Inside the Home Health Industry’s Choose Home Lobbying Push

Home health stakeholders have been lobbying for the Choose Home Care Act of 2021 ever since it was introduced in the U.S. Senate at the end of July. That push has now reached a critical juncture.

Beginning last week, the Partnership for Quality Home Healthcare (PQHH) and its provider members have been holding virtual meetings with key Senate and House lawmakers, along with their staffers. The goal of the meetings, which will continue into early December, is to solidify bipartisan support so Choose Home can attach itself to a future legislative package when the time comes.

“We just want to make sure that we are ready for any legislative opportunities as we move along in this process, whether that’s an end-of-year package or something else,” Joanne Cunningham, executive director of the Washington, D.C.-based PQHH, told Home Health Care News. “We just want to make sure that we are doing our due diligence so we’re ready for anything.”

In the Senate, Choose Home is sponsored by Sens. Debbie Stabenow (D-Mich.) and Todd Young (R-Ind.). Reps. Henry Cuellar (D-Texas) and James Comer (R-Ky.) are the sponsors of Choose Home in the House, where the bill was introduced in early October.

As of Nov. 15, there were 30 total co-sponsors of Choose Home, with political affiliation split close to even at 12 Republicans and 18 Democrats.

“I really haven’t yet met with a single congressional staffer or member of Congress since we’ve started where there’s been a response other than, ‘We like this idea conceptually. Now tell us more,’” Cunningham said.

If enacted, Choose Home would create a pathway for eligible Medicare patients to receive extended care services as an add-on to the existing Medicare home health benefit for 30 days post-discharge. In addition to core home health offerings, those services include transportation, meals, home modifications, remote patient monitoring, personal care services and more.

The idea, Cunningham explained, is to give people a greater ability to choose how and where they recover, whether that’s in a skilled nursing facility (SNF) or at home.

“I’ve been working in the home health space for a long time,” she said. “And there’s always been this question of, ‘OK. What percentage of SNF patients could be appropriately and safely cared for in the home?’’’

Building a case

At least nine unique organizations and dozens of individual lobbyists have registered to lobby on Choose Home, an HHCN review of OpenSecrets data shows. Among those organizations are PQHH and the National Association for Home Care & Hospice (NAHC), in addition to provider giants like Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (LHCG), Elara Caring and Bayada Home Health Care.

In many ways, the massive advocacy push reflects the kind of collaboration and well-orchestrated campaign that the home health industry has become known for.

“What we’re seeing today — that we didn’t see years ago — is the industry continuing to work on these things collectively before making any decisions about what the advocacy approach is going to be,” Angelo Spinola, the co-chair of the home health and home care industry group at the law firm Polsinelli, previously told HHCN. “I believe that’s here to stay.”

Other organizations lobbying on Choose Home include AARP and the National Multiple Sclerosis Society. The American Health Care Association (AHCA) is also registered to lobby on the bill, which it has publicly opposed.

Since last week, Cunningham said she has had dozens of conversations about Choose Home, with dozens more in her pipeline.

“My schedule is jam-packed,” she said.

Chad Creech, chief integration and strategy officer at Alternate Solutions Health Network (ASHN), has been equally busy setting up meetings to talk about Choose Home. Launched in 1999, the Dayton, Ohio-based ASHN delivers home health and hospice services in Ohio, Florida, Virginia and Michigan.

“We’ve had multiple talks over the past week and have more scheduled this week as an organization, mostly with the districts that we work directly with,” Creech told HHCN. “What we’re trying to do is to convey truly what patients and families are requesting of us. We’re giving [lawmakers] specific patient case scenarios.”

An real-world example of a possible Choose Home patient: an independent, 65-year-old man that had scheduled mandibular cancer surgery on his jaw.

“When they were getting ready to be discharged, they had a [feeding tube] and were going through all these different factors,” Creech said. “The family and the patient really wanted to go home, but there’s not enough services … to make sure we have a safe [experience] with the traditional home health benefit. So they were required to go to the nursing home for 20 days, then come home and continue their rehab.”

‘A great bridge’

In the past, the home health benefit has been viewed in a mainly post-acute care context. Lately, though, health care experts have argued for the modernization of home health care in the U.S.

“Like all the other sectors, [home health agencies] are not only in a dynamic state given COVID-19, but also given consolidation and a change in the role of home health in the orbit of the care continuum,” Karen DeSalvo, chief health officer at Google Health and a member of the Medicare Payment Advisory Commission (MedPAC), said last December. “It’s going to be an interesting few years, as we continue to understand whether home health is one sector, or if it’s evolving into one … where there’s multiple pieces.”

Choose Home alone wouldn’t be an overhaul of the traditional home health benefit. Instead, it would serve as an important bridge that gets the benefit one important step closer to where it ultimately needs to be.

“I think this is a great bridge,” Creech said. “It’s a great start to really modernizing the benefit.”

Choose Home would be particularly impactful for providers like ASHN.

Originally founded as a privately owned community-based home care company, ASHN made the decision about a decade ago to exclusively work with hospitals on joint ventures to lead their home health and hospice programs.

Its most recent JV was in September with Memorial Healthcare System in South Florida. A month prior, ASHN likewise announced a partnership with The Ohio State University Wexner Medical Center.

“[Choose Home] would really allow us to add an additional benefit and have more appropriate patients going home versus, say, a short-term stay in a skilled nursing facility,” Creech said. “With the hospital partnerships, we are seeing higher-complexity cases, higher-acuity cases coming out of the hospital, even pre-COVID. And with COVID, when it hit, we started to see even more patients being sent home.”

Having “more pieces to help solve that puzzle” is critical, he said.

“Maybe personal care services in the home or telemonitoring, all those different factors,” Creech said. “Those conversations are happening on an ongoing basis with the executives inside of our hospital systems.”

As PQHH, ASHN and their peers continue to meet with lawmakers, home health stakeholders are also working to get a formal price tag attached to Choose Home via the Congressional Budget Office (CBO).

“We’re obviously in the queue,” Cunningham said. “Our champions made sure that Choose Home was in the CBO queue, which it needs to be.”

An independent analysis found the Choose Home model would save up to an estimated $247 million annually by offering facility-level services in the home setting instead of a SNF or other institutional setting.

It’s unclear when CBO will score Choose Home, partly because there’s so much other significant activity happening in Congress, from the major infrastructure package to historic investments to the country’s social safety net.

Cunningham doesn’t see all the other legislative conversations as roadblocks, however.

“There’s a big, huge robust Medicare conversation taking place,” she said. “And we’re all sort of seeing that play out as part of the broader Biden administration priorities. Choose Home is very compatible with that entire [mission] of doing a better job of providing opportunities for more care in the home when it’s safe and appropriate. I actually think the bandwidth issue is not an issue. It’s not a challenge.”

President Joe Biden is expected to sign the more than $1 trillion bipartisan infrastructure plan into law on Monday.