Bill Dombi met his first bully in kindergarten.
It only took a day for him to fight back, leaving the bully with a bloody nose and Dombi punished in a corner, the retiring president emeritus of the National Association for Homecare and Hospice (NAHC) said as he bid farewell on the last day of the organization’s annual conference in Tampa, Florida.
"I was smiling the entire time—and learning that’s not the way to do it," Dombi told the crowd during his last moments on the convention stage. "You’ve got to go to law school instead."
Dombi is retiring at the end of the year and was celebrated throughout this year's event, which was launched under the NAHC title, but actually took place as the National Alliance for Care at Home Home Care and Hospice Conference and Expo after NAHC and the National Hospice and Palliative Care Organization (NHPCO) merged in July.
During his final general session, Dombi looked back 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.
"That day that I said yes was the beginning of a stunning opportunity that I had to be part of an incredible team of people," he said.
Upon taking on the suit, he walked in to find boxes of records and claim denials for thousands of patients to comb through in order to select 12 named plaintiffs for the case. While he was stunned by the amount of information, it got better when he was able to add members of Congress as plaintiffs.
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.
It 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 ending 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 an enormous 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 of 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," he 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 focused 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 care in the home.
Those dreams might be fantastical, he admitted—but he encouraged attendees to keep fighting to move in that direction.
"We have to stand ready and be capable of working in all forms to defend ourselves," and to keep CMS, HHS or states from "bullying homecare around," he said, before exiting to a standing ovation and the soundtrack of Tom Petty’s classic "I Won’t Back Down" playing loudly in the hall.
"Bill, we won’t back down, just so you know," said Dr. Steve Landers, CEO of the new Alliance, as the music faded. "We’re not going anywhere."
