For more than 40 years, William A. Dombi has been one of home-based care’s fiercest advocates.
He became the National Association for Home Care & Hospice’s (NAHC) vice president for law in 1987, and has been a key player in many of the advancements and milestones that have moved the industry forward. Those include the growth of the home health benefit under Medicare, the implementation of the home health prospective payment system in 2000 and much, much more.
In 1987, Dombi spearheaded a notable lawsuit that changed the scope of coverage under the Medicare benefit.
In 2017, Dombi became NAHC’s interim president and was named the association’s permanent president the following year.
Last month, Dombi revealed his plans to retire as president by the end of 2024. This announcement comes amid NAHC’s merger with the National Hospice and Palliative Care Organization (NHPCO).
Home Health Care News recently caught up with Dombi to look back at his time at NAHC, and on what he believes to be the biggest accomplishments during his tenure.
Providers taking on an ownership approach with NAHC
“This translates to the members being highly engaged in everything we do — from advocacy to education and so on. What that means for the community of health care at-home is that we now have an army of people representing the interests of home care, in contrast to many other associations that are staff driven. There’s only so much a small staff can do, and now we have an army working together on behalf of everyone else.”
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Unifying the voices of home-based care
“Typically, when it comes to trade associations, or other representative bodies, there’s constant fracturing, and sometimes division, that turns into non-productive outcomes for the people that we represent. What we did with what we call NAHC 2.0 was establish a mission to have that unified voice. There’s two ways to have a unified voice. One of them is to speak as a single organization, and the other is to all have the same message. We have made progress on both fronts with our upcoming merger with NHPCO. We’ve made this progress by working with multiple other voices that represent one or more home care interests, on the national and state level. There’s still work to be done, in terms of that unification, but we’re no longer facing a splintered industry voice.”
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The end of site-based continuum of care
“For many years, decades even, people looked at the continuum of care as a step down from a hospital, to a skilled nursing facility, to home care and so on. Now, the breadth of care at home is greater than it’s ever been, with hospital-level of care at home, with skilled nursing facility-level of care at home, etc. When we look at how this happened, there’s no one person or one party that can be credited. It was clearly an effort from a multitude of people. I would have to say, NAHC has certainly played a part in helping make that happen — continuing to have that kind of culture throughout the home care community and believing that there is not yet a ceiling on what can be done.”
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Ushering home care into the future
“I believe we’ve had a lot of impact on both the involvement of technology in care at-home, and also changing the image of care in the home from a high-touch setting to a high-touch and high-tech health care setting – of clinical technologies and operational technologies. When people were trying to figure out what to do with patients during COVID, the clinicians, the administrators and the owners of companies all embraced technology as a serious tool to be able to expand what they could do during that very tragic time, and to invest in the future. Now, of course, we’re seeing the fruits of that in so many other ways, where major international global tech companies are investing in health care services in the home setting as well. A lot of hands, and a lot of brains went into taking tech, and making it such a central part of health care services at home.”
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Working in all forums effectively
“This one goes back to the very beginning in my tenure at NAHC, all the way to 1987, but it carries all the way through today. It’s a recognition that our role, as representative of a community of home-based care providers, requires us to work in all forums effectively. It’s not just dealing with legislation pending before Congress, or regulatory matters through various agencies like CMS, or the Department of Labor, and many others, but also in terms of in-depth research and the ability to demonstrate that we will go to war, if necessary, on behalf of our providers when we think they’ve been wronged. That means going into court with various litigation activities. That began in 1987, when I came to NAHC and prosecuted a case to deal with the entire Medicare home health benefit. This, ultimately, changed the entire benefit, in terms of what the scope of coverage is. That was just one lawsuit of many that we did. Litigation is the last resort, but what we’ve seen when we look at other health care trade associations, we see them doing what we’ve been doing for 30 plus years, and that’s protecting our members interests, even by going to court. Whether it’s the most recent case by the American Health Care Association, on the staffing requirements, or the American Hospital Association on their 340B drug discount litigation, or many others like that. All forms need to be explored in order to be really a bonafide representative of your membership.”
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