The Threat (and the Opportunity) Is Real
Each year we are faced with regulatory and reimbursement changes and challenges that make it more difficult or more expensive to provide services. Some are troubling and time consuming while others threaten the viability of some agencies. Every new challenge is often followed by cries that these are “industry altering” threats. Think about introduction of OASIS. RAC audits. Face to Face. Rebasing.
Don’t get me wrong, these are serious challenges but they don’t reach the magnitude of “industry altering.” Today, however, there is a real threat, one that has the potential of becoming the third home care challenge that could reach the status of industry altering. It is a threat that will start in nine states (AZ, FL, IA, MA, MD, NC, NE, TN, WA) and will ultimately expand to all fifty states. First, a little history.
Industry Altering Challenge I. The Medicare Denial Crisis
The first Industry Altering threat was caused by the service and payment denials of the late 80s and early 90s. Basically, agencies found that many of their services were denied. Denied meant no payments. No payments meant agencies could not pay bills and staff. Results: closures. Many closures.
Following a major lawsuit lead by the National Association for Home Care and Hospice, the problem was rectified, the definition of eligible services expanded and our industry began experiencing significant growth in numbers of agencies, patients served and revenues. Great stability for roughly 18 years…and then the second challenge emerged.