From Patient to Provider: One Home Health Owner’s Strategy

As the home health care industry booms with interest from Americans increasingly seeking to age in place, one new agency is finding its way around the bustling market.

Jacksonville, Florida-based Family Focused Home Health Care, a private duty home care agency, recently became licensed by the Agency for Health Care Administration and is opening its doors to clients.

For founder Jim Borngesser, this day has been a long time coming. What was just an idea 10 years ago finally came to fruition when life events — including a battle with cancer — brought him even closer to the industry.

While recovering from his treatment for cancer of the appendix, Borngesser received a visit at home from a nurse and says she made him and his wife more comfortable. Prior to that, he had sought additional care for their parents as they aged.

So after winning his battle with cancer about a year ago, and finding that the company he worked for had closed his division, Borngesser “dusted off this idea.”

Now, Family Focused Home Health Care faces a future full of opportunities and challenges, especially as home health care ranks among the fastest-growing sectors in the U.S.

Home Health Care News caught up with Borngesser to chat about the challenges involved with being a private pay provider, what keeps him up at night, the ongoing battles against home health care fraud and the controversy over workers’ wages.

Home Health Care News: What’s it like being the new agency on the block?

Jim Borngesser: It’s tough. There are about 178 competitors just in my Jacksonville, Fla., market. There has been massive growth in Florida in the last five years.

It’s hard as a new agency because you’ve got so much competition, and you’ve got a hangover from the past when it was like the beginning of the insurance industry. You’ve got some people who do bad things and they’re taking care of a slice of the population that’s really vulnerable — so it’s a bad combination.

But I’ve got a strong sales and marketing background and a personal history that empathizes. You put all that together and you’ve got an opportunity to feel really good about what you’re doing.

HHCN: How do you differentiate yourself from the sea of home health agencies in your market and nationwide?

JB: Part of it is the basics: Know your clients and what they’re looking for.

I spent a long time — probably a good six months — doing research. I met with over 12 companies, starting with people I knew all around the country, and went through all the questions.

It gets back to the basics as far as what I’m doing: Understand who the patients are, then how are you going to brand your agency? That starts with its name. “Family Focused” really says it all for me when you look at how we position ourselves in the market. It’s your family, their needs, our focus.

Then it’s about getting the word out. The biggest opportunity for us will really be just getting our footprint established.

HHCN: What made you choose to establish yourself as a private pay agency?

JB: People thought I was crazy, saying, ‘Are you nuts not going Medicare?’ The market is there — I totally get it. But it’s one word: predictability. Medicare changed a whole lot of rules and regulations about a year ago as I was doing the research and talking to Medicare and private duty professionals.

Medicare not only can pay you, but they also have the ability to take the money out of your account. When you’re looking at the Medicare side, you’ve got these changes going on, and then the other side is the Affordable Care Act and how it’s all fitting together.

Now, in the last year and in the next few, I don’t know how people who are reimbursed by the government will be able to predict where their business will go, because the government can de facto make any change.

My goal was to get in and get the brand established as private duty. I’ll reassess over the next few years [whether to accept government or private insurance]. We might add Medicare some day but we’ll always be private duty. I’ve got to think that hopefully between Washington and the states and hospitals, things will get more predictable once we get through this chaos period.

HHCN: What are the challenges involved with being private pay?

JB: It is very difficult for a number of reasons: One, it’s harder because people have to pay for care out of pocket. This isn’t covered by any insurance, except long-term care insurance, so people are taken aback. It’s that shock. If it were covered by private insurance or government insurance, the market would be huge. People flock to [those agencies] tremendously.

There are going to be some hard decisions we’ve got to make — it can’t be something that is just for the rich. We’ve got to figure out how to make it work for people across the board. [Right now, our client base] skews middle- to higher income.

HHCN: What keeps you up at night?

JB: How do I provide good jobs for my employees and keep them employed, and to do that, how do I get more demand for my agency?

We’re above minimum wage, but the caregivers are part-time, given that they’re working from agency to agency. So how do I get enough capacity and how do I find the revenue to do that? The more I can get them paid, the more loyal they will be.

HHNC: Speaking of wages, what are your thoughts on the nationwide call for a $15 minimum wage and overtime protections?

JB: I’m a good person to ask, because my background is corporate America. I’ve always held the standard that if people work hard you have to pay them. And if they work overtime, you’ve got to honor that. To me, it makes sense.

Coming into this industry, I was doing heavy research and was reading about home health aides [not receiving] overtime pay. It shocks me. I came in and set the policy; I wrote an 80-page corporate manual and said, “I will pay overtime.” I think it’s the right thing to do to pay overtime. I know that increases my cost base, but I think agencies will have to realize you have to pay more to get what you want.

HHCN: Another hot topic in the industry is fraud. Do these cases harm the reputation of the entire industry — whether private pay or government-reimbursed?

JB: Definitely. There are two ways you harm the industry: People who provide terrible care and people who rip off the system — that’s money that should’ve gone to someone who really needed it.

Florida has done a really good job as far as handing out fines and clamping down on that to shut the process down.

The use of technology is also going to help us crack down on fraud. The more use of technology, the better.

It’ll take time [to build up the industry’s reputation] and people doing a good job to get some good press out there about those who are making a difference. Hopefully that becomes more of the norm.

Written by Emily Study