Two years after taking the helm at the American Association for Homecare (AAHomecare), President and CEO Kay Cox continues her mission to educate legislators about the value of home care. On the eve of the AAHomecare Legislative Conference, we spoke with Cox about the state of the industry and the battles ahead.

Dealer Provider (DP): It has been 2 years since you took over as president and CEO. What has surprised you most since then?
Cox: It is not that any particular issue has been a surprise, but what has impressed me the most is the commitment of the home care community we serve. Our stakeholders—both providers and manufacturers—truly rally around their patients. They show tremendous support for the patient population, the senior population, and the people they work with on a daily basis. I am impressed by this fact because home care is still a relatively young industry. It is heartening to know that our AAHomecare community is genuinely committed.

DP: AAHomecare actively encourages providers to contact state and federal legislators and get involved in the political process. What do you say to providers who claim they just don’t have the time to get involved?
Cox: I say do anything you can. That might mean becoming an active member of a state or national association, sending a letter to a prominent individual, or lobbying in Washington. Basically, I tell providers, “You can’t afford not to be involved.” The home care business is a complex one, and your business depends on you staying visible and active. For example, I have suggested that providers invite a Congressional member to visit their organization or go on a home visit with the provider.

It is important to understand that forces outside of you control issues like reimbursement, paperwork, and much more. Providers who do not want to become victims will do their best to remain active and involved. Involvement is one issue, being aware is another. It is very important for providers to keep their finger on the pulse of what is happening in Washington. It’s almost impossible to establish your budget or your business plan if you don’t know the direction of reimbursement, for example. Staying aware is critical to staying competitive. That’s why we encourage providers to stay in touch with AAHomecare. We disseminate a wealth of information that is intended to help keep them informed on important political and legislative matters.

DP: Among legislators, what is the most common misconception about home health products and services? What is the best way for providers to correct these misconceptions?
Cox: Generally, legislators do not understand how clinically and technically advanced home care has become. They seem to see the industry the way it was 15 years ago. My experience has been that legislators do not understand the level of sophistication we have reached. Today, we can do almost everything in the home—short of surgery.

How do we correct the misconceptions? Well, we are educating the legislators. Providers can certainly help, too. They can actively pursue their members of Congress and share the success stories. Let them know that home care is performing miracles. Providers can personally relay those miracles—the new pathways to patient care—to legislators. We need to keep the rapport going, to talk about the personal anecdotes and about ways home care is improving quality of life for countless patients.

DP: Which members of Congress do you consider “friends” of home care?
Cox: I consider all members of Congress potential friends! Naturally, we have a handful of real champions in our corner, and we continue to cultivate these relationships. Rep Mike Ross (D-Ark) is a great example. He is literally one of our own! Mike and his wife own a pharmacy and Mike is an HME provider. He is a tremendous champion for our industry and our cause.

Other names that come to mind include Sen Mike Crapo (R-Idaho) and Sen Blanche Lincoln (D-Ark). Both of them helped establish the chronic obstructive pulmonary disease (COPD) Congressional caucus. Rep John Lewis (D-Ga) and Rep Cliff Stearns (R-Fla) supported their efforts. When I think of “friends” to home care, I also think of Rep Dave Hobson (R-Ohio) and Rep Harold Ford (D-Tenn). I could name several more, but the point is that every member of Congress is a potential friend. It is all about educating them on the value and the success of home care. For example, we recently started cultivating a relationship with a new potential champion of home care, Rep Patrick McHenry (R-NC), who is just 29 years old. He is open-minded, energetic, and we have strong hopes that he will work to support home care.

DP: When you started 2 years ago, some HME activists held out hope that nationwide competitive bidding could be stopped in its tracks. In a recent Dealer/Provider Midweek Analysis, you compared competitive bidding to a train that has been gathering steam for several years. Specifically, you said, “What we can do is influence how fast this train moves and what direction it takes.” As of now, what is your best-case scenario for the shape and direction of competitive bidding?
Cox: Essentially, competitive bidding has been around since the early 1990s and gathering steam ever since. While we can’t stop the train, we can make sure our voices are heard. One way we are doing this is by sitting down at the table with CMS and talking about the direction competitive bidding should take. AAHomecare represents one third of the members on the Program Advisory and Oversight Committee, which advises Medicare. We are discussing the pressure points—that is, each individual component of competitive bidding. These issues include protection for small providers, exemption of rural areas with low populations, contractor implementation, quality standards, mechanics of the bidding process, product selection, and bidding cycles. We are dissecting each issue and developing strategies. In fact, we have even retained a consultant who is a former senior advisor to CMS. His input is invaluable as we look at each piece of the competitive bidding puzzle.

What providers need to understand is that competitive bidding has now passed into law. At the moment, we can’t change that fact. But we can look for opportunities, develop strategies, and help steer the outcomes prior to the anticipated 2007 changes.

DP: The new Secretary of Health and Human Services, Michael O. Leavitt, has already said positive things about the role of home care. Do you think Secretary Leavitt will go beyond words and become a true ally?
Cox: Yes, I definitely see Secretary Leavitt as an ally. I have personally met with him and his team, and he is very open, sympathetic to patients, and committed to the nation’s health care in general. As a former Governor of Utah, he has dealt with health care issues for many years. But some of the best evidence that Leavitt will prove to be an ally came just recently during a National Conference of State Legislators. During that meeting he called for more home and community-based care in Medicaid.

He has talked about the idea for rebalancing and the need to change the basic construct of health care, so that it is more efficient and delivered in the setting where people want to be served. Home care fits this model.

DP: What is AAHomecare’s number one legislative goal and how has the organization fared so far in pursuing that goal?
Cox: I can’t say that there is a singular legislative goal that we are after. Our mission addresses the entire breadth of home care. Some years, like 2004 and this year, are more regulatory than others. So for us, there is a good deal of strategic planning right now. For example, we are working to avoid Medicaid cuts. We are building the foundation now so we can move quickly when Medicaid legislation takes off. But as far as the “big picture” goes, our goals are to stay visible in Washington, continue dialoguing with members of Congress, and weigh in on the key issues. If we do all of this right, we will be poised to act at the opportune moments.

DP: When you see the many challenges ahead, what gives you optimism?
Cox: Our members do not give up. The home care community is genuinely committed to improving quality of life for patients—and that is what gives me the most optimism. If our members won’t give up, we won’t. With every small victory, we are building a foundation for a better tomorrow for providers and patients alike.

Q&A conducted by Marianne Matthews, a contributing writer for Dealer/Provider.