The Man Who Rewrote Medicare Home Health Law | Bill Dombi on 50 Years of Fighting for Home Care
Featuring William "Bill" Dombi
About This Episode
Transcript
Tom Maxwell (00:13)
All right. Welcome to the next version or next episode of the Last Visit First Podcast, the industry's leading podcast. My special guest today is William Bill Dombi. He's one of the most influential legal and policy leaders in the history of home based care. Over a career spanning nearly five decades. Sorry, Bill, he has helped shape virtually every major federal legislation, regulation, and legal milestone affected the home and hospice community.
Bill served as the president and CEO of the National Association of Home Care we call NAHC or NAHC, depends on where you're from, from 2018 until its merger with the National Hospice and Palliative Care Organization to form the National Alliance for Care at Home. Prior to becoming the CEO, he spent decades at NAHC's vice president for law, serving as the industry's leading chief counsel, strategist, and advocate for Washington, D.C. His impact reaches back to the earliest days of Medicare, home health, and hospice.
Bill served as the lead counsel in landmark litigation and expanded Medicare home health coverage, helped shape the creation of the Medicare Hospice Benefit in 1983. Also contributed to the development of the home health prospective payment system. He has represented providers, patients from before Congress, CMS, federal agencies, and the courts for more than 40 years. Following his retirement from NAHC, Bill joined Arnold Golden Gregory LLP as a senior counsel.
And also serves as the Board of Advisors for New Day Healthcare. Known for his integrity, intellect, and unwavering commitment to protecting access to care at home, Bill Dombi has become one of the defining voices in our industry. Welcome to the podcast, Bill.
Bill Dombi (01:44)
Well thank you, Tom. Great to spend some time with you. I've always enjoyed it, whether it's on a golf course with you kicking my tail or talking business.
Tom Maxwell (01:52)
Yeah, it's been I got into this business in two thousand five, so we've known each other a long time. We spent a lot of time together. And I've been, I'm proud to say, I've been to every Home Care 100 and been to every NAHC annual conference that they've had. I go to all those. So it's been fun. It's been a lot of money at Knock with you. All right. You spent
Bill Dombi (02:06)
Yeah.
Tom Maxwell (02:07)
your entire career fighting for care delivery at home. What first drew you to this business or this mission?
Bill Dombi (02:12)
You know, what first really drew me in was a a s a summer job I had at a public interest law firm in Connecticut. And they asked me to to study what's going on in Medicare. And as part of that, I visited virtually every nursing home in the state of Connecticut and dozens of home care agencies. And i what what it was was the difference that I saw between being in a nursing home and being in your own home.
You know, that three dimensional connection with the people that were there. And I I'll never forget this one woman who lived in a a shack that was on the outskirts of the dump, as we called them back then. she was born in that place ninety years earlier. It had dirt floors, no running water, and it was it was deplorable in so many ways. And I told her I would help her find a place to live. And she says
This is where I want to live. This is my home. so those combination of things that having that direct experience meeting people triggered a mission. I
Tom Maxwell (03:19)
That's awesome.
Bill Dombi (03:19)
didn't know then it was gonna be a lifelong mission, but I'm glad
Tom Maxwell (03:22)
Yeah.
Bill Dombi (03:22)
it was.
Tom Maxwell (03:23)
When was that? Do you remember?
Bill Dombi (03:25)
Yeah, that was the summer of nineteen seventy-six, after my first year of law school. and the reality is that the main reason I was there was they wanted me on their softball team because we'd almost won the championship the year before I left for law school. And
Tom Maxwell (03:40)
That's awesome.
Bill Dombi (03:40)
so they didn't even know what I was gonna do for work, but we came up with something that turned into affect my life even more than softball did. Yeah, we did win the championship too.
Tom Maxwell (03:50)
good. Well Bill, you look great. you're still hanging in there, you're still working. I knew you weren't going to retire by the way. I predicted that pretty easily. I know you're slowing down a little bit, but you're not going to retire. All right. Looking back over nearly fifty years, what accomplishments are you most proud of? Because you've done a lot.
Bill Dombi (04:05)
You know, it it's you know, it's it's somewhat humbling when you look back at your life, you know, and you try to define it in some ways. And I think I've contributed, but it was always done through teamwork, always done, you know, with a combination of really bright, hard working people, you know. And so I I I if I were to pick my top five, they would be during law school,
I wrote a grant and established an advocacy program representing Medicare beneficiaries. That summer work that I did blossomed into a national advocacy organization ultimately representing Medicare beneficiaries in so many capacities of advocacy. you know, but you know, to be able to help other people has always been part of my mission in life. I came to NAHC because I
Came in touch with somebody named Val Halamandaris, who had been chief counsel at the aging committees of the House and the Senate and was the CEO of NAHC at the time, but our path had crossed multiple times over previous years. And he asked me to come to NAHC to form a public interest law firm and to sue the Medicare program. The end result was a lawsuit called Duggan versus Bowen, and we rewrote through the lawsuit the entire set of standards for coverage of the Medicare Home Health.
benefit, expanding it to cover people with chronic illnesses and the like. And when I talked about teamwork, what I was able to get done there was a natural result of being associated with a Washington, D.C. set of people that included Val. And I'll never forget the day he said, Would you like to have some members of Congress as plaintiffs in this lawsuit? And one of them included Claude Pepper.
Tom Maxwell (05:50)
Wow.
Bill Dombi (05:50)
And if
you people don't know who Claude Pepper is, if you were to check him out, you would find that he deserves, you know, probably an a a a monument somewhere dedicated to him. If there was room on Mount Rushmore, even as well. So the the Duggan lawsuit, you know, I also remember somebody said, Well, you probably hit the peak of your professional accomplishments through that lawsuit. You know, and that that was nineteen eighty seven to nineteen ninety
Tom Maxwell (06:16)
Yeah.
Bill Dombi (06:16)
one was was that work. So hopefully it was the case.
Tom Maxwell (06:19)
No.
Bill Dombi (06:19)
But from there, you know, I'll I'll add a couple of things. My son's wedding week weekend, we helped save home health care from the plan to put together the Affordable Care Act. They wanted to take billions and billions of dollars from the home health benefit to support a good cause, creating health insurance, right? But we were able to s save it. I'm not so sure. My son was happy. I know his mother was not happy that I spent too much time on the phone in in doing so.
number four was one of the best experiences I had, you know, in advocacy, and that was getting the change of law that allowed non-physician practitioners to certify eligibility for the Medicare program and what made it so special. a senator by the name of Susan Collins, who's been in the news a lot lately, stuck with us for thirteen years to get this one across the finish line.
You know, I mean yeah, it it took Odysseus less time to get home fr fr from the wars than it did for us to
Tom Maxwell (07:23)
It's true.
Bill Dombi (07:24)
get this across the finish line. And the last one on my list, actually you mentioned in the introduction, Tom, which was the merger of NAHC and NHPCO. It was my fifth try. in Washington, if you're divided, you get double screwed. we needed unity, we still need unity. and
merging those two organizations together was certainly one of the highlights of of the work that I did at the association.
Tom Maxwell (07:51)
For sure, for sure. Well, you know, you named a lot of really awesome people. Senator Collins, absolutely. She's been a fan of Home Health and Hospice and really helped us do a ton of stuff. So we appreciate her. So
Bill Dombi (08:01)
And Senator Collins did the same kinds of visits that I did that had her adopted
Tom Maxwell (08:05)
For sure.
