From Congress to Health Care

David Davis has many laurels on which he could rest. He has been a U.S. Congressman representing Tennessee’s 1st District; a four-term member of the Tennessee Legislature; founder of the award-winning home medical equipment company Advanced Home Care; and one of the “Health Care Heroes” of the Business Journal for the Tri-Cities of Tennessee/Virginia. The Johnson City, Tenn.-based respiratory therapist has racked up a slew of other awards as well, including honors from the Tennessee Association for Home Care and from East Tennessee State University as Respiratory Practitioner of the Year.

It is perhaps his current endeavor—Shared Health Services (SHS) and its consulting arm, Affordable Wound Care Consulting—of which he is most proud. SHS specializes in wound care and saving limbs through hyperbaric oxygen therapy. “It’s a blessing to see a patient who was facing amputation walk out of the clinic,” says Davis, who launched SHS after selling Advanced Home Care in the mid-1990s with the purpose of establishing wound care and hyperbaric oxygen therapy clinics in hospitals (see sidebar). “That’s why I’ve been in health care since the seventies.”

In those decades Davis has had several vantage points from which to observe the evolution of health care. In addition to his political offices he has been—and continues to be—a small business owner; he’s served as a surveyor for The Joint Commission, a health care accrediting body; and he’s been a delegate to the White House Conference on Small Business. What he has seen hasn’t always been heartening, but it has been instructive… and it’s been life changing.

“It’s a blessing to see a patient who was facing amputation walk out of the clinic. That’s why I’ve been in health care since the seventies.”

The End and the Beginning

Davis started his career as a respiratory therapist in the late 1970s. “It was a hands-on, personal thing,” he recalls. “When you were trained as a respiratory therapist you stood, you didn’t sit down, and you didn’t take care of two patients at a time.”

He relished providing that personal, attentive care. By 1986 he had opened Advanced Home Care in Johnson City, and he’d expanded into all lines of HME. He became heavily involved in the National Association for Medical Equipment Suppliers (NAMES), the precursor to the American Association for Homecare, and the Tennessee Association for Home Care (TAHC). NAMES tapped him as its first National Supplier of the Year. TAHC gave him its John W. Hines Award for administrative excellence. Life was good, but it was changing.

In his roles with the state and national associations and as a Joint Commission surveyor, Davis was getting a bird’s-eye view of home care’s future. “I could see it changing to just supplying equipment. That was just not my nature,” he says.

As an aside, he notes that the very future he feared almost 17 years ago has come to pass. His father is an oxygen patient and the family is pleased with the provider. However, the provider only comes out to the house once every six months. “That’s ‘no hands on’ care,” Davis says, noting that in his day, “we went out every month, we always took their blood pressure, and we listened to them. That’s one of the things we’ve lost. I think it is problematic for the patient, and for the taxpayer. If they don’t get the proper care, they’re going to end up back in the hospital.”

Davis was bothered by the governmental red tape that was strangling his business, threatening its ability to provide superior service to patients. “I think that’s one of the reasons I sold my home care company, in fact,” he says. “Being part of NAMES and being involved in political advocacy, I could see things changing, and I decided that if there was a good deal on the table it would be a good time to sell.”

The offer hit the table, and Davis bid home care adieu. But he couldn’t stay out of health care. In 1996, shortly after he sold Advanced Home Care, he started Shared Health Services. It was his grandmother who got him involved.

“I had a diabetic grandmother who was scheduled for an amputation,” he says. Davis had worked with a specialist in hyperbaric oxygen therapy, however, and he thought that type of treatment might be a better answer. It was. “My grandmother died with both feet and all her toes, so I knew hyperbaric therapy worked.

“So many amputations are needless,” he adds. “The woman with breast cancer has a better chance of living five years than a person with an amputation. And it’s cheaper to take care of the patient and maintain the health of that patient rather than amputate body parts. That’s a spiraling process that usually ends in death.”

He wanted to make sure that others like his grandmother who were dealing with the devastating effects of diabetes, radiation damage, osteomyelitis and other problem wounds had that same chance at healing and a better life. So he became a certified hyperbaric therapist and created SHS. “A lot of similar companies started about that time. When I first started in the industry every hospital had wound care, but it wasn’t in a cohesive manner because no one was coordinating services. Now it has become a specialty.”

Hyperbaric oxygen therapy can be used to treat diabetes wounds, osteomyelitis, radiation damage and other wounds that have not responded to conventional wound care. This super infusion of oxygen actually grows new blood vessels to help with healing.

Into the Future

What is Hyperbaric Therapy?

Hyperbaric oxygen therapy can be used to treat diabetes wounds, osteomyelitis, radiation damage and other wounds that have not responded to conventional wound care. It is administered in a chamber in which a patient can sleep or watch television for two hours while intermittently breathing 100 percent oxygen. The oxygen is systemically transferred to the blood stream. This super infusion of oxygen actually grows new blood vessels to help with healing and has been proven to facilitate the use of antibiotics, enhance leukocyte function and reduce wound edema.

Source: www.sharedhealthservices.com

SHS contracts with hospitals—currently from Pennsylvania to Florida and Kansas to West Virginia—to become their provider of wound care and hyperbaric oxygen therapy. “We hire and train the staff, buy the equipment, but it’s still their department,” Davis explains, adding that it’s a turnkey setup for the hospitals that includes everything from the day-to-day management of the clinic to assisting hospitals with marketing and educational programs. SHS has a team of managers that provides 40 hours of training in wound care and hyperbarics to clinic physicians and staff.

