America’s Healthcare at Home: Mark Kassir, Chief Executive Officer

by HCE Exchange on February 12, 2013

Mark Kassir, chief executive officer of America’s Healthcare at Home, recalls the mid-80s, when he was working as a respiratory therapist at Children’s National Medical Center in Washington, D.C.

He noticed that children were often staying at the hospital weeks, if not months, after they could have been discharged to receive home care. The insurance companies were not paying for a large percentage of the expenses incurred, and discussing home care was not an option in spite of the American Association for Respiratory Care (AARC) advancing a study that asserted it was cheaper to take care of patients at home than in an institution.

As Kassir’s career progressed, he worked with many start-up companies who were geared for home care, but their equipment wasn’t tailored for children. After his last position as president at a company that went from $1 million to $30 million in annual revenue, he decided to branch out on his own. Kassir started America’s Healthcare at Home with the mission of providing customized home-care services to all ages.

“In home care, my opinion is that you can be a big corporation, but you’ve got to be able to work within the region and be able to tailor your services to what that region wants, and a lot of these big corporations, they just want to McDonaldize everything,” Kassir said. “Their attitude is, ‘This is how we’re doing it, and it’s going to work for everybody,’ but it doesn’t.”

America’s Healthcare at Home is located in the Baltimore, D.C., and Northern Virginia markets. And even in those localized markets, Kassir said individual doctors want different services.

”Everybody can buy the same equipment. It’s not an equipment issue. It’s what can we do. Can we do a little bit more to help the patient in the home to keep them from being readmitted into the hospital and make their quality of life a little better?”

A full-service company

America’s Healthcare at Home is a full-service home medical-equipment company, offering everything from walkers to ventilators and CPAP machines. The company will even go so far as to set up intensive-care units in the home if the patient is stable, and it will provide babies suffering from sleep apnea with apnea monitors.

America’s Healthcare at Home employs several respiratory therapists and deals often with respiratory issues.

Business is currently good and growing, Kassir said, adding that hospitals want to discharge people. They’re incentivized financially to do so. The biggest obstacle for the company right now is reimbursements.

Coping with minutia

“We’re in an industry where the person who is ordering the product is not paying for it, nor are they using it,” Kassir explained. “And the person who’s using it didn’t order it and is paying some of it, but not all of it. And the person who is paying for it isn’t using it nor did they order it.”

As a result, the reimbursement process has never been harder or more complex.

Kassir said when he first got into the business, a doctor would order, for example, oxygen from America’s Healthcare, Kassir’s people would get the prescription and the insurance information, and issue the oxygen almost immediately.

Now, they have to call to verify the insurance and get an authorization from the insurance company, which can mean getting labs and reports and studies to prove that the patient genuinely needs the device. Usually, authorizations are only for 30 days, so when the 30 days is completed, should the patient still need the device, the process starts all over again.

America’s Healthcare confronts these obstacles by developing solid partnerships with physician’s offices and educating patients on the paperwork, doctors’ appointments, and the equipment use that is expected of them.

But the difficulties go beyond even this.

The Medicare conundrum

For America’s Healthcare at Home and for most companies like them, Medicare comprises a significant percentage of its business.

Kassir said Medicare is now doing competitive bidding. As a part of the program, all of those who provide medical-equipment services will have to bid on different product lines in oddly defined “regions.”

“The problem with that is there are a lot of guys who have no idea what they’ll be bidding, they’re smaller companies, not knowing what true costs are to do business, which will keep that price below-cost in some cases,” he explained. “But they don’t hold those bids. After Medicare comes out and awards it, they can still pull out. They could mess up the number for everyone else and not even take it.”

Originally, Medicare said the bidding regions would be individual cities, but the end result found it to be a combination of cities. Therefore, Kassir would have to bid on two regions—one made up of D.C. and Northern Virginia and the other Maryland, Delaware, Philadelphia, and other parts of Pennsylvania—to get the kind of Medicare business he was receiving before competitive bidding.

Therein lies another negative, Kassir said. Winning one bid doesn’t mean a company has won the entire service line for that region. Kassir may win oxygen and wheelchairs, but he could lose out on beds and hospital chairs. And Medicare doesn’t always factor in the service component when accepting bids.

“For a patient who needs a hospital bed, a wheelchair, and oxygen, they’re going to call two different companies to service them,” he said. “So it’s the government getting involved, not really knowing what they’re doing, don’t understand it. They refuse to accept the fact that there’s a service part to this industry. They look at what the cost of the actual equipment is and base the bid on that.”

Everyone gets hurt

It’s important, Kassir asserted, to realize that everybody will get hurt by this.

“They’re either not going to have the availability of the services or the services are going to be strongly scaled down,” he stated, adding that his company has found that sending a respiratory therapist out to a home every few weeks can actually be preventive care. But with scaled-down services, patients will end up getting sick before they go to a doctor.

Then, Medicare will have to pay five-fold.

“People are being shortsighted out there, and people are making decisions in the government, in the insurance industry, who have no idea what real life is.”

-by Pete Fernbaugh

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