Bill Dombi (08:05)
as a mission, going to these rural home health areas and seeing these patients up there too. And Val, as you said, Val Val
itself is himself is was you know one of the gods small G of home care.
Tom Maxwell (08:17)
Yeah.
Yeah, he's the matchmaker too. That I met Jennifer because of Val. He made me go to he's like, Maxwell, you need to get your butt to to the nomination committee 'cause you know, they used to bring in members and he's like, You owe me you need to get down here. And I'm like, I really want to go, Val. And he's like, Just come, it'll be fun. And so I've met went down and we were at McCormick and Schmidt's and he did the same thing to Jennifer when she was the CEO of the Minnesota Home Care Association. She's like, Hey, we need a representative. You got to get here. And so she was late. We were all sitting at dinner at McCormick and Schmidt's and in walk Jennifer and that's what we met.
First time. She had no clue who I
was. I had no clue who she was, but Val is a matchmaker. So we've been married now
ten years.
Bill Dombi (08:53)
Yeah, so those what what what is it? Kevin Bacon, two degrees of separation kind of thing?
Tom Maxwell (08:57)
That's right, that's right, that's right.
That's right. Well many people many people know Bill Dombi, the advocate and leader and the CEO of Nock. Tell us about Bill outside of Washington.
Bill Dombi (09:08)
Well, you know, there's not much of Bill outside of Washington, but to the
Tom Maxwell (09:13)
huh.
Bill Dombi (09:13)
extent that there is a Bill outside of Washington, you know, I I'm a hopefully a good spouse to a woman I love so much. We've been married forty four years, this past June. we produced two of the most amazing kids imaginable. You know, one of them I would not have said that about when she was sixteen, but I can say that
Tom Maxwell (09:33)
Yeah.
Bill Dombi (09:35)
now she is an incredible person, an incredible mother. And my son just we we always worried about my son because he was so nice. we could he wasn't doing anything wrong. What kind of kid can you describe like that? And now
Tom Maxwell (09:49)
That's right.
Bill Dombi (09:50)
in this next generation, five beautiful grandchildren who who make me feel so alive so many times. You know, so
Tom Maxwell (09:59)
that's awesome.
Bill Dombi (09:59)
Bill Dombi otherwise you see a poster of guitar behind me
You know, I'm a guy who displays rather than plays, it seems at this point.
Tom Maxwell (10:07)
Collector.
Bill Dombi (10:09)
Some some some someday those guitars will come back into my hands and play a note or two that bring a smile. I guess one one other thing to mention, you know, is something my father gave me that I never really appreciated until later in life. I love to work with my hands as well as my head. You know, outside the window that you can't see outside of.
Is a deck that's being replaced by me. I'm sure that I'll cut myself here and there, do something a little bit less than professional out of the whole thing, but I'll be so happy, you know, to to be able to look at it and say, I did that.
Tom Maxwell (10:45)
That's cool. That's
cool. It's a skill I don't really have. I I've tried I a lot, but I yeah, like putting together a cabinet in the closet, you know, just like end up throwing it through the window. So now I have a handyman that does it. I don't have those skills. I'm I'm jealous. All right. Tell us about you you told us about the lady that you went to visit that had the dirt floors. That's awesome. But is there another patient or family member out there that just reminds you really why this work matters that you remember?
Bill Dombi (11:09)
God
absolutely it took me a nanosecond when you know I started thinking about that question and they're now both d long deceased, but it was Bernie and Eleanor Dunn in Brantford, Connecticut. Bernie had Parkinson's and a few other chronic conditions. maybe one of his chronic conditions was his wife Eleanor who
Tom Maxwell (11:30)
Ha ha ha.
Bill Dombi (11:32)
was a stalwart advocate for Bernie, you know, and she was gonna do everything she could.
to keep her husband she loves so much at home. Bernie may have wished he could be institutionalized at times because she was
Tom Maxwell (11:47)
Ha ha
Bill Dombi (11:48)
so stalwart. But the two of them together were such a great team. I learned so much through them, learned so much about what it's like to be a home care patient, what it's like to have a relationship with a provider of the services. In this case it was the Brantford VA at that point.
And I have to say, the Brantford VA learned a lot from them too. I mean, everything from the clinical side of it to the administrative side of it to the fact that one of the staff of the Brantford VA somehow got a hold of Eleanor's checkbook and wrote some checks to herself. You know,
Tom Maxwell (12:25)
no.
Bill Dombi (12:26)
saw the bad side of it too. But then the Brantford VA and the bank stepped up and made everything right at that point in time. So, you know, whenever I think of
You know, advocacy and the why Bernie and Eleanor come to mind.
Tom Maxwell (13:32)
Great, it's a great story. It's awesome. All right. You were involved in creating many of the policies our industry now takes for granted. Which one was the hardest battle?
Bill Dombi (13:42)
God, they were all, you know, hard. but probably the the hardest battle, you know, really was end of life care, the hospice benefit. You know, and and it was hard because the culture of Americans and humans maybe generally is not to look to end of life and not to give up, which is what people first thought of hospice to be as compared to a choice.
you know, a dignity with dying aspect of it. So you you didn't have the the massive demand for that kind of change because it was an affront to a culture which had been so deeply established in in in this country. and combine it on a policy side, what you're gonna tell us this'll save money? We don't believe you. You know, kind of thing. You know, so
that you know, it was difficult to work your way through those various barriers to end up with one would have to believe the most important change to the Medicare program since the inception of the Medicare program. You know, I had a small part to do with it. You know, there were people from all over the world who had a bigger part because they had had hospice much longer than that. And
Hospice in the United States was effectively born with Connecticut Hospice, you know, which was, you know, a f not for profit, mostly volunteer operation before the Medicare benefit was created. So we were in the right place to be able to participate. but w w well rewarding to get it in the end, but not
easy.
Tom Maxwell (15:22)
Yeah, and I mean that's changed a lot over the years, but I mean we're still I mean it's still being scrutinized everywhere. I mean, I was just watching a bunch of guys on T V this
morning.
Bill Dombi (15:32)
when when half of the people who are on Medicare that die in a year have used hospice, I'd call that a pretty good success in changing culture
Tom Maxwell (15:39)
For sure.
Bill Dombi (15:40)
and creating options, yeah.
Tom Maxwell (15:42)
Sure. And it helps that,
you know, President Carter and a bunch of these other, you know, celebrity types are using hospice and talking about it and and that helps a ton too. So I think I think it's getting better and
better more and more recognized.
Bill Dombi (15:53)
Yeah. And and you no longer have to tell people what it is. They know what it is nowadays. You know, and I and I'd have to admit, you know, being on an airplane and someone asks, What do you do? And I would often mention hospice before I would mention home health care or home care.
Tom Maxwell (16:11)
Have you ever seen
Guy Fierry on the Joe Rogan show where he talks about hospice? There's a clip. Yeah,
Bill Dombi (16:17)
I have not seen that show. No.
Tom Maxwell (16:18)
I'll send it to you. There's a clip where he's talking about his family member, I don't know if it was his dad or uncle or somebody, but and him and Joe Rogan so Guy Ferry, the diners drive ins and dies guy. I he just goes super passionate about it. And Cole and I've reached out to him a bunch trying to get him to, you know, do a message for the the hospice nurses and the angels in this industry. And he's agreed to do it, but we haven't got it yet. So we're work we've we've been working on it over a year. But he
That clip is really good in in that show. He talks about it's the the greatest angels in the world. He's like if you haven't experienced hospice, you don't know what you're missing out on and it's it's like a
Bill Dombi (16:48)
Yeah, and
Tom Maxwell (16:49)
big endorsement.
