A former hospital nurse and now the CEO of Healing Hands Healthcare, Summer Napier is all about home health innovation.
That’s why – since opening in 2016 – the Texas-based Healing Hands has launched a multi-faceted hospital-at-home initiative and a home-based oncology care program. It’s also why Healing Hands is so bullish on forward-thinking legislation such as Choose Home.
“If I could use one word to describe the industry and the change that I’ve seen, it would be ‘innovation,’” Napier told Home Health Care News during a recent podcast conversation.
But while the industry has taken several leaps forward, the 2023 home health proposed payment rule could result in one giant step back, Napier believes. With tighter margins, many providers will be forced to lessen their pace of innovation and become even leaner across their operations.
HHCN caught up with Napier to talk about that idea and more during our most recent episode of Disrupt. Highlights from that conversation are below, edited for length and clarity.
As a company, the for-profit Healing Hands provides home health, hospice and private-duty home care services across 22 counties in North Central Texas, employing roughly 250 individuals.
HHCN: I like to ask founders when I get an opportunity to do: How did you decide that you wanted to start a home health business of your own?
Napier: [My co-founder] and I started out as hospital RNs. When we got into nursing, we wanted to take a holistic approach. Being in the in-patient setting didn’t give us the feeling or the satisfaction that we both wanted. We wanted to see the patient through their disease process, to help them get to the end, or what we might call the management part, of their chronic diseases.
We struggled to walk into a different shift and have a different patient every time. You never really get to see where that patient ends up.
We were able to satisfy that need by moving into the home health space. That’s how we made the transition from hospital to home health. Then as far as starting our own business, we both worked for a large home health corporation that was publicly traded. I have some unpopular opinions, so we’ll just go ahead and give that disclosure. There are great corporations, and there are not-so-great corporations. Sometimes with a corporation, it’s just your values and theirs don’t align.
For us, we just wanted to do it differently. Home health is an extremely heavy job. No matter what we did, it felt like they were always asking more from our staff, who were giving everything. They were trying to squeeze more and more out of these people, who were pouring out themselves on the daily. We really felt a calling — whatever you call it. For us, it was a calling, a drive to go out and just do it differently.
We started Healing Hands — it sounds very cliche — with the notion that we would spend all of our time as a leadership team investing in the people who are pouring themselves into our patients. In return, we believed our patients would have better outcomes. That’s really the core value that Healing Hands was built on. That has led to exceptional growth and exceptional patient satisfaction.
What year did you officially get off the ground, up and running? 2016?
Yes. That was 2016. And it was an event on its own. We started out in early 2016 by trying to obtain a brand new license. We get to the point where we get our license, then it’s July of 2016. They come out with a moratorium for Texas. They say, “If you haven’t had a Medicare certification, you’re not getting one. You have to buy a Medicare provider number.” We were like, “OK. This is not great. We’ve risked our whole lives for this, and now here’s the moratorium.”
I would say the higher powers worked. In that same week, an agency that had been in our area servicing our counties for 30 years, the initial owner passed away. The children were running it. And in the same week that the moratorium came out, that small agency came up for purchase. It was basically just a license and a provider number. We were able to take that and never miss a beat with where we were at, in terms of opening up.
That closed on Sept. 1 of 2016, which happens to be my birthday. We bought an agency on my 31st birthday. And that was yesterday, so when your listeners hear this, Healing Hands will have turned six years old. It’s been a wild ride — and one that I would do all over again.
Healing Hands has been around for six years. A lot has happened in the home health industry, from 2016 to now. What would you say are some of the key ways that you’ve seen the industry as a whole change over the past several years?
If I could use one word to describe the industry and the change that I’ve seen, it would be “innovation.” We’ve become a lot more forward-thinking.
Home health agencies used to be very set in their ways. They used to say, “This is what we do. This is the kind of patient we can take.” I’ve really seen the industry progress by stepping up and saying, “OK. We’ve always done these things, but now we’re going to do these things. And if we haven’t done them, we’ll figure it out. And we will look for progression, and we will look for opportunities. And we will show up when people need us.”
