Capitalizing on the backlash against for-profit home-care agencies-many of which have been accused of or investigated for Medicare billing fraud-the Visiting Nurse Associations of America unveiled a major restructuring last week intended to reassert itself and its not-for-profit home-care agencies as the leaders in the field.
The association, which represents more than 200 not-for-profit, Medi-care-certified home-care agencies, named a new president and chief executive officer who comes from the for-profit side of the business.
It also said it plans to relocate its headquarters from Denver to Boston so it will be closer to more of the nation's leading medical institutions and policymakers.
Carolyn Markey will assume the top job in mid-October. She previously served as national director of home care for Birmingham, Ala.-based HealthSouth Corp., the nation's largest for-profit rehabilitation provider.
Although Markey is crossing ownership lines, she said her experience will help the mission-driven association make its transition from a loosely affiliated, educational resource to a more tightly linked business alliance.
Markey said the association, which had a 1996 budget of $2.2 million, plans to build regional and national networks of VNA agencies that can share clinical expertise and compete for managed-care and group purchasing contracts as well as create a national image for the VNAA.
In addition to its structural changes, the association has stepped up its support of President Clinton's controversial proposals to place a moratorium on the Medicare certification of new home-care agencies and to double the number of an-nual home-care agency audits.
Clinton called for the changes earlier this month as part of the government's ongoing crackdown of alleged Medicare billing fraud in the home-care industry (Sept. 22, p. 13).
"We need to restore confidence in and the integrity of home care," Markey said. She said the new rules may result in administrative burdens for the VNAA's members, "but it's worth it to restore trust in the industry."
The decision to tighten the organization's focus and heighten its visibility became a priority following the group's annual meeting in April, said VNAA Board Chairman Janice Treml.
"We are afraid that home care is at risk and, because of our history, we thought we should take a leadership role in the current debate," Treml said.
The first VNAs were formed in the 1880s in Albany, N.Y., Buffalo, N.Y., and Boston to provide community-based home-care services. In 1983, they formed the VNAA to support their development primarily through educational forums and advocacy efforts.
By 1995, VNAs represented 6.6% of all home-care agencies and 46% of all not-for-profit home-care agencies. They serve about 8 million patients annually and brought in almost $4 billion in total patient revenues in 1995.
VNAs have been struggling in recent years to compete with larger healthcare networks and chains that have the wider geographic coverage and operating efficiencies that managed-care plans and other third-party payers are looking for.
According to a VNAA survey released last year, 72 of the 151 respondents said they had entered an affiliation, merger or acquisition agreement with other providers, both not-for-profit and for-profit. Another 37 said they were planning some type of affiliation in the near future.