Is it even possible anymore to start a home nursing business?

[Roland]

I know of a local couple who started a home nursing business about 17 years ago. Her only experience was as a Med/Surg RN (2 years), she was so successful that her husband went back to school to become an RN to help run/work the business. Now they have over 40 RN's plus numerous other professionals on the payroll and live in a two million dollar home.

In any case my wife and I have entertained the idea of one day starting a home nursing business. I called the local (Indiana) home and hospice association and the person I spoke with said that to have any hope of becoming certified for the prospective payment system/ Medicare/Medicaid that you needed to have at least $250,000.00 up front to put into the effort. She said that you could not even apply until you had either seven or nine full time clients. Is this something that has developed in recent years or was it always this difficult to become certified? My dream is to have a homecare agency that pays the nurses a very high percentage of what is paid each hour. Thus, if I could bill Medicaid $50.00, I would like to be able to pay the nurse at least $35.00 ( in a perfect world I would change the law so that nurses could bill Medicaid/Medicare directly, but alas this probably is not possible). My main profit would come from getting to keep most of what I and my wife earned as home care nurses. Is this pure fantasy or something that can still be done?

[NancyNursz71]

I think payor source requirements vary based on state regs. We had a private pay case but still had the 10 MCR/MCD cases. Request a copy of the Conditions of Participation from your state link-- heck, if you're really lucky, someone at the state level might just answer the question rather than refer you to the book LOL! It does stink, but in the typical knee jerk reaction, we are all punished rather than targeting the offenders. I've seen and heard of some incredibly unethical practices in home health and because the geriatric/ psych population is so vulnerable, I'm glad that there is at least some protection through regs. It sounds like your company would be a dream to work for-- let us know if you go national! Keep in mind, the hospital agencies have the ability to snap up the "profitable" patients; they now before discharge exactly what the patient's needs will be. I wish you lots of luck and a laid-back surveyor for the initial survey. It is a huge market and since you plan to value your staff, you will always have a loyal group behind you.

[homehealth43130]

It all depends upon your State. You cannot bill Medicare until you have a Medicare provider number - that can take several months to a year depending on how backed up your state surveyors are. In Ohio they do new starts last on the list - if they have time and money. Most private insurances require a Medicare certified agency - so you cannot bill them until you are Medicare certified. Private duty cases do not require Medicare certification, so technically you could do enough and charge enough with the private pay to float until you get your certification survey. In the mean time, you still must comply with all the Medicare regulations for your Medicare clients. You should go to the CMS website to get copies of the conditions of participation and contact your State surveying body to determine how long it may take to get your initial survey.

Speaking of how different home care is now than 17 years ago - its two different worlds and there is no comparison. My suggestion is for you to really look at where home care is going i.e. P4P, OASIS, OBQI, Medicare Statement of work and really determine if this is what you want to do. You should also contact your state home care association for information.

So do the seven plus patient clients that you need to apply for Medicare PPS approval need to be Medicare/Medicaid patients? Again, if they can be private pay (either their own funds or private health insurance) then it is at least feasible to start a small private pay only operation and then transition to Medicare/Medicaid and the cost would not be theoretically prohibitive since the private pay could help pay the bills of starting.

[jorogers]

you got bad information - you can start an agency for a fraction of $250,000 unless you are in a CON state. There are very few states that require a CON for Home Health. It is best to become Certified and market for mostly Medicare patients. I have seen numerous first year budgets for start-up that are submiited to Medicare and the budgets require less than $50,000. You can do it for less if you want to work harder.

[OahuRN]

you got bad information - you can start an agency for a fraction of $250,000 unless you are in a CON state. There are very few states that require a CON for Home Health. It is best to become Certified and market for mostly Medicare patients. I have seen numerous first year budgets for start-up that are submiited to Medicare and the budgets require less than $50,000. You can do it for less if you want to work harder.

What is a "CON" state? Also, it was my understanding that the "expensive" part of becoming Medicare certified was that you had to have several Medicare clients before you could apply for that certification number (and comply with all Medicare requirements). Thus, if you had even four Medicare clients and were paying four (or more) nurses to cover those cases their pay (the RN's covering the cases) would come out of your pocket until you were approved. Is this correct or am I missing something?

[SUNSFAN_RN]

Hi Roland, I'm going to throw my 2 cents in here as I worked home health for many years before going to the dark side. I have been in management at several home health agencies in the past and with newer agencies that want to become medicare/medicaid certified they will admit 7 patients that have medicare as their primary ins. pro bono and after they have completed there first 60 day cert period on all 7 medicare admits CMS will send in the surveyors to audit the charts, looking at the admit oasis and d/c oasis or recert oasis if there is one. Medicare pays on the PPS system which pays x amount for a 60 day cert period which is determined by the assessment in oasis. The answers to the MO questions determines the severity of pts condition and the score and the reembursement for the 60 day cert period. Out of that fee the agency must pay all staff salaries, wd care supplies and certain other things needed for the pts care. All overhead for your agency comes out of this payment. The principle owners of the agency will have to prove their financial stability to the state and CMS. Sorry this post is kinda long but this is only the tip of the iceberg as far as starting your own home health agency. You will want to start out accepting private ins. and hmos to build your business and your bank account. Good luck Mark

[caroladybelle, BSN, RN]

What is a "CON" state?

CON is Certificate of Need.

Some states are very choosy and limit how many of CONs they permit.

For example, Georgia is notoriously cheap as far as what it wants to pay out in Nursing Home Care and it is very difficult to get a CON for a Nursing Home. If you make it difficult enough (can't get Daddy or Mama into a "good" close by NH) the state pays out less in Medicare/Medicaid.

It is not enough to prove that you can get the clients, you have to prove that there are not enough providers of the service available before the CON is approved. And that is pretty difficult to prove.

[renerian, BSN, RN]

The agency I contract with has just started seeing reimbursement after one year of being open. Lots of ADRs to validate things are being done right. I know the owner has floated over 500,000 before being recooped.

Need deep pockets,

renerian:uhoh3: