Wednesday, November 24, 2010

A Leap Forward in Assisted Living Performance Management

November 24, 2010
By: Dave Kyllo, Executive Director, NCAL

The National Center for Assisted Living (NCAL) recently released the results of its Performance Measurement Initiative Surveys. This groundbreaking initiative establishes performance measures for consumers, policymakers and the assisted living profession.  Survey results show that many assisted living providers are using numerous ways to determine the quality of care and services being delivered to residents. The Initiative consists of 2 separate surveys, Performance Measures and Employee Vacancy, Retention and Turnover (VRT). Among the findings of the Performance Measures:
  • 98 percent of assisted living communities conducted criminal background checks on all new employees;
  • 91 percent of assisted living communities measured resident and family satisfaction; 
  • 94 percent had a licensed nurse available to staff and residents 24 hours per day;
  • 94 percent reviewed incident reports for residents;
  • 85 percent measured employee satisfaction.   
The VRT survey, a profession-wide survey that examined workforce stability, revealed that the overall retention rate for assisted living employees was 51 percent. The VRT provides a snapshot of the profession at a moment in time that may or may not reflect a national trend.

The Performance Measurement Initiative was developed to ultimately improve care by providing residents, family members and policy makers with tangible insight into an assisted living community’s operations. The Performance Measures survey was limited to NCAL members.
The surveys measured 10 operational areas dealing with resident and family satisfaction, employee satisfaction, resident occupancy rate, criminal background checks for new staff members, implementation of safety programs, and more.

NCAL will continue to issue this survey on an annual basis. To obtain a copy of the 2010 Assisted Living Performance Measures Survey Results or the 2009 Assisted Living Staff Vacancy, Retention, and Turnover Survey, contact Lisa Gelhaus.

Monday, November 15, 2010

A Year for the History Books

November 15, 2010

Advocating for Quality Care
This past year was full of challenges for long term and post-acute care providers. Yet with these challenges also came opportunities for new growth, new directions and expanded development. Garnering controversy and praise for months, health care reform dominated the airwaves and affected all of us in more ways than one. But reform was just one part of the story. The 2010 AHCA/NCAL Annual Report, Advocating for Quality Care, includes highlights for our profession from throughout the year, including workforce, quality, facility operations and more. Specific highlights include:

•    Health Care Reform: AHCA/NCAL advocated for the incorporation of many key issues into reform, such as a partial Part D fix, a national health care workforce commission, and establishment of a national center for better health care workforce analysis. Of course, all was not positive with the new law, and implementation of health care reform saw many difficulties. AHCA responded by creating the Health Care Reform Resource Center. An online clearinghouse of information, the Center has over 30 in-depth impact/analysis/policy papers and 23 guidance/regulatory entries.

•    Public Opinion and Medicaid Funding: In June, AHCA released findings of a poll by the Mellman Group which established that Americans, by significant margins, strongly supported passage of federal Medicaid relief and vehemently opposed any additional state Medicaid cuts. Taking into account the fact the Medicaid program already under funds the cost of providing care by at least $4.2 billion annually (according to Eljay LLC, a company specializing in Medicare and Medicaid payment and funding issues for nursing facilities)  the stage was set for the Driving for Quality Care RV Tour. The tour brought this message across the country and urged Congress to pass additional enhanced FMAP funding. Our success came quickly – enhanced FMAP was passed in August.

•    Quality: Through a coalition, AHCA was instrumental in developing the report, Patient in Pain: How the U.S. Drug Enforcement Administration Rules Harm Patients in Nursing Facilities. For the second consecutive year, AHCA—in partnership with the Alliance for Quality Nursing Home Care— released an Annual Quality Report, assessing the challenging dynamic of the nation’s rehabilitation and skilled nursing facilities and trends in quality, showcasing that we have improved on 16 of 26 quality indicators.

The Report, now available online, also reviews grassroots and PAC activities, member services, and legislative and regulatory issues.

