The end of the line for home health care?
By William F. Sullivan Jr.
It is truly ironic that in 2009, as we celebrate with pride the exemplary dedicated work Visiting Nurse Services of Connecticut staff has delivered with care and compassion to serve our community over the past 100 years, we face the greatest challenge to the agency's future; there are real questions about the future of our agency and the availability of home health care services for all Americans. What was begun by a group of Bridgeport-area women who sponsored a bicycle-riding nurse to travel the city administering to the needs of tuberculosis patients in 1909 is on the verge of being completely undone. And VNS of Connecticut is not alone. All of the nation's 9,800 home health care agencies across the nation face this same serious threat.
In what was probably the most politically active August in our nation's history, thousands of concerned citizens jammed town hall meetings sponsored by their representatives and senators to express their concerns about the proposed overhaul of the health care system. While some of these meetings featured yelling and shouting on the part of some participants, overall those who attended were there to express their genuine concerns about the proposed overhaul of the nation's health care system. What has been seemingly lost in the debate is the way our legislators intend to pay for this new health care system. Half of the trillion-dollar cost is proposed to come from new taxes on the nation's wealthiest citizens, the other $500 billion from cuts to Medicare reimbursements to health care providers, including home health agencies.
The health reform bills now before Congress call for nearly $57 billion (almost the entire federal budget for home health care spending in 2007) in Medicare cuts to home health over the next 10 years. This level of payment reduction represents an 11.4 percent decrease, yet our industry represents only 4.5 percent of the total Medicare budget. Home care will be required to contribute a disproportionate share of the reform package cost. The $57 billion translates to $860 million in cuts to Connecticut home health agencies, including VNS, where we would need to absorb a cut of about $1 million in the first year, $16 million over the next four years, and a cumulative of $63 million over the 10-year implementation plan.
VNS and its peer home care providers will not survive these draconian budget cuts. The majority of home care providers are operating with financial deficits under the current system. It is estimated that at least 70 percent of the nation's home health care agencies will close their doors within two years if these cuts are approved by Congress and the president. The result: clearly, home care benefits received by Medicare beneficiaries will be affected as patients lose the ideal option of recuperating at home, where they recover more quickly and completely, and are forced into unnecessary extended stays in the hospital or are transferred to a nursing home. Ultimately, access to home care will disappear for all Americans as agencies across the nation close their doors.
President Obama's administration recommended the Medicare provider payment cuts as way to finance health reform by saying that they will eliminate waste in Medicare, much of it prompted by fraudulent and criminal practices. This can be done without impacting the benefits received by Medicare beneficiaries, he says. Respectfully, we disagree. Rather than specifically targeting those who may abuse the system, proactively developing and intensifying strategies to identify and criminally prosecute offenders, the administration has designed a "quick-fix" that is simple and easy; one that lacks thoughtful insight, and realization of the dramatic consequences. More than 95 percent of our home health providers in the U.S. are caring, committed, efficient providers of much-needed, low-cost home health services to nearly 3.2 million Medicare patients. Slicing $57 billion from our Medicare payments is not a cure; it's a death sentence.
Those engaged in unethical behaviors will look for ways to circumvent the cuts. For the overwhelming majority of caring and committed home care agencies, we will fall victim to the cuts and the homebound Medicare patients in most need will be a defenseless casualty of this action.
VNS of Connecticut's nearly 500 staff members now administer to the needs of more than 8,000 patients, most of them frail elderly, who live in Fairfield, New Haven and Litchfield counties. Today, we deal with more than 260,000 patient visits each year. We can state for a fact, based on our patients' own comments, that our caregivers quickly become trusted friends to our patients and their families. This commitment has been evident at VNS of Connecticut for a century. And we are determined to do all we can to continue this important mission.
Over the next few weeks, home health agencies across the nation will be meeting with our elected federal representatives and senators urging them to stop the Medicare cuts to home health providers. Our agency and our peers in Connecticut have already begun that process and we have dedicated ourselves to bringing public attention to this important cause and convincing our legislators that our vital work should continue.
You, too, can help us protect home health care for all Americans. If you, a family member or even a friend has had the help of a visiting nurse or therapist, you know how important it is to make sure home care is available for everyone who needs it. You can join us in our battle by visiting our Web site at www.vnsct.org, clicking on the Friends of VNS icon on our home page and signing up to support VNS. We will occasionally email you all of the important facts you need to communicate with your legislators. When you hit the send button, our system identifies your individual elected officials and sends your letter directly to them. The process is easy and takes little more than 30 seconds to complete.
So please, help us preserve home health care so that like our parents and grandparents, we and our children can benefit from this critical service well into the future. VNS of Connecticut's 101st birthday is depending on you.
William F. Sullivan Jr. is president and chief executive officer of Visiting Nurse Services of Connecticut. He is also chairman of the board of the Connecticut Association for Home Care and Hospice.