Bill Dombi (16:50)
yeah, and what's really helped the cause of care in the home, hospice included, is the personal experiences so many of us have had. You know, the Dombi family may sound fragile when I explained this, but and we're not fragile, we're just normal. You know, my father, my mother were hospice and home health care patients. My sister was a home care, private pay personal care services and hospice patient. My son.
as a private duty nursing pediatric patient. You know, I can go on from there. Those personal experiences, you know, teach you a lot.
Tom Maxwell (17:27)
Yeah, for sure. It's Nana was on hospice and Habit took care of her and Compass back then and and she died. And one of the reasons we wrote the Muse platform was I had an experience where the chaplain told her she was, you know, gonna pass away. She needed to call her grandkids. So my dad texted me and said, Hey, make sure you answer the phone and I could say goodbye to her forty five minute, you know, conversation and and the next day she died. So I mean, thank goodness the chaplain recognized that and did the right thing. That's why we created Muse. We went we said we wanted
That experience to happen to everybody. So we want to be able to predict when Nana's on her last day so that the family can get there, we can provide more care in the home, make sure the chaplain's there, the social worker, whoever you want around is there. And that was that
was the whole purpose.
Bill Dombi (18:07)
I remember when my sister passed away. She was fifty-six at the time, so 20 years ago, this this was the case. and the nurse came immediately to the home to help us with that transition or whatever you want to call it. And at one point in time, like two hours in, I went to the nurse and I said, I don't want you to take this the wrong way, but we'd like you to leave. And she she she looked stunned and I said, No, it's because you've done your job.
You prepared us for this. You know. Which really shows you what palliative is all about.
Tom Maxwell (18:49)
Sure. That's awesome. That's good. All right. Looking back, what what almost happened that people today don't know about? Like as in your advocacy efforts. Like what what almost happened? Where where do we almost
miss?
Bill Dombi (18:59)
the most stunning thing that I could offer was before my advocacy efforts because at that point in time, you know, I was an emerging Beatles fan rather than anything else. But that is in the cre in the creation of the Medicare program, it wasn't until the last minute that there was a home health benefit. I mean it you know, you you could look at the versions that started in the fifties and going on to the mid sixties and there was no home health benefit in there. And then it was inserted by
You know, again, one of the patron saints of home care, Senator Moss, Frank Moss out of Utah. and had the wisdom to put it in at both part A and Part B. So did it almost not happen? Neither one of us would probably be here if it didn't happen. And that's the path it was on at that stage.
Tom Maxwell (19:45)
Yeah, I don't think most people knew that. I I I think it you know, as the the people that are coming in the industry today think it's just always been a benefit. But it's I mean, it hadn't been that long ago that we got hospice. I mean it was eighty three that Yeah.
Bill Dombi (19:55)
Yeah, nineteen eighty two, nineteen eighty three for hospice. Eighty
two was the passage of the law.
Tom Maxwell (19:59)
So before that what did they do? W what what did people do before that?
Bill Dombi (20:03)
there were volunteer hospices be before that people did everything they could to stay alive, as painful as it might have been, and as futile as it might have been, and and and as much not in line with their own desires. that's what they did.
Tom Maxwell (20:16)
So they went to ICU
and just laid there in the bed and in the hospital.
Bill Dombi (20:20)
Death
deaths in hospital, you know, were w was the great honor to go die in the hospital rather than to die at home until people realize I don't even know this place.
Tom Maxwell (20:30)
Yeah, that's right.
And people waking you up all night long, every day, all day long. in today's leaders are experienced the industry's early years, what would what would surprise them the most?
Bill Dombi (20:39)
I guess everything surprises me, you know. You know, I you know, I mean th the good and the bad and the ugly, you know, in life all play a part in what I've experienced in my professional life. You know, the the the people like a Senator Collins, or or Val Halamanderis, or people like you and Jennifer, you know, the good part of it. You know, the the the ugly part, you know, there
was a point when
A ARP wanted to throw home healthcare under the bus with a co payment to fund the the what became Medicare Part D, the drug benefit. You know, a good reason behind it, but they're willing to sacrifice something of that nature. That was not good, solid kind of advocacy. So I mean, I I you know, I I'm not naive, but I'm not s overly cynical too, but anticipate you're gonna see good, bad, and ugly.
Tom Maxwell (21:31)
And I think on the ugly side, I mean, just talking about what's relative today is all this fraud. And I keep going back to how did we get here? How did we approve, you know, fourteen hundred Medicare provider numbers in the same county in LA? And, you know, it just it it blows my mind. There's a whole lot of that stuff that I'm just like, How did we get here? Like, you know these guys were doing bad stuff, you know they're fraudulent, you know that they're, you know, not bad I mean, they were just talking about one this morning on in Pennsylvania where the guy was in jail and was servicing his dad and billing home health.
or Bill and Home Care and I'm like, what are we doing? Like, how is this getting through the system?
Bill Dombi (22:04)
You know, a a former lead counsel for the Office of Inspector General gave me a line that I've passed on numerous times, which is he said, We at the OIG were surprised how long it took before organized crime realized it was e an easier way to big money cheating the Medicare program than it was to put the arm on the corner drug dealer or to you know
Get an army of pimps out there with prostitution generating revenue for them. You know,
Tom Maxwell (22:33)
Crazy. It's crazy.
Bill Dombi (22:36)
at the same time, you not that surprised on things that I I was one of the things a few people know that I I I almost went to the seminary in eighth grade. you know, I was an altar boy, I was a kid, probably they didn't belong within the body that I had with my
brain and and and such,
Tom Maxwell (22:54)
Yeah.
Bill Dombi (22:54)
meaning I I I wasn't as good as my some of these labels might have given me. in terms of good, I was asked to be a crossing guard, which was another step in the honors of a Catholic grammar school. And the three other crossing guards said, if you want to be really part of us, you've got to steal candy for all of us. All right. So
Tom Maxwell (23:17)
Yeah.
Bill Dombi (23:18)
Think of the juxtaposition of being at a Catholic grammar school and you've been selected to have this honor in like that and y now you're turning into a shoplifter kind of thing. So that was the beginning of growing up in life for for me, to realize that you know, there's there's a reason why you have Ten Commandments 'cause not everybody decides they want to follow the rules.
Tom Maxwell (24:49)
It's wild. All right. What's the biggest impact facing home health over the next five years?
Bill Dombi (24:55)
Yeah, I I I think it's one that you might find a little bit odd. Stagnation and stability. you know, if home care doesn't continue to be, you know, the hotbed of innovation, it will become stale, it will become, you know, usual. And if you become usual, you really don't grow. and and I don't
Think that that's the case. But when I look around, and this will be critical, the parties that are engaging in the home-based care innovation today, not enough of them are from the home-based care community today. They're they're outsiders coming in, which is great. You want to have that influx, you know, of new bright thoughts, but you you don't want the rest of the people who brought us to where we are today.
To sit on their hands either. and I mean, look at hospital at home. An incredible opportunity. And most hospitals that have hospital at home are running it from within the hospital rather than partnering with, you know, the existing infrastructure and the people who know how to do it best. I don't know if they don't have the confidence or they don't have the energy because they're fighting so many battles, whatever, like that. So what I see then, you know, is that.
You know, that that stagnation in innovation being the biggest barrier. Money's the first thing so many people will probably go to or staffing. I I I really go to that that that whole energy level.