2010 is indeed a year for the history books. Never before have we seen so much change politically coupled with a singular emphasis and focus on health care policy in Washington. As we reflect on these opportunities, we stand ready to tackle the challenges ahead so that providers can continue the hard work of caring for our nation’s frail, elderly and disabled.

Friday, November 12, 2010

Opting Out of Medicaid? Not the Answer

November 12, 2010

The New York Times today published an article highlighting the current reality faced by vulnerable populations and those who care for them in the state of Texas. In this post-election era, debates are focusing on how state and federal lawmakers will actively seek to alter federal health care reform. While a spectrum of opinions exist on methods to save state dollars, bad ideas – like states “opting out of the federal Medicaid program” – merit more discussion and review.

Anticipating the consequences for such a move is not difficult. Precipitously withdrawing from Medicaid would have a tremendously negative ripple effect throughout state economies, and to elderly Medicaid beneficiaries in particular. In today’s world, where approximately two thirds of nursing facility residents are Medicaid recipients, access to quality care would be threatened. State Medicaid rates, already low and underfunded, could not possibly support the ongoing care needs of a rapidly aging population.  As facilities would be forced to close their doors, job losses would be rampant and Americans would feel the economic crisis even more in their own communities.

This is not to say cost savings are not needed. Facilities in Texas and throughout America have invested heavily to increase capabilities to admit, treat and return home growing numbers of patients requiring intensive rehabilitative care. This is a clear benefit to both seniors as well as taxpayers. To help boost cost-efficiency, statehouses and Washington should help facilities improve their capacity to return patients home more quickly. This is a more realistic, logical and workable approach than rashly opting out of Medicaid.

What do you think? Share your comments below.

Monday, November 8, 2010

Reading the Post Election Tea Leaves

November 8, 2010

Today AHCA held a small reporter breakfast on the November 2nd election results, what they mean for the long term and post-acute care profession, and the GOP reform repeal recommendations. Our industry was short-shrifted in terms of recognition and true change to the way we are funded and regulated. In spite of all the dissatisfaction, however, the new Congress presents an opportunity for us to work with Republicans and Democrats alike to ensure those who came to the polls have their voices heard. 

One issue that had seniors voting in droves was their disapproval over health care reform. It’s fair to say the law missed the mark on several key items important to our sector. Some worth considering by the 112th Congress include:

•    Reimbursement Cuts: The reality is simple. Quality care delivery is tied to staffing. Staffing is the bulk of the costs to facilities. When reimbursements are cut, staff is forced to do more with less.

•    1099 Reporting Repeal: Although full repeal comes with a $17 billion price tag, strong bipartisan support from many members of Congress and the substantial involvement of multiple coalitions suggests that the prospects for a 1099 repeal are favorable.

•    Health Information Technology: The new law did not contain any HIT funding for our profession. We, along with those we serve, cannot afford to fall behind in this critical area.

•    Required Disclosure of Ownership and Additional Disclosable Parties Information: The law requires disclosure of ownership from parties with as little as 5% of property. The burden this law puts on facilities that are busy with caring for the elderly population is unreasonable and unfair. 

If we can say one thing about our profession, it’s that we have worked with both sides on the issues that matter most. In many respects, our sector lines up well with Republicans, and this will be an asset during the 112th Congress. The majority of long term and post-acute care providers are private sector deliverers of high quality health care. Not only are we efficient and effective in our care delivery, but we perform the same amount of treatment that a hospital does, for much less. Ours is a sector that is growing and creating jobs, which is a top priority of this Congress. Last year alone, the long term and post-acute care industry created about 50,000 jobs nationwide.

In terms of the Lame Duck session, our agenda is small but ambitious. We will continue to tackle the RUG IV issue and technical changes in Medicare Part B therapy services. As we search for legislative vehicles to house this legislation we will also work on the therapy caps issue and recommend a one year exemption from capping reimbursements. Moving forward, we recognize that the FMAP extension will be a tough sell next year. However, we will  advocate for this important provision and educate the new congressional leadership on other issues that matter most to our sector.