Home Based Health Leaders, Unite!

Eric Dishman

I like to think of myself as being a lot like George Clooney. Okay, okay, more like Ryan Bingham, the airport- and airmile-addicted character he plays in the recent movie, Up in the Air. (Except I don’t have his good looks, frequent romantic liaisons with strangers, or a job downsizing other people…other than that, I’m just like George Clooney, er, uh, Ryan.) I tend to talk a lot (this blog probably makes that clear enough). What I mean to say is that I give a lot of public talks…about healthcare reform and innovation for home and community-based care models.

So as I’ve been on the circuit these past few years, talking a lot, traveling a lot to different healthcare conferences and workshops, I have heard the latest on just about every topic: home care, home nursing, home dialysis, home medical equipment, home infusion, nursing homes at home, chronic care at home, concierge care services for the home, and many more. On the one hand, it is gratifying to learn from all of these associations and audiences and to see how much is happening in moving care to the home and community. On the other hand, I have to remember that I’ve got selection bias about where I spend my time…that home-based care is the exception, not the rule, in our nation’s thinking and prioritization of healthcare resources.

In fact, the current home-based care that does exist is under attack. Reimbursement for traditional care or treatment at home is being cut back significantly by Congress and Medicare, even though care at home is often more effective, cost-effective, and preferred by patients than institutional alternatives. I have written previous posts (see this blog entry, for example) about how overblown charges of “fraud and abuse”–caused by a few bad eggs–are being used to justify cuts to everyone in home-based care. These cuts are misguided, may well destroy the viability of a lot of small, community-based businesses, and are the wrong strategic direction for a country trying to improve quality, reduce healthcare costs, for more people.

All George Clooney kidding aside, I am seriously concerned about this. In full disclosure, some of the same fallacious fraud-and-abuse claims about home care are being used to deny the advancement of telehealth technologies, so as an Intel employee with vested interests in this kind of innovation, I am motivated to tackle this problem. As a patient advocate who has fought time and time again to get home care for a friend (see my previous blog about Janice), I am motivated to tackle these problems head on because I’ve seen first-hand how much better chemotherapy patients do when they get home infusion in their own homes than in hospitals. As a healthcare researcher, I have helped conduct dozens of game-changing studies of home-based health technologies that show great promise in reducing costs and suffering of diseases like congestive heart failure, diabetes, hypertension, asthma, COPD, Alzheimer’s, Parkinson’s, and cancer. And as a citizen, I believe home-and-community-based care is critical to America’s long term financial viability, competitiveness, and moral responsibility.

Which brings me back to my frequent travels and talks. Candidly, most of the home-based care industries and associations I have spoken to are not effectively championing their own cause and survival. I see many associations spending what small amounts of policy money they have on fighting small battles for their specific niche of the industry (doctors versus nurses versus concierge care workers versus dialysis versus Oxygen equipment versus infusion versus telehealth versus disease management, and so on). And even if they win the battle on occasion for a specific reimbursement code or a budget increase for their sector, they lose the larger war for a reformed healthcare paradigm that makes the home a major and lasting locus of care delivery for everyone.

I see some of these associations and trade groups so caught up in competing with one another for the same paying members and dues that they are unable or unwilling to band together with one another for a louder voice in Washington to carry out their very missions. I see home-based care companies ignoring the small but newsworthy fraud-and-abuse cases that they know do exist, hoping that the issue will go away somehow. And I see competitors so caught up in the game of competition that they fail to realize that no one will win if this entire collection of industries is legislated right out of existence or is ignored by healthcare reform altogether to be left as a barely-financed backwater of healthcare that just limps along.

I mean no disrespect in making these critiques, and it is admittedly unfair of me to characterize every company or association in this way, but as the pop culture phrase says these days, “I’m keeping it real!” My general observation from all these travels is that home-based health industries and associations are under attack, in part, because they have failed to band together, to co-fund a more unified and aggressive public policy campaign, and to self-police themselves for driving up quality of care and driving out what little fraud-and-abuse there is. I believe we as an industry can make significant improvements.

We need competitors to work together and to pool their policy resources for a more fundamental reform that brings the whole fold of home-centric industries forward. We need to learn from other sectors like long term care how they drove a Quality First initiative (see http://www.aahsa.org/qualityfirst.aspx) to improve care and fend off trumped up fraud-and-abuse claims that can bring everyone down. We need a united front and story about why shifting care to the home is important for patients, providers, and payers. We need a forum and action plan–driven by a coalition of coalitions–to move home-based health from a footnote or afterthought in the nation’s healthcare reform debate to a major tenant of innovation and reform.

Let’s figure this out and get moving. Even as it appears that a health reform bill is passing in Congress, it’s not too late to drive a more united front for home-based health. It will take months and years for current stimulus money and legislative fixes and updates to the bill to work their way through the system. But we need to start now. The demographic clock is ticking, the deficit is growing, and we need to build upon healthcare reform to make major changes so that home-based care becomes a fundamental part of our future.