Tom Maxwell (26:34)
Yeah, not worry that.
We there's a few other consulting companies that are out there that we were talking about. This is the number of people that are retiring that are that ran these big organizations. You know, think about the the Marcia Reissig and the Jeannee Parker Martin and you know, those kind of people that are retiring then and they're getting out of the business and they're and then who's the next levels to come up. And then do we have a a path to grow the next generation of, you know, home health and hospice leaders? And it's it's interesting.
Bill Dombi (27:00)
there's been interference with that pathway too that is tied to money. You know, that
Tom Maxwell (27:03)
For sure. For sure.
Bill Dombi (27:05)
the the money gave people the opportunity to have that mid management and that growth in in in management skills within people to be that next generation, to be able to mentor people to come along. But one of the things that was sacrificed early on as budgets were tight was that person in in the next generation kind of thing.
I do see some really, really smart people in home care, really dedicated people, really innovative, sometimes scarily so, you know, like we we might sometimes think there's no original ideas, but seems some of them still surface.
Tom Maxwell (27:41)
Sure, for sure.
I think there's a lot out there. But you know, there's just a lot of generation of people that have doing this for a long time that are leaving. I mean, the Keith Myers, you know, re regime of all his guys that are, you know, all getting out of the business and going on
to do something different. That that scares me. That that's an area that I worry
about.
Bill Dombi (27:56)
I'd recommend anybody considering any the next generation to read the book that Keith and Ginger put together about their story. You know.
Tom Maxwell (28:03)
It's awesome, isn't it?
Bill Dombi (28:04)
Yeah, it it's it's a it's available for free on Amazon. You know, they're giving it away,
Tom Maxwell (28:08)
I know. It
Bill Dombi (28:09)
you know.
Tom Maxwell (28:09)
I love that too, by the way. And he's he's such a great guy and he's influenced so many people's lives in this. I mean, whether it's patients or employees or staff and he's a he's an honorary guy. I mean, there's not another way to say it. is hospice in the crossroads today? What do you think happens with the hospice benefit?
Bill Dombi (28:24)
Yeah. Yeah.
Hospice hospice is mature at this point. The honeymoon's over. it was a longer honeymoon than any other benefit that I've seen had. know, it was susceptible to the same kinds of issues that are surfacing today, the California stuff and LA, you know, and the you know whatever you call the surge in the number of hospices out there and the fraudulent or abusive kind of conduct that's there.
But know, it's a twenty-seven billion dollar a year benefit, you know, with three plus million patients approximately each year. and and it probably is time for a deep dive review for reform purposes. That doesn't mean you throw out the good things. You know, I mean it is it it is a model of managed care that has so sick been so successful, and you don't want to screw that up.
But it's in the crosshairs for the bad reason, one that home health care went through in the late 90s. maybe it was out of arrogance or hoping to be different, but it was predictable that hospice was going to go through some of the growing pains that home health went through in in you know in the nineties. you know, operation restore trust, you know, went after a whole bunch of schemes which have resurfaced today in hospice. I mean, talk about no original ideas.
You know, create
Tom Maxwell (29:49)
Ha ha ha.
Bill Dombi (29:50)
cre creating a hospice and billing for phantom patients. You know, that that that's been done and it was done, you know, with great success, but done with a hammer dropped on it later on. So, you know, and sometimes you also have to look back and say, you know, it would have been helpful if this had happened at a lower scale earlier on. You know, I live in the land of metaphors of DC, and if somebody didn't tell me that I got a
a a math problem wrong, I wouldn't remember today what it's what the right answer is. You know, so for those providers who are non-compliant rather rather than fraudulent, which it still presents an issue. They make a mistake on a on a patient, you know, paperwork-wise or selection wise, you know, they need to learn and and oversight helps them learn from that. But oversight also stops hundred million dollar frauds from becoming $100 million frauds.
You know, I mean, talk talk about you know history repeating itself. Back in the nineties, you know, Val and I got called out to California by the regional administrator of then HICFA, the Healthcare Finance Administration, because they found a hospice that was building for phantom patients. And they wanted to have a surety bond created requirement to create it to prevent that from happening. We said the reason why this happened is because
You guys didn't do your job, which was already in the books, to go and s survey that provider within the first twelve months of operation. And the data was there to show how do you become a go from zero to a hundred million dollars in less than three years? How do you get that big that fast? You know, and had you just gone to a person's home and said, Tell us about these home health services you're receiving, they'll say, What? Somebody comes and vacuums my floor. You know. So
History repeating itself, same stuff going on now. Multiple providers, multiple locations, multiple medical directors, et cetera, et cetera. Predictable. Yeah.
Tom Maxwell (31:54)
And
yeah, in the twenty seven rule that just came out, I mean the the new amendment that's in there that says you have to disclose what's covered in the hospice benefit and what's not. That's, you know, that additional administrative burden that's gonna cause all these hospices to have more pain. By the way, you have to do it within five days, but I need a starter care nurse to go out on Thursday night, get her documentation done, get the planet care done. And by the way, on Monday morning you have to have that amendment done in in the patient's hands.
It's gonna cause more burden. Th that's one of the ones that's there. This SSVI where they're gonna flag all the hospices and
Bill Dombi (32:24)
Yeah. S S
S V I is is poorly designed, without a doubt. You know, just just like the you know, special n you know, us focus program was was poorly designed for for hospice. You know, when there are things at at at the base level like you know, crossing guards shoplifting candy, you know.
Tom Maxwell (32:44)
Right.
It's true. I I I I I think that, you know, that it's unfortunate, but the policymakers that put these policies in place, I I understand what they're trying to do, right? They want to give the amendment to the the hospice patient to make sure they understand what's covered and what's not covered. I get that. But the they're doing it for the wrong reason because of the SSVI. And by the way, we don't bill for all these other services. Somebody else is billing for that. So how are you as a hospice supposed to be responsible for, you know, medications that somebody else gave your patient? It's really bizarre.
Bill Dombi (33:12)
and Tom, you're you're you're you're a a technician, you know, of of the highest level in terms of the work that you did at Home Care Home Base and such, you know, but the solution lies in readily available technology. Okay.
Tom Maxwell (33:25)
For sure.
Bill Dombi (33:25)
You know, those billings outside of hospice for services allegedly unrelated, you know, the reason why those billings are happening is because the provider of services
doesn't have access to real-time data that an individual has elected the hospice benefit. Yeah. I mean, that that solution has been there in front of CMS for many, many years. Yet, you know, you might, you know, if you're a hospital, you won't know that a patient has elected hospice possibly for three weeks, four weeks after they've started on hospice. And so you see the patient, you deliver all the services you think they need at that point.
Of course the comatose patient isn't telling you I'm on hospice. Yeah, so so let's let's
Tom Maxwell (34:09)
That's right. That's right. And it it's crazy that we haven't figured that out.
Bill Dombi (34:14)
let's give an addendum and feel good about
Tom Maxwell (34:16)
Yeah.
Bill Dombi (34:16)
ourselves.
Tom Maxwell (34:17)
Right. I was on the Hicta team back in the day when we were trying to get meaningful use to be part of the Hicta was the technology kind of group that with NAHC had and I was in there with Keith Crownover and a whole bunch of other technology vendors and we were trying to solve this thing, you know. back then it was all scripts and McKesson, Lewis and all of us are in there and we
Nobody cared about what home health or hospice had to say. The hospitals all wanted to do that. They wanted to pay the doctors forty thousand dollars to adopt an EMR and and get, you know, high touch meaningful use or high tech meaningful use. And we were kicked out of all those conversations. It was sad because we really wanted it to happen. We were willing to, you know, spend the money and do the
technology to do it.
