Vermont’s Non-profit Home Care System Works Well
There is currently a challenge to the not-for-profit home care system in Vermont. Health planners at the Public Oversight Committee of the Department of Banking, Insurance, Securities and Health Care Administration and the Commissioner of BISHCA must decide whether to grant a Burlington-based for profit home care nursing agency a Certificate of Need (CON) to set up a Medicare-certified home care agency in Vermont. If the state decides to grant the CON, the decision would change over 25 years of public policy which has resulted in one of the best home care systems in the country. Below is a brief outline of why VAHHA members believe the current system works well and should be supported.
CON Rules
– Under the current CON rules, the state cannot grant a Certificate of Need for a home care agency unless there are substantial problems in access, cost, or quality. These are not problems in Vermont.Universal Access – The current system provides universal access to home health and hospice services. No other state can match this accomplishment.
Comprehensive Services - Vermont agencies provide a full range of medically necessary home health and hospice care to every town in Vermont and to all Vermonters, regardless of their ability to pay or the location of their residence.
Lower Costs – Home care costs in Vermont are among the lowest in the national and always have been. The absence of competition promotes efficiencies, assures the availability of specialists, and protects surpluses from profitable cases for use in free and subsidized services.
Social Contract - Competition could eliminate the responsibility of any particular agency to provide services to everyone in need.
Cherry Picking – In a competitive market, home care companies can cherry pick the most profitable patients.
The "Pepsi Challenge" – Show us one state where competition has resulted in lower costs per visit and higher access to services. Vermont is a leader in both of these measures.
Quality - Independent assessments of patient satisfaction of the VAHHA members indicate high levels of satisfaction. In addition, evaluations from the state, the Joint Commission on the Accreditation of Health Care Organization, and the Community Health Accreditation Program show that all 12 Vermont agencies provide high quality home care.
Fraud and Abuse - There is no agency fraud, abuse, or neglect in Vermont home care. Few states can boast this achievement.
Capacity - VAHHA agencies have repeatedly demonstrated commitment and capacity to respond to growing demand for services. Adding a competing agency would not increase that capacity but would result in increased health care costs.
Level Playing Field - Creating a "level playing field" by forcing private agencies to take their share of charitable patients would be virtually impossible.
Regulatory Costs – The cost to the state to regulate Vermont’s home health system is minimal. This is a frequently overlooked advantage of the present system.
Community Control – All 12 agencies are community governed.
Partnership - VAHHA members have long been valuable partners with the state and others to assure that Vermonters get the care they need. The current system fosters coordination and collaboration in the organization and delivery of services, rather than competition for patients, territory and funding.
Choice vs. Access - VAHHA agencies make every effort to assure that all patient are satisfied. If an individual or family is unhappy with the care they are receiving, the agency, with no questions asked, will assign another staff or make arrangements for another agency to provide service. Clearly choice is very important but unlimited choice of agencies could result in lack of access, especially for high cost, high need patients as the current agencies might not have the resources to serve all in need. VAHHA believes both choice and access are important. Unlike any other state in the nation, however, Vermont agencies provide a full range of medically necessary home health services and hospice to all Vermonters, regardless of their ability to pay or the location of their residence.