Regulation of home care stirs debate


December 14, 1993|By Patricia Meisol | Patricia Meisol,Staff Writer

Donald Kirson often wonders how it is that a company like his, which has between 50 and 60 children on ventilator units in their homes and another 800 people on oxygen, doesn't have a license or face inspection by state regulators.

For his own satisfaction, Mr. Kirson signed up his home medical equipment company, Kirson Medical Equipment Co., for periodic reviews by the national Joint Commission on Accreditation of Health Care Organizations.

He is one of those who would be in favor of a proposal being circulated by Maryland health planners to license home health companies and subject them to quality-control measures. Requiring a license would be the check on another major change suggested by the Maryland Health Resources Planning Commission -- deregulation of the home health care industry.

In an analysis of the industry, state planners call for doing away with certificates of need -- state licenses to operate based on need in a geographic area -- which they say are justified only when a public franchise can deliver better quality and lower costs than private enterprise. But today, with technology exploding, obtaining a certificate is costly, time consuming and, some say, prevents innovation in the marketplace.

But at the same time that some home health companies are constrained, the system offers little protection for consumers who use the latest gadgets that come to market. In addition to home health agencies that dispense a variety of skilled care, there are companies that only sell ventilators, home infusion services, rehabilitation services or AIDS-related home treatments. (The home infusion business is soon to be licensed.)

Home health care is a $158 million industry in Maryland. It is growing as fast as new and simpler ways to treat old problems are being invented. Another part of the regulators' ideas is to require existing companies to offer more than a few services.

The discussion is just starting. Diane S. Pedersen, executive director of the Maryland Association of Home Care, which includes at least 60 providers, says her group has decided to investigate what is happening in other states before taking a position.

According to Diane Curtis, director of the home health/hospice program at St. Joseph Hospital and president of the state home care association, providers weigh in on the question of deregulation based on the size of their service area.

Those who have state permission to operate in a wide area don't want it, she said. But those like herself, with access to only two jurisdictions, see deregulation as the easiest way to expand.

St. Joseph's home health company is a medium-sized effort serving 2,000 people a month. It would like to add postpartum services, for example. But it is approved to operate only in Baltimore City and Baltimore County. That means patients who come from Carroll County would be excluded from the new service.

The consensus in the industry is that agencies will proliferate if the industry is deregulated, she said. One concern is that costs will rise as these companies compete for the same patients.

If her firm can follow a patient home no matter where the patient lives, it is in a better position to compete for managed care contracts and lower costs, she said. "So a lot of us, unless we are able to expand to a larger area, we are going to have problems," she said.

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