Establishing private duty in a Medicare world.

The Balanced Budget Act of 1997 projects $16.2 billion in Medicare cuts over five years, which will force dramatic changes in the home care delivery system. Medicare agencies with a good public image and strong referral sources are in a strong market position to offer private-duty services. Agencies in a weak market position should immediately begin to diversify their services to succeed in this new environment. Private duty can be lucrative if agency management establishes efficient systems, maintains high standards, and thinks like entrepreneurs.