The National Association for Home Care is dealing with unrest within its membership ranks.
As the nation's largest home-care trade association by far, NAHC is growing along with the booming industry. Its revenues swelled 30% in 1994, to $12.9 million, and its annual meeting last October attracted about 8,000 attendees.
However, the group also is feeling the effects of consolidation in the field. For example, it can't pin down the exact number of members it serves, instead using a rough estimation of 4,000. It counts its members several ways, depending on whether they are big chains, divisions of integrated systems or small community-based agencies. NAHC had identified a total of more than 17,500 home-care agencies nationwide as of last June and estimated home-care spending at roughly $27 billion in 1995.
Earlier this month, the group held two unrelated meetings to alleviate members' concerns. NAHC has been defending its plans to accredit information system vendors and consultants, as well as its lobbying force in Washington.
First, the group hosted a meeting with 29 information system vendors who are concerned that NAHC's plans to lend its name to one company will give that firm an unfair advantage. The association's recent launch of a for-profit division called NAHC-Plus gave rise to the discontentment.
Next, NAHC met with the California Association for Health Services at Home, which has voiced concerns with several of the group's services. CAHSAH concerns. In January, CAHSAH threatened to resign from NAHC unless the group addressed several criticisms. NAHC replied with a six-page letter outlining the inaccuracies of CAHSAH's claims. In a March 13 meeting, CAHSAH presented Kaye Daniels, NAHC chairwoman, and Val Halamandaris, NAHC president, with a list of criteria it seeks in a national association. The two groups are still in negotiations, according to Joseph Hafkenschiel, CAHSAH's president.
Meanwhile, CAHSAH recently retained its own lobbyist, at a cost of $50,000 to $100,000, in a joint arrangement with the Home Care Association of New York State, according to Hafkenschiel.
"The lack of leadership, failure to involve CAHSAH and other state associations in development of policy, and incomplete and misleading information make us question your ability to represent CAHSAH in Washington, D.C.," stated a Jan. 11 letter, which was signed by Hafkenschiel and Joan Baier-Garland, CAHSAH's chairwoman.
The letter sent reverberations of concern through NAHC's membership. At least nine other state home-care associations also have sent NAHC letters supporting CAHSAH, according to Home Health Line, an independent weekly newsletter. Some of those provider groups complained that NAHC has instilled unjustifiable competition among its members through the formation of NAHC-Plus.
Vendor disquietude. Through NAHC-Plus, the association plans to "broker the provision of products and services," including consulting, legal, referral and information services, as well as group purchasing, NAHC said in a November 1995 news release. The association announced at its annual meeting last October that it would create the subsidiary, but it hasn't released details on the proposed services since that statement was issued.
At that time, NAHC also announced that it lent its name to one information system vendor, Atlanta-based Simione Central, which resulted from the recent merger of Central Health Management Services with Hamden, Conn.-based Simione & Simione Consulting Group.
However, it declined to release the terms of its licensing arrangement with Simione Central, and vendors are clamoring for a description of the due diligence process that led to the arrangement. In addition to a fee, NAHC receives royalties from Simione Central based on the sale of the system, called NAHC Information Systems, according to Steve Delfin, NAHC spokesman.
Since it announced the creation of NAHC-Plus, the association has confirmed that it would seek the input of vendors to help it identify the needs of its members, appropriate pricing and the best ways to link members with optimal resources.
"Of course, that's going to threaten some vendors, and that's natural," Delfin said. Specifically, home-care information system firms objected when NAHC lent its name to NAHC Information Systems without their input.
NAHC met with concerned vendors for the first time March 6 and formed a four-member task force that will advise the association on its information system-related initiatives. The association hosted a similar meeting with about 50 home-care consultants March 20.
In sponsoring the information system, NAHC is moving forward with its plans to establish a repository of information on home healthcare, Delfin said.
"As we move more and more into outcomes measurement, we feel that this is going to be a very valuable tool," said Doug Caddell, vice president of Simione Central. NAHC members who choose to implement NAHC Information Systems will benefit from a discounted pricing structure, Delfin and Caddell said.
Though NAHC's recent actions have provoked some outspoken critics, the association is risking unpopularity with a few members to offer services it says most of its members are asking for. About 200 of NAHC's members, or 5%, are information system vendors, Delfin said.
Two years of input from NAHC's provider members led to the creation of NAHC Information Systems, Delfin said.
NAHC is starting to expand its member services in a way that could ensure its viability three to five years down the road, Delfin said. With reimbursement cuts threatening providers, associations don't have the option of resisting change. "We're testing the waters," he said.