) and is also given a business card so they know who to call with any problems or questions.
That practice has been “wildly successful,” Deary says, adding that in patient surveys, it has a 98 percent satisfaction rating.
Deary also makes sure that patients' needs dictate what Great Lakes provides.
“We do not sell what we have, we provide what is wanted,” he says. “That's a paradigm shift in health care. If you just sell what you have, you're not meeting the needs of anyone — the patients, the families, the physicians or the hospital or even your employees. You have to take traditional, sound, well-constructed business models and apply them to health care and meet the patients' needs.”
It's all about providing superior quality care, Deary says. “What does superior quality mean? You call the patient the night before you visit. You're a guest in their home. You say ‘please’ and ‘thank you’ and ‘may I?’ Everybody has dog biscuits in their pockets. If somebody's son or daughter likes you because you call and give them an update, that's important. If someone's dog likes you, that's golden. It's all about relationships.”
It's Not about Medicare
Deary is not overly concerned about the challenges of Medicare and a volatile health care climate. “We have to make the most of the challenges that are tossed to us,” he says. “That's the entrepreneurial spirit. The true entrepreneur is going to find a way to realize success in spite of challenges, in spite of adversity.
“Regulatory compliance is critical, finding how to do more with less is imperative and increasing responsibility and accountability of employees is a big part of the secret,” he continues.
“Everybody has Medicare to deal with. The way they deal with it is the determining factor to what their future will be. Medicare doesn't determine your future — you do.”
Even with competitive bidding, tightening reimbursement and the uncertainty of the oxygen cap, Deary thinks Great Lakes will continue to thrive.
“Our unwavering commitment on the part of our staff to achieve our mission of providing superior quality home care is our greatest strength,” he says. “When you get back in your car or truck and you turn the key, ask yourself: ‘Did I just treat that person the way I would treat my grandmother?’ If you say ‘yes,’ well, thanks, you did a great job. And if you didn't, well, get out and go back and take care of them.”
Ultimately, it was that care for patients that prompted Deary to contact Schwarz about the oxygen cap. “The oxygen cap is a special situation. This is bigger than reimbursement,” Deary says. “It is about patient safety. And we have a responsibility to hold [Congress] to task and correct their error.”
Deary says he would seek a legislator's help again if need be.
“We have a responsibility as providers to help patients we have the honor to serve,” he says. “A single patient may not have the ability to garner the ear that as a provider we have the ability to do. Even though it's not covered under any type of reimbursement, the responsibility comes to protect the people we are charged with taking care of.”
He does not agree that legislators are inaccessible to providers. “You have their phone numbers … If you are reasonable and concise and accurate, these people will talk to you. We represent a voter population that is important to these officials. And seniors are active voters.”
He notes, however, that Schwarz's reaction is likely “not the norm. It took one phone call. But the point here is that we have all heard that if a legislator hears something from five of his constituents, it's important, and, if it's 10, it's a mandate. I knew I had 1,800 constituents who could call him if necessary.”
But it was Deary's call that made the difference.
Company Snapshot
Great Lakes Home Health and Hospice
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Home health, hospice care and full-service home medical equipment provider
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six offices serving 24 counties
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450 full- and part-time employees
Tips from the Top
William Deary, CEO of Great Lakes Home Health and Hospice in Jackson, Mich., has often found inspiration in other industries for improving the home health care business. Some of the things he's learned:
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Understand what your mission is.
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Don't allow anything to stand in the way of accomplishing your goal.
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Invest in technology. It will help you help your patients.
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Don't see challenges as problems, but rather, as opportunities. “I liken it to Tupperware and how it had to decide where the company was going when everybody started using Ziploc bags,” Deary says. Instead of responding by closing its doors, “Tupperware started making toys,” Deary points out, “and they're more successful than they ever were.”