Davis has also drawn on his background as a Joint Commission surveyor, which taught him to deal with details. “We perform a quality assurance assessment on all the hospitals we go into,” he says, noting that he wrote the Semiannual Quality Improvement Review (STAR) assessment based on Joint Commission standards. It helps ensure quality care and high operational standards by identifying areas where improvement is needed. He or one of his managers conduct the assessment. “That gives me the opportunity to be onsite working with the staff and the administrators.”

Although some of his competitors have 300 to 400 hospitals under contract, Davis says his company is much smaller. And while he is always looking to partner with other hospitals, he likes it that way. “We have a philosophy that goes back to when I started in health care—we get to know the patient like our own family. We are small enough that we know the patients’ names that we deal with,” he says. “They know they can call me, the president of the company, directly.”

Still, he points out that the company is large enough to make it efficacious in terms of buying power for wound care and hyperbaric oxygen chamber equipment and training.

While Davis gave up a snarl of red tape when he stepped away from HME, Medicare still plays a role in his business. Certainly there is no worry about competitive bidding at this point. However, hyperbaric treatment—which is covered by Medicare for certain applications—is not the first line of treatment; Medicare requires that more-conventional treatments be tried first. For example, in order for a wound patient to progress to hyperbaric oxygen therapy under Medicare, insufficient outcomes through other wound care therapies must be proven.

“I’m very focused on outcomes,” Davis says. His stint as a Joint Commission surveyor underscored the need for results, he said, and he is well aware that Medicare is beginning to look at the results it is getting for its bucks. “You prove good outcomes, and the best way to do that is to benchmark and say, as an example, before we brought this patient into a wound and hyperbaric center they were going into the emergency room three times a week, and we have been able to cut that.”

Another way to benchmark an outcome is to reduce the patient’s typical healing prognosis. If it is typically six months for the patient’s diagnosis, it’s a good outcome if treatment through a wound and hyperbaric clinic can reduce that time to eight weeks, he said. “You have to have benchmarks that you can actually prove,” he says.

Davis believes that outcomes are going to become increasingly important in all categories of health care, whether HME, hospitals or wound and hyperbaric centers. Health care dollars are shrinking even as the pool of patients to care for expands, so it is crucial that providers obtain good results. It’s going to take teamwork to do that, he says: “Continuity of care is going to be one of those government mandates—quality of care, outcomes and how we can get that patient better quicker so they don’t have to come back into the system.”

He foresees a day when HME providers will work closely with other entities to ensure those outcomes. “Health care in the future is not going to be just the doctor, just the hospital, just the company that provides the oxygen,” he predicts. “It’s going to be all of that plus the patient and the family. Everybody is going to have to play a role in the future.”

Sidebar:

Mr. Davis Goes to Washington

David Davis always thought his future was in health care. After all, he started his career as a respiratory therapist and was the founder and owner of Johnson City, Tenn.-based Advanced Home Care. Then he got involved in political advocacy through the National Association for Medical Equipment Suppliers (NAMES), and his future changed.

Drawn to politics as a way of making a broader difference, Davis won the first of his four terms as a Tennessee state representative in 1998. He sat on the Transportation Committee, the Government Operations Committee and the Public Safety and Rural Roads Subcommittee. He also was a delegate to the White House Conference on Small Business.

“As the owner of a small business, you really do have an understanding of health care and how business works—paying the taxes, making payroll. It’s good to have people serving in the legislative bodies who have that kind of experience,” he says.

So when Bill Jenkins—a Republican who had represented Tennessee’s 1st District in Congress—announced that he was retiring in 2006, Davis decided to run for the seat. He won with 61 percent of the vote. “As a congressman, I was trying to protect the home medical equipment industry and be an advocate,” he says.

HME needed advocates, then as now. Competitive bidding was looming; so were mandatory accreditation and threats to reimbursement for power mobility and home oxygen. “I was the ranking member on the small business committee and I was just trying to get the people in Washington to realize that yes, home oxygen might cost $300 a month, but if you put the patient in the hospital you’ll spend 10 times that on the first day. You’ve got to look at the total dollars in health care. I tried to bring a real-world understanding of how things work.”

He battled against proposed oxygen cuts and the reassignment of oxygen equipment ownership to patients after 36 months. On May 21, 2008, he testified against competitive bidding before a House of Representatives panel. “I can tell you that if an oxygen machine goes down or a tank runs out at two o’clock in the morning, they have to have care. It’s not just a piece of equipment you drop off,” he said during his testimony.

That August Davis lost his district’s primary by less than 1 percent. He declined to run again in 2010. With his four terms in the state legislature and his term in Washington, he felt he had been away too much from his wife and two children. He also wanted to concentrate on his business.
“I have been blessed with the opportunity to serve the people of East Tennessee in Washington and I may decide to run for Congress again in the future. But for now I can best help the economy by hiring staff in need of jobs and helping patients in need of high quality health care by focusing on my business,” he said in announcing his decision not to seek office.

Will he ever run again? “I keep my options open,” he says. Meanwhile, he remains a political advocate for the health care industry. “I think all health care providers need to become more involved in the legislative process. It’s important that they get their patients involved in the legislative process. As people in Washington are making decisions about health care, they need to understand that they are going to affect patients in certain ways.”