With the release of the proposal rule for 2018 last week, which included yet another payment reduction and the time frame for implementation of an entirely new payment methodology – the Home Heath Grouper Model(HHGM), conversations about the future range from disappointed to bleak. When I read that the final rules for both skilled nursing facilities and inpatient rehabilitation units included payment RAISES it added to the level of frustration. In speaking with a colleague about the pattern of payment reductions and the almost constant mantra about the level of “fraud and abuse” in our setting (see any recent MedPac report about home health as an example), the comment was made that home health spending is “the loose change that falls out of Medicare’s couch” when compared to facility based care and yet takes some of the biggest hits in health care reform.

In times like these, it is easy to get caught up in the frenzy of negativity. Change is coming and change is hard. 2019 is being positioned to be one of the biggest overhauls of payment and data collection the industry has seen in about 20 years. I am already hearing people talk about giving up and walking away.

Let’s put aside the burden for just a moment and think about WHY we ever chose to work in home health. Was it fame, glory or riches? For me it was about getting to be with people in need where they live. Trouble shooting the home environment they want to stay in to keep them safe and as independent as possible. Sure, at times that involved crawling on the floor trying to find the missing dentures, dealing with that precious little growling dog in a knitted sweater or managing strange odors by mouth breathing the entire visit. I learned I could do an entire visit without ever sitting down and could change a life by adjusting a bedside commode. I may end a day running straight to the shower and thinking of burning my clothes or eating a cookie made by a patient who is finally able to bake again. No two days are ever the same and creativity is a MUST.

I am not naïve about what is coming BUT I refuse to let it chase me out of this setting. People NEED us to stay the course. We must stay informed, advocate for our industry, plan for the future, learn from mistakes and always remember WHY we do what we do.

If you are in doubt – go make a visit. It can put everything in perspective

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