Androscoggin Home Healthcare + Hospice President and CEO Ken Albert was busy at the National Association for Home Care & Hospice’s (NAHC) annual Financial Management Conference last month.

In addition to leading his own organization, he was on the heels of a Washington, D.C., trip to vie for the entire home health industry in the wake of the Centers for Medicare & Medicaid Services’ (CMS) home health proposed payment rule.

The Maine-based Androscoggin is a nonprofit operator that employs 500 workers across all 16 counties in the state. In addition to his role with Androscoggin, Albert is also the chair of NAHC’s board.

Androscoggin had adjusted well to the Patient-Driven Groupings Model (PDGM), filling gaps in health care access throughout Maine in the meantime. It had navigated the pandemic as best it could, and actually came out with better hospital relationships on the other side.

All the while, the company was reinvesting more money back into the business to advance technology and offer more types of care to its patients.

But just like a great deal of other home health CEOs facing a potentially devastating final payment rule for CY 2023 from CMS, Albert was carrying around a proverbial question on his shoulders: “What happens to my business if there are no longer margins?”

Home Health Care News sat down with Albert to discuss that question and much more in Las Vegas. Below are highlights from the conversation, edited for length and clarity.

HHCN: First of all, what are your thoughts on the Preserving Access to Home Health Act? How bullish are you on these legislative efforts?

Albert: I’m totally bullish on it. First off, the groundwork for this was laid well in advance to the meetings with members of Congress in person. The associations are getting much better at developing relationships. They’ve always been good, but I think they’re getting much more progressive in developing relationships with members of Congress, from an advocacy standpoint.

While anticipating what might come down, there had been a lot of work done in advance. I was very impressed with the speed with which the various sectors of our industry came together. The large organizations and the national associations came together within a matter of days, with a multi-pronged strategy designed to address the proposed rule. That’s remarkable in an industry that could very easily be fractured and have multiple perspectives on the same issue.

Then the strategy with key members of Congress, both on the House and the Senate side, those meetings were just great. There was sincere interest from the staffers, as well as those in Congress that we met with, in our assessment on the impact that this would have on the industry. And an appreciation for the integral role of home health care in the health care continuum.

If CMS or governmental payers have a design change in mind, they cannot do anything to undermine the predictability and sustainability of the industry as we know it today. And it’s really imperative that Congress gets that.

I think transparency is the other thing. When you are taking $4 billion out of a $17 billion spent, you should be prepared to show your work. And we do not have that information. And something is wrong with that picture.

You mentioned that 44% of agencies would be operating in negative margins if the proposed rule became final. What would you do as a leader of an agency if that went through, to survive in that environment?

I think for organizations that don’t have reserves, this will not be sustainable. So it’s not a matter of shedding or becoming more efficient. It’s not about pockets becoming a little less empty. It’s about emptying pockets. And so absent reserves, those organizations will close. With PPS, we saw 40% of providers leave the market. This is another time that could urge several providers across the country out of the space.

If you’ve got reserves, though, you’re going to be looking at service-line diversification. So you’ve got your home health and hospice, but then you’re also looking at transitional care and behavioral health – as a home- and community-based service provider – to really diversify your service portfolio to fill the gaps in the specific communities that you’re serving.

And I also think that we’ll be looking at new ways of providing care. I think the pandemic really advanced the utilization of technology and how we deliver care, but this is going to drive it further. For instance, even though it’s not reimbursed, integrating virtual visit strategies into your overall health care delivery methods.

You need a margin to be able to invest in your business. It’s just the way business goes. And I think in the health care sector, you’re constantly reinvesting in the innovation of your business – identifying gaps in the specific communities you serve – whether that’s employing new technologies, or really advancing care programs. But those investments are going to go away, and you’re going to see people pull back to the very bare minimum that’s necessary in order to satisfy the Conditions of Participation.

When PDGM came down the pike, Androscoggin adjusted, especially with wound care programs. Can you explain how you did rejigger things?

I’m from a rural state. So access to wound care clinics is limited to certain geographic areas of the state. We have long had a small infrastructure of wound care specialists in the field, and certified nurses collaborating with physicians, and having medical staff who also collaborate with primary care physicians. And we doubled our investment in that.

So expanding using virtual strategies, but also doing face-to-face with certified wound care specialists in long-term care facilities, assisted living facilities and in the home setting.

But that’s expensive. And you need that margin in order to invest in it innovatively. And we will look at programs like that. We launched the Maine Center For Palliative Medicine. We have 14 individuals on the medical staff that are providing palliative medicine. And what do we do with those programs when the margin supporting those has gone away?

If we can take out the doom and gloom for a second, what are the things that you’ve been excited about at your agency?

I think one of the things is that, you know, we’ve always had great collaborative relationships with the hospitals in our service area. But one of the things that the pandemic did was really forth the requirement that we’re at the same tables navigating care. And that has continued.

We’re independent. We’re not owned by a hospital system. So we serve six different hospitals. Having the nature of those relationships be in truly monitoring the patient’s condition longitudinally, as opposed to in a silo, has been great.

But, at the same time, you have a workforce that is tired. A workforce that has given as much as they can get right now. And as an employer, you know, you put in resilience-building programs, you do what you can do to keep these people in the field.

I think where I get my strength from is things like this. I got a letter last week from this patient who just really explained in detail the four or five clinicians that were in there taking care of him after a traumatic surgery that impacted his life. And so I think the response from the community, to to our organization, is part of what helps. Philanthropy is down across the country. It’s not down for us, though, and we’re seeing some areas where it’s actually up.