Monday, December 19, 2011

Senior Flash Mobs Dance in the Holidays

Not in the holiday spirit yet? These seniors will help you out! As reported in NPR today, senior citizen flash mobs have been surprising shoppers across the country with fun Christmas dance routines. Check out their moves and let us know if you spot one!

Wednesday, December 14, 2011

What's New at Provider Magazine

The current issue of Provider magazine takes an in-depth look at the funding changes in store for Medicaid programs across the nation as the federal government and states grapple with the challenge of paying for dual-eligible beneficiaries.

The cover story, "CMS Opens Gates to Funding Changes," takes a deeper look at managed care in the Medicaid world by going to providers in Arizona for answers. Arizona is one of the few states with managed care programs in place for long term care. As detailed in the story, the solutions favored by many policymakers in Washington may actually present another level of challenges for providers and drive dollars away from caring for Medicaid-eligible seniors. A source tells Wagner how the market has responded to the Medicaid shift to managed care by creating a new niche of facilities specializing in Medicare-only beneficiaries in Arizona.

This month’s Provider features a number of News Currents pieces on hot topics like observation stays, assisted living oversight, accountable care organizations, and quality data released by AHCA showing further progress in caring for residents. Columns focus on caregiving, management, and technology for long term care, from aquatic therapy gaining favor in facilities to telehealth options expanding in rural Georgia.

Check out the December issue for more.

Tuesday, December 13, 2011

In Case You Missed It

AHCA/NCAL President & CEO Mark Parkinson appeared on CNBC's Worldwide Exchange this morning. Check out a clip:

Monday, December 12, 2011

A Breakdown on Bad Debt

As 2011 is winding down, everyone, even Congress, is trying to check off their end-of-year to do list. On a federal level, that means extending the provisions that need to be extended and issuing last minute bills before adjourning for the session. That is the case with the recently introduced House legislation you may have seen in the media. While this is not predicted to pass the Senate, the bill includes a provision that could have a disastrous effect on every nursing facility in the country.

Medicare bad debt, a little-understood and little-discussed issue, is cropping up now that it is included in this legislation as a pay-for to help offset the cost of the doc fix. Bad debt is easily explained but not easily resolved, and may only become more difficult in the years ahead.

On its surface, bad debt is fairly simply. Take two sisters – Mildred and Ingrid. Let’s imagine each sister lives in a different state, and Mildred is on Medicare, while Ingrid is on both Medicare and Medicaid. Both fall at home and are admitted into the hospital and then discharged to a skilled nursing facility where they receive comprehensive rehabilitative care. Medicare covers the first 20 days of a SNF stay, but on the 21st day they are required to pay a copayment to the facility. Mildred, who is not covered by Medicaid, must pay this copay - $141.50 in 2011 – out of pocket. Ingrid is not responsible for her copay, as she is a Medicaid beneficiary.

Some Mark Parkinson with your coffee?

The early bird gets the worm - or in tomorrow morning’s case, gets to watch AHCA/NCAL President & CEO Mark Parkinson on CNBC’s Worldwide Exchange. Show starts at 4:00 am ET/3:00 am CT, but the governor’s appearance will be during the 5:00 – 6:00 am time slot. So, a little more time to sleep in.

Mark will be returning tomorrow as a guest host on the global business program, which provides in-depth coverage on issues that impact global investors. He’s expected to provide some of his personal business insight (from all those years owning and operating assisted living facilities) on topics such as the European debt crisis and the current state of the U.S. health care system. He’ll help interview guests, including CEO of Frontier Rare Earths James Kenny and 3M CEO George Buckley.

Hopefully, he’ll also get the opportunity to talk about how the long term and post-acute care profession is coping through this challenging economic and political time.

So, set that alarm clock… or if you really can’t get up that early, set your DVR! We’ll keep you posted on any clips that CNBC posts online as well.

Wednesday, December 7, 2011

Feeling the Pinch

Graphic by AHCA Public Affairs
As communities and providers feel the pinch of the tightening budget belt, The Moran Company released a study this week, echoing the fact that operating margins of nursing care centers are razor thin. The report emphasizes the concern advocates across the nation are raising about protecting seniors’ access to care.

The study, commissioned by the American Health Care Association to examine the potential, financial impact of changes to Medicare reimbursement policies, reiterated the fragility of the long term care industry.  The Moran Company, an external research and consulting firm, evaluated the operating margins of nursing facilities for most recent available data (FY 2009) and found that margins were at 0.75%.  This finding confirms the previously reported MedPAC data that margins for the industry are threateningly low. 

Tuesday, November 22, 2011

Post-Super Committee: Turning to 2012

On Monday evening, the Congressional super committee tasked to recommend $1.2 trillion in deficit reduction announced that it failed to come to bipartisan agreement. This announcement was made after months of apparent struggle by the 12-person committee to agree on where to trim funds over the next ten years.

The end of the super committee debates, however, signals the new beginning of a familiar fight over Medicare spending.  As always, the Association is working diligently to promote responsible spending of Medicare funds and proactively shrink costs.  AHCA has already designed and promoted a proposal to reduce Medicare costs for post-acute care and encourage skilled nursing facilities to reduce $5 billion worth of hospital readmissions over 10 years.

As proposals from various groups regarding where the nation will trim its budget begin to surface, Congress must first focus its upcoming December agenda on how to save billions of dollars to offset the upcoming expiration of a legislative fix that has prevented annual cuts in payments to doctors.

