If there’s an industry that’s more in flux than health care, it’s hard to know what it is. As president and CEO of Visiting Nurse Health System, Mark Oshnock is trying to navigate in an environment clouded by the unknown details of health care reform.
Oshnock, a former industry consultant trained as an accountant, took over the Atlanta-based system in 2004, when revenue from providing home health care and hospice care was $26 million. This year, it’s expected to hit $62 million, with more growth ahead as baby boomers age, swelling demand.
Oshnock, 56, talks about his strategy for dealing with an unpredictable market, an innovative program of doctor home visits and promising job prospects “for the next 30 years.”
Q: How are you managing through all the uncertainty?
A: Health care is so government directed. We have this decision maker out there, totally devoid of market forces. It’s frustrating. The government is looking at revamping how they’re going to pay for home health care in 2014. We have no idea where it’s going.
All we know is that Medicare believes home health care is an answer to the cost dilemma. But so far, home health has been getting cut. We can take care of a patient at home right after a hospital stay for about $500 a week, where a hospital will charge about $25,000 a week. I’d ramp up home health care like it’s nobody’s business, but it’s not happening.
What you do in an unknown environment like this is not invest very aggressively. We’re not going to spend $1 million to launch a new program when we’re not sure if it’s going to be paid for. Until we know the path the feds are taking, we have to be tentative.
Q: You’ve been experimenting with doctor home visits. How’s that working?
A: We launched the program at the end of 2010 and have 200 patients now. The doctors provide primary care for seniors with chronic conditions who can’t make it to office visits. A doctor visits once a month and a nurse practitioner visits, too.
If we are able to reduce patient costs over a year, from what comparable patients cost, Medicare will share the savings with us. It’s a beautiful thing. I wished we started earlier. We would probably be at 2,000 patients now. But I’m not that smart. Certain things just hit you over time.
The big change recently has been the importance of home health care to our hospitals, because they are getting financially penalized if patients come bouncing back to the hospital unnecessarily. So all of a sudden, we’re an important piece of the equation.
My best advice for young people is to go into nursing or physical therapy. There’s a guaranteed job for the entire length of your career. We’re paying experienced registered nurses about $60,000 and experienced physical therapists about $85,000.
Q: What’s the most important business lesson you’ve learned?
A: In the end, it’s all about client satisfaction. Make sure the client is driving the car and you’re providing the gasoline the client needs.
Client satisfaction in my old life as a consultant was about my business clients. In my life here, it’s about our patients and our referral sources – doctors and hospitals.
Every change we make, we look at client satisfaction. The importance of that can’t be overstated. We do a lot of tests and surveys before and after introducing an innovation. Without that kind of data, you may think someone is happy. But unless you have the data, nobody is happy.
Q: In your current job, you’ve been able to benefit from the relationships you developed when you were a health care consultant. Would you please discuss?
A: When I was a consultant for 25 years, I was based in Atlanta, working with Emory, Northside and Piedmont hospitals as clients. Knowing the hospital leadership from my old life made my transition to Visiting Nurse easier.
You can’t burn your bridges, no matter the industry. As you get to the top, it’s a small world. Someone could be a peer one day and a client the next.
I know that I did not appreciate those relationships in my early days. But I have found that in 90 percent of cases, I can find someone that I have known in a prior life that I can bring in to help us out. Developing that network over time is a snowball that keeps getting bigger and bigger.
Q: What’s the best way to manage?
A: Surround yourself with smart people who know more than you do, and don’t be intimidated. You can’t get too comfortable and think that all you need to know is already in your head. You need to retool your skills and bring in fresh points of view.
Everyone needs to be comfortable to put things on the table. You need to be able to tolerate “no” from your people. Problem solving is preceded by open brainstorming. If you don’t have that, there’s no problem solving.
Each week, Sunday Business Editor Henry Unger has a candid conversation, called “5 Questions for the Boss,” with a top executive in Georgia. Some remarks are edited for length and style.