Editorial: Finding a voice for health care

Last week Addison Independent reporter John Flowers reported on the dire state of Vermont's health care system, which ranks the highest in the nation in cost per capita for health insurance. According to Dr. Bruce Hamory, the consultant who did an exhaustive review of the state's system, a typical mid-level health care plan for a 40-year-old is twice as expensive in Vermont as it is in neighboring Massachusetts, and over the past five years insurance rates in Vermont have increased 108%.

As Hamory said, and as all Vermonters know, that's not sustainable.

Part of the solution to reduce health care costs, Hamory said in a preview of a report his team will deliver this fall, will include providing more health care services at home rather than having patients use expensive emergency care or hospital-based systems. Health care entities like Addison County Home Health and Hospice (ACHHH), Hamory said, should work closely with the hospital system to serve patients before they require that more expensive care.

Tell that to Congress.

As Flowers reports in a lead story in today's issue, the U.S. Centers for Medicare and Medicaid Services (CMS) and Congress "have been pounding non-profit home health agencies with Medicare reimbursement-rate cuts" for the past two years and have proposed a third consecutive cut this year.

ACHHH executive director Deb Wesley said reimbursement cuts of about 7% over the previous two years have reduced revenues by $338,000 for the local agency. That's not catastrophic for a 90-person organization that brings in about $8 million annually, representing a cut of just over 4%, but considering increasing costs (goods and labor), a mission of helping anyone regardless of their ability to pay, and increasing demand because of our aging population, it's certainly going in the wrong direction.

Moreover, the CMS is predicting they'll force a third of the 11,400 home health agencies in the U.S. out of business by ratcheting down on the reimbursement rate. Why are they doing that? Because about 83.5% are for-profit ventures, and those businesses are not in states with a "certificate of need" process, like Vermont has, and they don't have to serve clients who can't pay. In other words, those for-profit home health care businesses cherry-pick their customers and the services they offer to game the system and make high profits. To that end, CMS's move to lower reimbursement rates to those for-profit centers makes sense.

But why isn't there a carve-out for nonprofit home health care systems? Good question, Wesley responded, adding she and her colleagues across Vermont opposed the first two cuts and are working to stop this third round of cuts before they do more harm. But with little progress. Already in Vermont, the Franklin County Home Health Agency (FCHHA) was forced to close its doors this past January, after serving the greater Saint Albans area for 55 years.

We're certain Sen. Bernie Sanders, I-Vermont, who chairs the Senate Health, Education, Labor and Pensions Committee, has heard from Vermont's home health care constituents, but perhaps his Senate colleagues have not heard it loudly enough.

As Vermont has no choice but to navigate a new path toward a sustainable health care system, many individual voices galvanized behind common-sense approaches to affordable care will need to orchestrate their collective message with force and conviction, time and again. The Visiting Nurses Association of Vermont, which represents ACHHH and other home health care facilities across the state, shouldn't be shy to rally opponents against this third rate cut and tap into that collective voice that is surely frustrated by Vermont's high rates.

Done well, we should be able to raise the roof off the Capitol in D.C. the way it should be done — without scaling a wall or breaking a single window, but with voices against a policy that harms the very agencies we need.

Angelo Lynn

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