Bill Dombi (34:57)
Yeah, and and what sector of health care was the one first ready to go with the electronic medical records? It was home care.
Tom Maxwell (35:04)
Yep, it's true.
They still do. We it's it's amazing how many faxes get processed through the Forcura product and the Worldview product today. yeah,
Bill Dombi (35:14)
It's still happening today, yeah.
Tom Maxwell (35:16)
it's crazy. I mean it's a whole business around that. I mean Craig made a hell of business. All right, Medicare Advantage, let's talk about that a little bit. So you think it continues to grow? Yeah.
Bill Dombi (35:24)
Can I use four letter words? Can I use four letter words?
Well, let let's let me let me be truthful, very transparent about my bias. I am enrolled in the Medicare program, but I am not enrolled in a Medicare Advantage program. Yeah.
Tom Maxwell (35:37)
That's funny.
Bill Dombi (35:38)
I I I I think it's fraudulent, at least deceptive advertising to even call it an advantage along the way. But from a a home care provider's perspective, you know, it it's a loss. you know, there's no way to put it otherwise. If you find people who are making any money
you know, to keep their head above water and breaking even even at this point. You know, they're a rarity along the way. And so you've got the traditional Medicare home health programs subsidizing Medicare Advantage plans as they buy it by ads at Super Bowls. you know, on the hospice side, you know, y you had our the trial of going into Medicare Advantage and it probably went away more because the plans didn't want hospice. They didn't want to be known as the death squads, you know, rather than because hospice, you know, was there.
is it growing? Well, you're you're seeing the real, you know, mindset of Medicare Advantage as they're closing out territories that there otherwise had served, rural areas, in particular inner city areas that they didn't find profitable enough. You know, so I mean that kind of tells you where, you know, what their mission, you know, is by and large along the way. So
From an advocacy standpoint, it's really frustrating. You know, Congress had, you know, both sides of the aisle and both houses of Congress have been cheerleaders for Medicare Advantage for many, many years. That's starting to soften a bit, but mostly around prior authorization or marketing practices. know, on the issues of choice and access to care and fair reimbursement to providers to get the best providers, you know, in their network.
They're they're not there yet, but the one place they're may never go, you know, is back to where they were at the start of Medicare Managed Care, before it was even known as Medicare Advanced, which was, you know, requiring the plans to pay a fair payment rate equivalent to the traditional Medicare benefits. So regulating, you know, what they charge, you know, is probably, know, territory that they may not tread to. So where does advocacy go on that? You know.
I'm not saying you give up on Congress. You still work with Congress on this and the regulators on this as well. But what has to happen, and I think the alliance has a a a role for sure in this, and others do as well, is arm the providers of services with what it takes to be effective negotiators. even if that means a provider saying, I'm not gonna take it, you know.
My contract's up with you. I'm not going to renew it. You're not paying enough for me to deliver these services. I'm tired of subsidizing you. I'm tired of giving you free visits. those kinds of things, you know, because the leverage, is there to only a certain extent. You know, every now and then when I have you know, time to to just think in the dark, perhaps I think of, you know, isn't there a right to boycott?
as a provider of services, the Medicare advantage plants without running afoul of the antitrust law. So the lawyer in me comes out on that because somewhere we need to gain some leverage along the way. and even what the the alliance, can help educate and help arm people with how how to strategize into negotiation. But there's there's an example that somewhat haunts me on that, that if you're successful in a negotiation,
At some point the plan revisits it. And there was a p a point in time when the plans were offering capitated payment to home health agencies until they realized that the home health agencies were making money off of capitated payment and and they moved back to discounted per visit reimbursement at that stage. You know, what what the plans need to do, is recognize the best partner they could get is a home care partner.
So if if I see a future that could be positive, it really comes in a form of ACOs more than it is managed care, or comes in D SNPs or I SNPs and those kinds of things where you where you have a a much more hands on management of what's going on in there and you could get the benefit of knowing how to deliver care in an efficient way together as compared to one pa one's a payer
and one's a provider.
Very important part of the future. Medicare advantage will evolve. It's not going away. And it is looking I mean the greatest growth area, you know, is in this in the special needs plans area for the plant for the plants now.
Tom Maxwell (40:12)
Sure. I mean, I I remember back in the early days of home care home base, everybody was ninety something percent Medicare and they're always like, Your tool works amazing for Medicare, but it doesn't do these Medicare Advantage plans and we're like, It's five percent of your business. Why do you care? And but now it's like everybody's
Bill Dombi (40:24)
Yeah. Yeah.
Tom Maxwell (40:25)
f you know, sixty forty or fifty fifty, or maybe even, you know, fifty percent of is is one particular plan and then they have about, you know, twenty five other or thirty other plans they have to take and they're all over the place and it's it made that job so much harder. It made it so much harder.
Bill Dombi (40:39)
You know,
and as an investor in home care, you know that when doing due diligence, you look at what's your proportion of Medicare Advantage business and you know,
Tom Maxwell (40:47)
Sure.
Bill Dombi (40:47)
you discount the the the the value of that company, you know, based on a high proportion because you know it's not a positive within it. But why do the providers take Medicare advantage? Because the leverage is there on the referral source to say, you're not getting our original Medicare patient referrals, the good ones.
unless you take some of these off our hand 'cause the hospitals are going through the same financial issues that the home health are going through.
Tom Maxwell (41:14)
Sure. And then yeah. And it's funny because when I was at H Bork at GE back in the day in the pr physician office practice management side, they hated Medicare. Like we all the doctors didn't want to take Medicare. They wanted to take all these commercial insurances and and so and then I get over to hospice and home health and you know April's teaching me about, you know, how we love Medicare. And I'm like, What are you talking about? Everybody hates Medicare. It's totally opposite, right? So it's it flip flops. And so then you take that and you go, Okay, now why is it so difficult for this business to run? Well the hospitals
you know, get paid less on Medicare, but home health, it's a better benefit on the home health side. So I get it. It's harder. We got to figure it out. We gotta solve it. Nana shouldn't get a different home health agency because of who she has as a payer. Nana should get taken care of by the best possible payer. And that's the problem.
Bill Dombi (42:00)
not just a different provider, but a different care plan.
Tom Maxwell (42:05)
For sure. It should be the exact same no matter who who's, you know, what insurance plan she has. For sure. that that's a tough one. I I know everybody does it. All let's talk about artificial intelligence a bit. Everybody in their world is creating artificial intelligence. I get as an investor, I get calls every week on here's a new company, here's a new AI strategy, here's a new ambient listening. Where can we genuinely improve care with AI? And what should we be cautious of? And I know you've written a few articles and
talked about this a little bit.
Bill Dombi (42:32)
Yeah, you know, and in my whatever you call my retirement, I've had so many invites to be on advisory boards at emerging AI companies that really exciting kinds of thought processes that are there, you know, and they're focused in a variety of ways from a clinical perspective to an operation side. Compliance, you know, is a big part of it. And so I mean, where do I think AI can fit in? AI can fit in everywhere.
on the clinical side, on the operation side, on the paperwork side, the efficiencies elements of that, but you know, what AI is going to be the best fit, what AI is going to work versus not, you know, and and one other element to it that I see as, you know, a a a on balance. I I'm concerned that AI moves away from being a tool to being the operation itself. and
it's easy to get there to do so. I mean, think about back if when you when you were in high school and you had to write a book report and you hadn't read the book, if AI was around, boy, that book report would be pretty good, wouldn't it? You you just All
Tom Maxwell (43:37)
Here. I use it every day.
Bill Dombi (43:41)
right. Give me a report that a a fifteen year old would have written on on this book called Huckleberry Finn. You know, and and and make some mistakes in it. You know, you tell you tell to not make it perfect so it sounds like it was real.
so you you you can get lazy, I guess, you know, on AI, or you can use it as a you know, a real sharp tool. Like, you know, I I I referenced the hands-on project stuff I'm doing this deck, for example. You know, a sharp blade on that circular saw makes a lot different than a a dull one would, you know. You know,
Tom Maxwell (44:13)
For sure. Yeah.
Bill Dombi (44:14)
a a laser level technology will fix the deck that I built built before that was not level.
pi and technology will be there, but the tool is is is is a tool in that way. I find the AI stuff to be absolutely electric as an element within home care. And we've talked about that stagnation and the innovation kind of barrier that might be starting to surface in some capacity. AI could be, you know, one of those juices that that that set sets home care continuing to be the the incubator of new ideas in healthcare.
Tom Maxwell (44:46)
I agree with you. I I I just think about the we talked about this on a few previous podcasts, but just medication management. If I got a Nana's got twelve meds, the average of patients on twelve medications. We know that from our other businesses that we're invested in. They're on twelve medications and if I'm a nurse, th those medications came into some kind of H and P packet and through, you know, whatever discharge planning tool I have and now I get it in on a piece of paper of facts and that doesn't get loaded into the EMR. So now if I'm a nurse, I gotta spend twenty minutes. It takes two minutes per medication to load all the details in that medication.
I gotta make decisions around it. I gotta check it through first data bank or whatever to make sure there's no drug to drug interactions. Nowadays you can take a picture of it with AI using secure HIPAA compliant. It'll drop it in the EMR in one minute. So I just saved you 25 minutes as a nurse right there. Just boom, here's here they all are. It'll go tell you if they're compliant with each other or if we if there's any contraindications, it'll tell you the reason why we need take that medication. It'll tell you if it relates to the diagnosis codes which you put in for the hospice benefit.
So we saved you time there. Now we can listen to the visit. We can, you know, through ambient listing, we can do all those kind of things. We can make your documentation easier, better, more compliant. We can ask Nana questions that she'll answer for us. I think people have to adopt the tools and use them. I do fear that we get lazy and people just use that as the the ultimate right. You still need to have a nurse in the loop, you still need to have a human in loop around the AI stuff, but why not use it?
Bill Dombi (46:02)
Yeah,
th this this tool can't make a judgment and judgments need to be made. You know, particularly when it comes down to you know individualized decisions on patients. You know, everybody seems to be having at least one element of uniqueness, which is a great thing about humanity. You know, we're not all the same.
Tom Maxwell (46:18)
True.
I don't think it replaces it. We're not gonna get robots in the home. We're not gonna replace nurses and chaplains and aides and social workers.
Bill Dombi (46:24)
I I I
foresee robots, if not androids, into the home at some point in time. You know, we don't we won't we won't have the workforce to do it, you know.
Tom Maxwell (46:33)
Yeah, but not for home health visits. I think you'll have they'll be in the home to help monitor and do those kind of things, but I'm not sure they're gonna go do any physical assessment of a patient.
Bill Dombi (46:39)
you know, not in my lifetime,
but you know, I've read enough science fiction t fr
Tom Maxwell (46:42)
Yeah.
Bill Dombi (46:43)
from way back to see how much of it became reality today. You know, case in point. Yeah.
Tom Maxwell (46:49)
Yep, it's true. It's true. I remember
when we were starting Home Care Home Base, we were working on the Windows mobile devices. They were almost like a Blackberry. And we th we were teaching nurses like, okay, you can do all your documentation on this little Blackberry. And they're like, my God, that's amazing. Like people are like, Are you kidding me? I mean, now we have all the tablets and all those kind of things. But yeah, back at the I mean, it's evolved so much. And there's actually a case at Homecare Homebase in one of the offices in Kentucky.
That we have one of every device that we used to sell. And I remember
Bill Dombi (47:19)
that's great.
Tom Maxwell (47:20)
it's it's it's so cool to go look at that, like I cannot believe we convinced nurses to use this as their documentation device.
Bill Dombi (47:25)
One of the devices that would be in my cabinet when I started practicing law, we had this great celebration the law office. It was a public interest law firm, as I mentioned, when we actually got a grant to be able to buy IBM Selectric typewriters that had the correcting tape built into it, you know. So
Tom Maxwell (47:45)
You know what's
funny? They don't even teach typing anymore. Cole, our podcast
Bill Dombi (47:50)
Well.
Tom Maxwell (47:51)
producer, didn't have to go he's twenty three years old, went through college and high school in a great high school in Minnesota, and he he didn't have to take a typing class. They don't type, they use computers. Yeah.
Bill Dombi (47:59)
Well, I I don't know how to type. I still don't know how to type. I'm
still a hunting pecker. And in in a law school class on legal writing, I handed in my first paper and it was handwritten in cursive by two other people plus me. And and and and
Tom Maxwell (48:13)
Well, they don't they'll teach that either.
Bill Dombi (48:15)
and and the and the professor said, What is this blank? You can fill in the blank. And I said,
Tom Maxwell (48:20)
Yeah.
Bill Dombi (48:22)
I'm in law school to become a lawyer. I'm not gonna need to type.
Why did I not have vision forward about the
Tom Maxwell (48:27)
Yeah.
Bill Dombi (48:28)
keyboard that's sitting right here in front of me now?
Tom Maxwell (48:31)
For sure. That's for sure. wow. All right. If I gave you a pen and said you could change any regulation in Congress for CMS,
what would you change? a great question.
Bill Dombi (48:41)
Yeah, I mean there's probably a lot,
you know, I I would build the system to have palliative care as an actual full fledged benefit on its own, you know, and and not a replacement for hospice, but you know, to work side by side with hospice, pre hospice or for those individuals who still want curative care, you know, to to ignore
that healthcare is intended with a goal to be palliative, to feel better, you know, to be less pained, etc. You know. I mean I I grew up with a dentist who wouldn't tell us that there was such a thing as Novocaine as he drilled our teeth and we reached for the sky out of s you know pain, you know, out of the whole thing. Healthcare's not supposed to be painful, you know? That that's athletics, if you no pain, no gain, but that's not healthcare.
Tom Maxwell (49:35)
That's right. Hey, but you know
what learned from that doctor though is you brush your teeth better, I'll bet you if you had to go if they didn't give you Novocaine.
Bill Dombi (49:43)
Well,
th this I I'm I'm much younger than you were that you know, the kinds of things I mean, I still have silver fillings in my teeth. You know,
Tom Maxwell (49:50)
Wow, yeah.
to but talking about this palate of care, but if it's one the things if you gave me the pen and said, Tom, what would you change? And and I will tell you that in our in my career around technology, a lot of the patients that we've looked at are I are, you know, ESRD patients, in stage renal disease, the hit neuron dialysis. And it really blows my mind that some of these are the sickest patients that I look at all the time. They're the I mean, they're the you know, multiple comorbidities, they're really sick. They need to be on hospice, they should be on hospice, but because
Dialysis is considered curative. Hospices don't put on. They don't or the patient doesn't elect hospice because the doctor's not going to tell stop dialysis and go in hospice. You're going to die if you do that. So why can't we be on hospice and get, you know, in-stage renal disease or dialysis done at the same time? That to me that one just blows my mind. And it I see these patients every day, Bill, and it's there's they're the saddest, sickest patients, and they die on home health and they shouldn't never die.
Bill Dombi (50:37)
I mean there's a there's a long s subset of other things that we both probably would want to change. You know, Medicaid, home community based services, optional benefits, they should be mandatory. You know, the h home health, homebound requirement, you know.
Tom Maxwell (50:50)
my gosh.
Bill Dombi (50:51)
Nothing but nothing but a trap for people. And then, you know, as you're bringing up with hospice, the six month requirement, you know, which was created simply because somebody did some calculation to say that's the that's the breaking point from when the care will become more expensive than
than if they s you know didn't have a hospice available to them. But you know, nowadays, you know, that calculation's no longer a valid one. I mean, you can save money by being on hospice for twelve months. You know, so
Tom Maxwell (51:18)
For sure. And provide
an amazing benefit in a social worker and a chaplain and an aide for a hospice patient for 12 months when they need it the most, especially at dementia hospital.
Bill Dombi (51:28)
Yeah, I I mean it's the whole picture. Hospice is the whole picture. you know, I I I'm starting to compose my list of what music I want to listen to with music therapy, you know, should I want that as a palliative part of my hospice care? But that's the flexibility that hospice brings is you w whatever it takes to have it, a comfortable death, so to speak. You know, I will branch out.
beyond classic rock with that list, you know. I I love jazz as well and and even some of the music today. you know I might even have a rap thing or two to you know
Tom Maxwell (52:01)
I want to hear that. Send me that list.
Bill Dombi (52:04)
I don't expect to see K pop in mind my
Tom Maxwell (52:07)
Yeah,
something you don't know about me. We had a dog named Einstein. He was the VITAS hospice dog of the year and Einstein had a he was born with a he was a Swiss mountain dog and he was born with a limp foot and like he could run on everything, but for some reason he held his foot up and they never could figure out what was wrong with him. So we would take him to all these assisted livings and and he would just take off running and he would run and then he would hold his foot up and all the patients thought Einstein had a hurt foot. So they would all get down on the floor with him and like crawl their wheelchairs and
Rub on Einstein. But that dog made so many people happy. And that was part of the benefit, right? We got zero money for it. He did it four days a week. I mean, the dog loved going to the assisted living to it's an amazing benefit. And but yeah, Einstein was he could figure out how to get people to pet him by just holding his foot up like that. It was a really cool dog.
you've been fighting all these difficult legislative fights in your career. How did you remain so optimistic, Bill? You did
it for so long.
Bill Dombi (54:45)
I'm not sure that word optimistic ever fit for me. You know, I I consider myself to be, you know, certainly a bit pragmatic, but whether you call it optimistic or pragmatic, my experiences are you're gonna face having to step back. But so long as you go two steps forward, you know, you're going to be there. you're gonna succeed if you're on a bona fide mission. you know.
anticipating those setbacks, but anticipating you know what you can learn from those setbacks that help you take those two steps forward probably is the foundation for any kind of optimism that might be assigned to me that I consider to be more pragmatic than than anything else. honestly I I I look at what's wrong before I look at what's right, I think, because you can learn a lot about
how to make something right by looking at it what it's wrong, which still gives you a somewhat of a sour view on things. the the line I used for many, many years was the only way to avoid a problem with Medicare is to stay young and stay healthy. know, and and and so I I have toned that down a bit. You know, they they they make a lot of mistakes, but they do a lot of good too in the Medicare program. And so trying to channel the good part
of what you see in Medicare, Medicaid, and other you know and s healthcare stuff, you know, is the is the reason why we can see those two steps forward.
Tom Maxwell (56:11)
Yeah. And
poor you and your family, every fourth of July or every Halloween you had it was ruined by Medicare or ruined by CMS. I mean, every year it came out right before the fourth of July. Every year
Bill Dombi (56:19)
With the with I I
Tom Maxwell (56:21)
you're spending all weekend reading this stupid rule and trying to re write a response to it and get everybody motivated and I mean and then here's Halloween, we get the final rule.
Bill Dombi (56:30)
when I was a young attorney, those Fourth of July's meant family picnics, which meant once my relatives aged and were on Medicare, it was like office hours answering their questions about Medicare. So I was thinking
Tom Maxwell (56:41)
For sure, for sure.
Bill Dombi (56:42)
I was thinking of that too in addition to how, you know, burning the midnight oil reviewing three hundred pages of regulation on on on days like that. know, but CMS seems to be
less predictable as to when things come out today, but
Tom Maxwell (56:58)
Yeah, it's always I mean it's always been yeah, they last year of course and the year before they had they were a little delayed, but we we used to predict, I mean, almost every October thirty first and I actually put it in Chat G P T and said, Give me the the last twenty years and it was pretty close to those dates every single time.
Bill Dombi (57:12)
Yeah, the last the last
Friday in October, you know, is was often what it was and and and the last Friday in June, was was what for the proposed
Tom Maxwell (57:21)
That's right.
Bill Dombi (57:21)
rules, you know.
Tom Maxwell (57:22)
That's right. And you guys will be prepared. And I I know that those fights are tough. I mean, you guys are you go, you argue, you get Senator Collins to write bills, you you you know, work with all the other congressmen and and then y you get to the end and they it still comes out with, you know, they may reduce the rate cut by a little bit or something, or they'll add some more things in there and they're just like, Are you serious? Come on, guys. And are you listening to us? That's that's the part that always frustrates me. I'm like, Does anybody care and are they listening? I mean you have thousands and thousands of people signing a petition and
Do they care and do they listen? And I know that there's a million things that CMS has to deal with and and is home health that it's our most important or hospice is our most important, but is it theirs? But I always question are they listening? Are they paying attention to this?
Bill Dombi (58:02)
Yeah, and y you look for your you know, your people who will be devoted heroes on the advocacy side in Congress and the people even within administration on you know on that. But they you know, you you leave a meeting bringing out your you know what what what you want to see done, your ask and you defend it and you support it and everything else, and somebody walks in the door as you leave with the same playbook of what's my ask, what's the why why's this should be a priority.
So you are competing with a lot of priorities there. And members of Congress, for example, their knowledge, you know, often doesn't go below service level because they're working in so many different areas. So you build that into your strategic approach. You know, your tactics have to take that into consideration as well. but you know, in the end, you know, it's that mission driven approach that you take that keeps you going back and not giving up, you know.
my my my walk off the stage song at the last NAHC annual meeting with me as the president and CEO was Tom Petty, Don't Back Down.
Tom Maxwell (59:11)
Remember. It's good. It's a good choice too, by the way.
Bill Dombi (59:14)
yeah, I you know, I mean i it it just came to me one night and and I I ran with it and boy I felt good, you know, w hearing that in the background, you know, as I was walking off. Yeah.
Tom Maxwell (59:25)
For sure, for
sure. All right, let's talk about what you're doing today. What what are you up to now? You're involved in a a law firm, you're sitting on a couple of boards. Tell me what you're working on.
Bill Dombi (59:35)
Well, you know, I I told my wife that you know what this retirement was gonna be a glide path. All right. And I told her it would be three buckets, three buckets and a hammock. Okay. The three buckets were gonna be stimulating kinds of activities. The bucket was the hammock was gonna be obviously self-defined in that respect. It's now she said, I think it's nine buckets now, she said. And that hammock
Tom Maxwell (59:56)
Ha ha.
