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Editor's Perspective

The Evolution of In-Home Health Care

My first real involvement with the home care industry is as recent as the mid 1990’s.  At the time I owned and managed the assisted living program, The Friendly Villa (pictured at right above) and I brought in a home care company to manage the skilled needs of my residents.  The company I used at the time was called Metrostaff.  The attending nurse was thorough, competent and really had a great personality which helped the residents adjust to her rather easily.

I met another gentleman in the medical equipment business and he handled all medical equipment needs.  His personnel were responsive, he was attentive to my concerns “owner-to-owner” and both relationships worked well.  Today in this same area of SE Michigan there are hundreds of home care companies, some skilled, some unskilled and more private duty oriented and some have divisions on both ends of the business.

I help develop companies on both sides of the aisle and they are both needed throughout America.  I render assistance through a combination of creative marketing events, strong web presences, relationships I have developed in long-term care and rather aggressive “business to consumer” and “business to business” marketing.  Unfortunately there is much to be disappointed about in home care compared to when I ran the Friendly Villa back in the 90’s.

Today Medicare rules governing the operation of a skilled agency are a bit more stringent.  Some providers complain that these rules stifle innovation, while others have manipulated them for their own selfish advantage.   The newspaper articles have been disheartening as more and more people are arrested for Medicare fraud, some billing for services not rendered while others pay people for their Medicare numbers just to bill for bogus services.

We have actually witnessed arrest after arrest.  It is interesting that the Medicare program was established to help the elderly and disabled but it also attracts providers who are focused on nothing but profit and others on dishonest gain.

We found this report from The Miami Herald (USA) December 15^th, 2009, “Federal agents arrested 26 suspects in three states Tuesday, including a doctor and nurses, in a major crackdown on Medicare fraud totaling $61 million in separate scams.

Arrests in Miami, Brooklyn and Detroit included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so that he could bill for twice-daily nurse visits.

The U.S. Department of Justice and U.S. Department of Health and Human Services said the total of 32 indicted suspects lined up bogus patients and otherwise billed Medicare for unnecessary medical equipment, physical therapy and HIV infusions.”

The fraud, waste and trouble goes much deeper than the raid discussed above.  So I take this opportunity to talk about what all of us can do to keep this area of service clean and respectable.  By the way on July 14th, 2010 at Burton Manor in Livonia, Michigan I will chair the “Innovations in Care Dinner and Awards Presentation” and at that time in the presence of hundreds of members of the long-term care community will showcase home health providers worthy of our attention.

The things I hear lately are disturbing. Here are a few:

Home health agencies are:

Medicare rules are being flaunted and often with the cooperation if not support of physicians writing the order for care.  Even worse is the fact that providers are not uniting with a loud voice to draw more federal     attention to this problem or to identify and embarrass those who behave this way in their industry.

Take it a few steps further and you have:

Buying Medicare numbers:  I have long been against this practice.  Likely you have heard of it.  An entrepreneur completes the requirements to become Medicare certified which involves serving 10 patients in a skilled discipline and establishing a clinical operation.

Then this person sells the Medicare number, often for a huge fee. Of course now the federal government wants a company to operate for three, (3) years before it can be sold, along with its Medicare I.D. number.  In any event one prominent concern when you buy this number is that it often costs more than what it would cost to establish your own agency while at the same time you inherit whatever baggage and history, legal or otherwise, that might have existed with that number and/or its previous owners.   You are then just stuck with it.

There is also the very negative stigma associated with the home health care entrepreneur who prefers to enter the business this way.  I hear it everyday, and the under-current of this talk will only get worse.

Treating Medicare I.D. numbers like auctioned commodities gives the impression that making money is the only concern of the buyer and seller.  Of course it is appropriate to earn while rendering care.  However, person-centered reliable care should be the operational priority and often it is not.  After all the owners did not even bother to learn the business from the ground up in many instances.

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