Health care is no longer just a brick-and-mortar issue. It’s something that we carry into home based care. We’re here, and we’re ready to stand up and take that on.
The home health space is highly competitive. What would you say helps Healing Hands cut through that competition? What sets you apart, your organization apart?
To be honest, we never think about what our competitors are doing. We never spend our time focusing on what they’re bringing to the table, or who they’ve decided to team up with or partner with. We’re just too focused on what we’re doing next. And that’s honestly one of the things that sets us apart; we don’t get involved in “being competitive.”
We try to speak highly of our competitors. We try to speak highly of the work that they’re doing. We think that if they have a good name, then we have a good name, and vice versa. It’s about lifting the industry up. So again, we don’t really care what our competitors are doing. We don’t think about them. We’re not worried about them. I don’t even care to know how many patients they have. I don’t know where their referral sources are coming from. We just focus on ourselves. That’s No. 1.
I’ll also say, listen, we do have really good people, and we try to make sure that they are “holistically whole.” That is different. You know, a lot of corporations, it’s about productivity. “What can you do for me? What can you do for me? You’re here to work.” We see it differently.
For us, it’s more about, “Hey, how are you today? Are you able to walk into your patients’ homes today and give them everything they need? If not, I might need to give you a paid personal day.”
That’s something that we have the luxury of doing, that some corporations do or don’t do. We have to make sure that before our workers go into a home, they are mentally there. We need to make sure they are holistically there. Sometimes we have to make decisions that may not sound like great business decisions, by giving them a personal day or a mental health day, choosing to send somebody else in when we didn’t have them scheduled or didn’t have that planned in the budget.
We focus on what we’re doing, and we focus on our people. I believe that’s what sets us apart.
I want to shift gears a little bit. We’re talking on Sept. 2. The last day stakeholders could comment publicly on the 2023 home health proposed payment rule was Aug. 16. Did you leave CMS a comment?
Yes. We did leave a comment. I’m a firm believer that if you don’t speak up and don’t advocate for yourself, then you really don’t have any right to complain. Our director of quality took the time to write a very detailed letter, with all of the comments and data that we collected. I would encourage everybody, if they didn’t submit a comment to CMS, to always do that going forward.
Let’s get into the proposed rule a little bit. I think all of our listeners know the high level takeaway: that it would cut aggregate home health payments by about 4.2% next year, an estimated $810 million. It would also open up the door to PDGM-related clawbacks from CMS and some other permanent payment adjustments. If the final rule ends up looking anything close to the proposal, what would that mean for the industry?
A lot of the progress that we’ve made with taking risk and being forward-thinking would be put in danger. It’s important to have a little bit of margin for innovation and taking risk. I think we lose that progress that we’ve made there. The ability to move forward with things such as hospital at home, or RPM or telehealth, we lose that, too.
I don’t think that’s the only consequence that you’re going to see. I think you’re going to see referral conversion rates go down. I think you’re going to see the non-admissions go up due to short staffing. I think that you’re going to see a lot of benefits cut to staff. Benefits are expensive, and you need benefits to attract and retain staff. I think the impact is wide and deep.
As CEO of Healing Hands, I’m sure that you’ve done the math, trying to figure out what the proposed rule could potentially mean for your business. What’s that look like next year?
I’m not going to share too much, but not share too little. We would not lose anybody, but we would have to get extremely lean on some of the things that we are a little bit more generous with. Just the reality of it comes down to charity care. We’re a for-profit agency, but we do a lot of charity care with the profitability that we do have. That profitability isn’t, you know, huge. Generally, it’s not a lot in our industry. But we do give it back. So we’re going to have to look at cutting charity care.
And we’re going to have to look at taking some of the payers that we lose money on. In our opinion, it all comes out in the wash. If you do what’s right, you always get rewarded for it. But we’re going to have to make decisions as an agency that we haven’t always had to make. If there’s a 26-year-old oncology patient who is unfunded, we’ve always taken him. We’ve had the staff and the funds to float that patient. Will we, moving forward?