Bill Dombi (59:56)
is in the basement. You know, as you referenced,
Tom Maxwell (59:58)
Can't you see the sun?
Bill Dombi (1:00:01)
you know, I I'm I'm senior counsel at the law for Marlowe Golden and Gregory.
I've always practiced law, even as the CEO, I wanted hands-on practice law. It's a lot different because it's generally representing individuals rather than representing a cause kind of thing, you know, or an issue or a policy goal kind of matter. but still very rewarding. you know, you've got to be accountable to your community at large when you're going for the cause, and you've got to be accountable to your client. And, you know, so representing them obviously in the world of healthcare at home, everything hospice home care.
compliance related, transaction related, innovative approach is being taken. I'm on the advisory board for New Day Healthcare, which was one of my goals was to be able to learn continued learning on home care. And you know, working as an advocate in an association, you can learn a lot from your membership, but you learn even more by being somewhat on the inside of that. No, I don't go to the New Day office and
roll up my sleeves and and work, but I get to work with people who are, you know, really just incredible people pulling together an organization that is mission driven itself. now, unfortunately deceased leader Scott Herman was an inspiration to so so many people, an inspiration, you know, for me as well. We miss him dearly in that respect. But they've gotten me involved in in anything and everything I wanna be there.
in in some kind of roles as advisory board, people tell you if I don't ask you a question, don't give me an answer. You know, they're they're willing for me to step up and say, look, here's here's my view of it. You know, but I've learned a an awful lot. I'm on three home care related boards of directors that are not for profits as well. The Research Institute for Home Care, I'm a co-chairman of that. you know, great experience. And we're trying to get more and more people to understand the
value of research. You know, Bill Bourne was one of the founders of it many years ago. Probably no one listening to this will even know that name beyond you.
Tom Maxwell (1:02:04)
they will. They will. Everybody knows Bill. The the wheel.
Bill Dombi (1:02:07)
Mark Bay Mark Baiada has kept it going, you know, inf infusing
Tom Maxwell (1:02:09)
my gosh. my gosh. I love him too.
Bill Dombi (1:02:12)
support that otherwise wasn't there on it. So I'm on that board. I'm on the board for the Foundation for Hospice and Home Care in North and South Carolina with Tim Rogers and the North Carolina Association.
Tom Maxwell (1:02:23)
yeah, I didn't know that.
Bill Dombi (1:02:24)
having a a a lot of fun on that. And I'm on a on a board of something called independence allies for independence. It's a Washington know coalition of sorts, which brings together mostly patient oriented voices on healthcare at home, the disabled as well as the elderly on that. So definitely enjoying, you know, what what those things offer There's probably some others in there that I've forgotten that I can't you know, but
They'd haven't been really forgotten.
Tom Maxwell (1:02:55)
That that's awesome. So you're still busy? And y you're like me. I retired and said I was gonna do this, do nothing. And Jennifer and I spent seventy seven days and it was terrible. Like I she's like fatty, get off the couch, go find a job, do something. Like, let's do it. So it we're now and and we've invested in multiple home health and hospice technology companies as well as I'm on a couple of home health agency boards and I I actually love the being involved in the boards on the on the home health agencies is amazing because it's it keeps you relative, it keeps you thinking. And people are coming to me and saying, Okay, you
You wrote the technology that the industry uses. Why do they do it this way? And how do we change it and where do we use it better? And it's it's been a lot of fun. I've I've learned probably more know, being on that board than I did or on these boards than I did. Like I was on Agape in St. Croix and I learned more from, you know, just being in in the action there with everybody and and it's real, right? You got real problems and you gotta solve And and before we were just building technology and saying, Hey, use it this way and now they're like, Why'd you do that? I still get accused for a lot of those things, but it's it's fun.
Bill Dombi (1:03:52)
I s I
s I still ab aspire to some of that work life balance. And so if my plan holds true on Thursday at noontime, I'll be merging the two together to see a movie called Spider Man New Day.
Tom Maxwell (1:04:08)
That's funny. You're taking your grandkids, I hope.
Bill Dombi (1:04:10)
Yeah, so when what's that? Will I bring the kids?
Tom Maxwell (1:04:14)
Yeah, grandkids?
Bill Dombi (1:04:16)
if they have the time for me, maybe. You know,
Tom Maxwell (1:04:18)
Yeah.
Bill Dombi (1:04:19)
I I would bring I would bring them if they have the time for me. What what all these grandparents realize when they hope to spend more time with their grandchildren is will the grandchildren have time for them? These kids are so so busy. So wonderful kids, so so busy though.
Tom Maxwell (1:04:33)
Cool, that's really cool. All right. If we wanna get a hold of you, Bill, how do we get a hold of you?
Bill Dombi (1:04:37)
I'll I'll give out two things. I don't hesitate to talk to people, give you know, give un unrequested advice even, of course. But my email address is a simple one. It's W A, my first two initials, Dombi. W A Dombi ten at gmail dot com.
You somebody who gave me advice about moving to retirement was she she said, your world will shrink. And and mine has. It has shrunk. But it was it was a massively wide world before. I would visit, you know, in some years 40 states to do presentations for the state association, plus others on top of that. So traveling all over the place, eating crappy food everywhere in airports.
You know, that's been reduced somewhat, although I still have frequent status on a number of airlines that way. But I I don't miss the travel, but I do miss the people that I got to see as as frequently as it is, you know. so and I may not remember that person's name having met them ten years ago in passing, but I may more likely remember their face. But when they start telling me w what we talked about I'll remember that as well. So
It's been a great ride. I w I would not do much different.
Tom Maxwell (1:05:52)
Yeah, and the the industry's very grateful that you were a part of it for so long and did it for so long. I I worried a lot when you said we talked to them a couple of years ago and you said, I think I'm gonna retire maybe it was four years ago and I'm like, I don't think you're gonna retire but you might get a different job or go to a different office, but you're not gonna retire.
Bill Dombi (1:06:08)
In in
twenty in twenty years when you're my age, you might be thinking differently about your your definition of retirement too.
Tom Maxwell (1:06:11)
Nah.
I I don't want to stop, Bill. I'm having so much fun now. And I I you I don't create spreadsheets. I look at and and it's just it's so fun to I'm not, you know, even close. I I I can't wait for thirty more years from now. And I love what we do every day and I love who we take care of and the patients we're dealing with. And and you know, I still play golf all the time. Don't don't underestimate that. But I I really enjoy what we're doing and and the things we're doing. Thank you for being on the podcast, Bill. You're an amazing man and
You're a leg a legend in our industry and everybody knows that. I know everybody's gonna watch this podcast and learn something from it. And if they wanna reach out to your law firm, how do we how do we get you to the law firm if someone wants to engage you there?
Bill Dombi (1:06:49)
Well, you can try the same email address that
Tom Maxwell (1:06:51)
Okay.
Bill Dombi (1:06:52)
I gave, but the other one is William dot dombey at AG dot com. Arnold Arnold Golden Gregory.
Tom Maxwell (1:06:56)
A G G, I like that. That's cool. That's awesome. All right. Thank you, Bill. Appreciate you being here.
The the the new day band, the old day band. All
Bill Dombi (1:07:14)
And we've got that's yeah, that's it. You get it.
Tom Maxwell (1:07:17)
All right, thank you, sir.
Bill Dombi (1:07:19)
Take care.