The House Call Is Back
PHOTO/Matt VOLPINI
Janet Mapes, a home health care nurse with VNA Care Network & Hospice of Worcester, examines patient Paul Cleary inside his Worcester home.
“Over time, there’s been a push for people to be treated in the community more so than in a hospital or an institutional setting. So this certainly allows us to serve the customers in the setting they want to be (in).”
Matt Salmon
Chief Operating Officer, Salmon Health and Retirement,
Westborough
As registered nurse Janet Mapes wrapped the lower half of Paul Cleary's left leg in gauze, she started chatting with her patient about the cars he owns, one of which he'll be driving in an upcoming St. Patrick's Day parade. He noted that his daughter had one of the cars this particular day and Mapes mentioned her by name.
The two settled into easy conversation as Mapes did her work. She checked Cleary's vitals and asked general health questions. It all took place in a finished, pale yellow basement room at Cleary's Worcester home. It has a large TV that Cleary can watch as he relaxes. There's also a table filled with medical supplies including gauze, gloves and sterile wash. After about a month of visiting Cleary a few times a week, treating him for second- and third-degree burns on his legs, a recent Wednesday marked his discharge from VNA Care Network & Hospice.
"It looks like our friendship's coming to an end real soon," Cleary said, looking at Mapes. She responded that their friendship wasn't ending, just her time as his nurse.
Cleary sustained the burns in an accident Christmas Eve. He spent 10 days at Massachusetts General Hospital, undergoing treatment that included skin grafts, before he was sent home under the care of VNA. Mapes and other nurses have tended to Cleary, as well as physical therapists who have helped him regain movement in his legs.
Cleary has had VNA care before after various medical procedures and said he's never had a bad experience.
"I'd rather be home recovering anyway," he said.
After 30 years as a hospital nurse, Mapes transitioned into home health a year ago.
"I think that home nursing is the future of nursing," she said of her decision to make the switch.
She's probably right. According to the U.S. Bureau of Labor Statistics, home health care is the fastest growing industry in the country, increasing jobs at an annual rate of 6.1 percent this decade.
As baby boomers age into retirement and the health care industry faces regulatory pressure to keep costs and hospital readmissions down, home-based health care is becoming a more viable option for patients.
Growth Opportunity
Matt Salmon, COO of Westborough-based Salmon Health and Retirement, said his group had planned to add home health to its roster of offerings — which include active-adult and assisted-living communities, as well as rehab and skilled nursing centers — before it acquired Milford Regional Medical Center's VNA and Hospice of Greater Milford in August.
"Over time, there's been a push for people to be treated in the community more so than in a hospital or an institutional setting. So this certainly allows us to serve the customers in the setting they want to be (in)," he said.
His group is gradually adding to the 136-employee staff of the Milford Regional VNA that became part of Salmon to meet demand, and it plans to expand its services beyond 20 communities in the Milford area and into Northbridge, Westborough, Northborough and Worcester within a few months.
For VNA Care Network & Hospice, based in Worcester the push for new employees partially comes from its deal with UMass Memorial Medical Center last summer in which it purchased the hospital's home health arm that provided 85,000 home health and 28,000 hospice visits annually. It's also seeing more patients from a 2011 deal that made it a preferred provider for Atrius Health sites, which include Reliant Medical Group facilities.
UMass Memorial cited stiff competition in the home health industry in announcing its deal with VNA. Meanwhile, Milford Regional noted uncertainty over home-based care reimbursements prior to its deal with Salmon.
Whit Mayo, a senior research analyst with Robert W. Baird & Co. in Nashville, said those sales aren't necessarily part of a new trend.
"I think that that's a sort of isolated example of a broader trend that's been occurring for a number of years," he said. "It's not hospitals exiting home health; it's hospitals exiting non-core service lines."
Reimbursement Worries
But Mayo does think the industry has reason to be concerned about reimbursements.
Medicare reimbursement cuts of 26.5 percent were avoided in fiscal cliff debates between Congress and the White House in January for another year, but many still worry because any cuts could affect them. Home health agencies get most of their funding from Medicare and Medicaid, with each payment based on a patient's assessment per "episode" in a 60-day period. More so, Mayo thinks home health in particular could be affected by cuts.
"Home health has been long associated with fraud and abuse and that makes a subsector more uniquely vulnerable in the context of this deficit that we're running," he said.
Barbara B. Brooks, vice president of clinical services at VNA, said the agency is concerned about the impacts fraud cases have had on the industry. She said that, rather than regulations focusing on where there have been problems, particularly in states like Florida and Texas, the industry as a whole has more regulations to follow.
"It's really increased the cost but not the reimbursement," she said.
Salmon said the Milford VNA acquisition is helping Salmon Health meet new requirements to reduce hospital readmission rates. He said the average patient at Salmon's Beaumont skilled nursing centers stays two to three weeks after leaving the hospital before returning home, and that it discharges 1,000 patients a year.
"Re-hospitalizations are a big issue," he said. "So, having the VNA in our continuum allows us to keep a better eye on the patients we discharge home from our skilled nursing facilities. We're already seeing an improved ability for us to reduce re-hospitalization."
Denise McQuaide, CEO of Parmenter Community Health Care in Wayland, said her nonprofit saw its patient numbers increase 20 percent last year, to about 2,400, and it plans to add about 10 employees in the next 10 months (It currently has about 100). However, her agency faces increasing difficulty with reimbursement concerns and competition from larger home health organizations.
Because Parmenter isn't affiliated with a hospital system, it relies heavily on word of mouth and McQuaide said the agency is looking at who it could partner with in the future. However, she said Parmenter's board has ruled out being acquired by a larger entity.
"We really see ourselves as that type of small local business drawing from the local residents who really want that high quality, nimble agency and not the 800-pound gorilla," she said.
Parmenter has taken steps to increase visibility in the community by offering seminars such as babysitting classes and fall prevention for seniors. And for the first time, it has hired a liaison to meet with case managers and seek referrals. It's in the process of hiring a second liaison.
"Parmenter never had to do that," McQuaide said. "We had one person who was in charge of marketing and did a lot of outreach … Now we're realizing that in order to compete, we do have to have more than one person out there representing" the agency.
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