Those are problems and questions that we’re thinking about. We’re hoping and praying that the cut isn’t as stringent as it looks to be, because we don’t want to have to turn those patients away.
With Medicare cuts, are you looking to expand further into other potential revenue streams outside of fee for service, whether we’re talking about Medicare Advantage or value-based contracting?
Absolutely. But that question is twofold. With these cuts, a lot of providers are looking to diversify. They’re looking for more opportunities. But going the Medicare Advantage rate route is sometimes worse than this cut. Because if you’re trying to contract with Medicare Advantage and risk-based contracting, sometimes they’re coming in and wanting 80% of the Medicare rate. Next year, that will be 80% of Medicare rates with the proposed cut. Providers need to be thinking about that when they’re going out there trying to diversify, just to make sure that they’re not getting in worse than where they already are.
But for us, we have joined an ACO. We are not stopping. We know that even though this might be a small setback, we know that health care is coming home. We are looking for opportunities. Just yesterday, I was on the phone, doing an interview with a top-level executive at a Medicare Advantage organization. And they were asking questions like, “How are you reducing cost?” We were talking about our hospital-at-home program and SNF-at-home program. They were very intrigued about it.
We just have to know the numbers, and we have to know how to sell home health care. We have to know how to show the value in the work that we do. We’re looking for ACOs. There’s BPCI. There’s hospital at home. We’re hoping to get Choose Home passed.
What else is on your radar as the CEO and leader of Healing Hands? There’s so much that we could dive into, from Choose Home, which you mentioned, to workforce issues and emerging technology.
One of the big things that we spend a lot of our time on here at Healing Hands is hospital-at-home programs. We do it two ways. We have an internal program, where we kind of piecemeal together all of the disciplines that we need. And then we have it where we also are a staff organization for a local hospital that uses the CMS Without Walls waiver. That’s where we spend a large majority of our time. We’re very passionate about it.
We also have a large interest in oncology. We have a large oncology program, where we try to help manage the symptoms of these patients who are receiving treatment. There’s a high risk for them bouncing back into the hospital, about two or three days after they receive either chemo or radiation. We have a large opportunity there, to come in alongside those oncology patients and their providers, and plan appropriately to make sure that we help with that symptom management at home. That allows them to recover where they want to be.
We’re also excited about the home infusion therapy benefit and what’s going to come with that. It’s a newer model, and I don’t feel like it’s truly come to fruition yet.
We are not necessarily big in technology, because one of the things in home health is that there’s really not a ton of reimbursement for it. We have some exceptional RPM companies in our industry, and I will continue to fight so they get the payment that they need to utilize those services. But just being very transparent as an entrepreneurial owner, it’s really hard to invest money into something that you can’t utilize, or you don’t get reimbursement for.
We have a lot of home health leaders thinking about hospital at home. Going back to when you were talking about your background, you were in the hospital setting. Do you think that experience gives you unique insight? There’s not many CEOs who could say, “I worked as a registered nurse at a hospital.”
I do think it was valuable. We worked at a hospital overnight as charge nurses, so that we could build Healing Hands during the day. I do think it was valuable to see that there’s really not much they do in the hospital — aside from the major issues like stroke, heart attack, some high-acuity surgeries — that we can’t do at home.
If somebody has a COPD exacerbation and they go to the ER, what are they going to do? They’re going to give them fluids. They’re going to give them IV steroids. They’re going to give them a breathing treatment. And they’re going to do that repeatedly until they recover. Why can’t we do that at home?
I think that a lot of people get scared to bring high-acuity patients home, not realizing that we do these things all day, every day. We can do all of those things in the home.
I’m a big baseball fan. If Healing Hands was in a nine-inning baseball game, what inning would you say that Healing Hands is in, and why?
I would say we’re just about to throw the first pitch. We’re in this for the long game. I’m 37, and I plan on doing this work for the rest of my life. We’re looking forward to what’s to come. Just like any baseball game, there’s going to be a few outs — a few strikeouts. We’ll take that with a grain of salt. We’ll dig our heels in, and we will go forward and we will continue to bring health care home.
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