Congress Can’t Cut Our Caring Attitude


By Walter W. Borginis III, CPA, CGMA



As part of the negotiation process with the union that represents the majority of our home health nurses, the union negotiation team suggested that I take some time away from my air conditioned office to accompany them on some home health visits during the current hot spell with temperatures near 100 degrees.  They suggested that these visits would give me a better perspective on the work that they do.  Given the fact that I am not a clinician, I agreed to their request.

I was able to make four home health visits with one of our very qualified pay per visit nurses in our managed care division. She is also a member of the union negotiation team. The four patients we saw all involved wound care. Two of the patients were bed bound and are able to stay at home only through the care provided by their family and the VNA. Otherwise, they would be confined to nursing facilities.

The visits demonstrated the important services that we provide in very challenging conditions. Our care is adeptly delivered in partnership with the caregivers and this key relationship allows the patient to remain both safe and stable at home where they prefer.  As we made the visits, there was no discussion of the ongoing union negotiations. Our discussions focused on the nature of the patient’s wounds, the computer system and use of the laptop in the home, and the complex logistics of getting medical supplies to the home.   We also discussed the difficulty in getting managed care authorizations for one patient’s specialty mattress and the extremely detrimental impact on the patient caused by the delay in getting the insurance company to authorize. We lamented the inability of some patients to qualify for Medicaid services, which is not helped by Pennsylvania’s rejection of the expansion of Medicaid to new income groups under the Affordable Care Act.  A lot of these “gap” patients receive free care from the VNA as part of our proud 126 year old history of service to the poor of Philadelphia. Our conversations were solely patient focused.

Throughout these visits, our nurse was extremely caring and professional and demonstrated a deep desire to help the patient.  Some of the services provided were above and beyond the complex wound care that generated the managed care referrals.  It was very impressive to see how caring our clinicians are and how positively receptive our patients are. They are true patient advocates.

As a week has now passed from the time of those visits, it occurred to me that I have learned several valuable lessons, including one that is not so obvious. It is clear that our clinical staff is extremely caring and performs their work very well in spite of the triple threat of oppressive weather, bad neighborhoods and non-responsive managed care companies. We care for the poorest of folks living in less than ideal conditions. These patients are not the marketing targets of the large health systems or nationwide for profit providers that dominate today’s healthcare environment. They are largely underserved and their medical conditions make them very much in need of care.

Most importantly, I learned firsthand that our deep and profound caring for patients has continued without regard to the many challenges we face. As we struggle to create a budget after the imposition of 17% of case mix creep cuts applied to Medicare payments over the last six years or the 2% sequestration cut or the upcoming Medicare rebasing cuts of 3.5% in each of the next four years, our caring endures.  As we struggle with the ongoing challenges of collecting face to face certifications from overworked physicians or the continued conversion of Medicare patients to lower paying managed care insurances, our caring spirit thrives.  These grim items complicate our existence and challenge our financial survival.  It is clear, however, that these problems do not detract from the quality of our care or the caring nature of our staff.

The real lesson is that CONGRESS CAN’T CUT OUR CARING ATTITUDE and the spirit of the not for profit healthcare agency continues to flourish and contribute to the overall welfare of an underserved portion of America.  In America, we are capable of doing great things, but the ultimate measure is how we take care of our poorest members. I urge you to take the time to arrange for a member of Congress to make the same type of visits in order for them to understand the value of home care.  There are truly valuable lessons to be learned.