Medicare is considered a very likely source for this pricey cut—a cut that comes on top of the 2% slash in the automatic trigger resulting from the inability of the super committee to develop an alternative plan to trim budgets.

More cuts to the long term care profession via Medicare mean that access to quality health care is once again being threatened.  As the final days of 2011 wind down, AHCA is gearing up to protect the funds necessary to keep high quality, person-centered care available to families and loved ones across the nation in 2012 and beyond.

For up-to-the-minute information on AHCA’s efforts on protecting Medicare and defending the nation’s elderly and disabled individuals, follow us on Facebook, Twitter, and the web.

Friday, November 18, 2011

The New Old?

A new Census report on older Americans is getting a lot of media attention lately.  Americans are living much longer than before, with the oldest segment (85 and above), growing the fastest.

Not surprisingly, nursing homes play a critical role in caring for this new population. Among the report’s findings:
  • A majority of those over 90 years are women living in a nursing home.
  • About 11.2 percent of those ages 85-89 live in a nursing home. This rises to 19.8 percent for those ages 90-94 and 31 percent for those ages 95-99.
  • The majority of individuals in the “oldest old” have some type of disability, thus requiring care in a nursing home.
  • Those in the oldest segment have insurance through Medicare, Medicaid or a combination of both.
With our elderly population growing, the need for quality long term care will grow as well. With so much focus on reducing the federal deficit, it’s important for our policymakers to look for reasonable solutions that don’t jeopardize the care that our nation’s seniors rely on. AHCA/NCAL will continue to support a more methodical, long-term solution to our nation’s rising health care costs and growing deficit.

You can read the full Census report here, and check out NPR’s blog post for a quick summary.

Thursday, November 10, 2011

The Not-for-Profit Difference

When it comes to caring for the elderly and people with disabilities, not-for-profits (NFPs) have a common mission. Their approach includes a passion for community involvement, a focus on person centered care and a goal to meet the personal, spiritual, and healthcare needs of individuals living in their communities.That was the message that Gary Kelso, president of Mission Health Services of Salt Lake City, Utah, brought to Washington, D.C. during a recent visit.
The NFP Council meets in Washington, D.C.

Kelso was in town for a regular meeting of the AHCA NFP Council, which includes representation from large and small NFP long term care providers nationwide.  While the Council discussed the current political climate and potential activity of the Supercommittee, they also discussed ways to enhance AHCA/NCAL member services to NFP providers. 

Some highlights of the Council’s discussion include:

• Creating a NFP-specific strategic plan for the Association.
• Strengthening representation of senior housing and home health/hospice providers.
• Cultivating NFP leaders in the long term care profession.
• Collaborating with other organizations dedicated to quality long term care services.

Over 25 percent of AHCA/NCAL’s membership, or 2,800 nursing and assisted living facilities, as well as developmental disabilities services providers, is made up of NFPs. As Kelso points out, this number continues to grow and diversify, and AHCA has helped foster this group with a NFP-specific publication, a NFP track at the Annual Convention, and much more. 

To find out what else the Council is up to, check out Gary’s recent interview with Provider magazine’s Meg LaPorte. And be sure to visit the new NFP webpage for more information.

Tuesday, November 8, 2011

Campaign Watch: Romney's Healthcare Plan vs. Paul Ryan's

Former Gov. Mitt Romney and Chairman Paul Ryan, AP Photo
Politico reports that at a policy speech on Friday at the Americans for Prosperity summit, former Gov. Mitt Romney identified possible ways to address the rising cost of Medicare and supported some of the policies suggested by House Budget Committee Chairman Paul Ryan.

Romney supports the creation of a “premium support” program to help Medicare beneficiaries buy a similar, private insurance plan. The only difference between Romney’s proposal and Ryan’s is that Romney wants to keep Medicare as an option for seniors, while Ryan would have eliminated the program for future seniors.

Thursday, October 27, 2011

On the Road Again

AHCA/NCAL President & CEO Governor Mark Parkinson is on the road again, speaking at a myriad of state affiliate conferences and conventions about the ability of skilled nursing and assisted living to be at the forefront of the health care sector. Just in the month of October, Parkinson has been to Pennsylvania, South Dakota, Alabama, New Jersey and Florida.

Still in his first year as President & CEO, these visits not only allow Parkinson to speak about his vision for the association and the profession, but meet with state affiliate leaders, members and partnering businesses. It gives him to the opportunity to learn firsthand how our sector is currently grappling with the sluggish economy and rounds of reductions from federal and state governments.
Governor Parkinson with SDHCA Executive Director Mark Deak

"Hands Off"

Check out this ad from the National Committee to Preserve Social Security and Medicare. It features a wide range of Americans worried about cuts to Social Security, Medicare and Medicaid by Congress.

AHCA also has an informational campaign to educate Members of Congress and the public about the dangers further cuts to Medicare and Medicaid would have on access to skilled nursing care. Learn more and find out how to take action at

Wednesday, October 12, 2011

AHCA Attends New Hampshire Presidential Debate

Pre-Debate look at the Bloomberg/Washington Post
Debate Stage (October 11, 2011

As the race to White House continues, AHCA is in the front seat following the candidates, the political conversations, and the changing future of the long term care profession. Last night, AHCA was on scene at the New Hampshire Presidential Primary debate in Hanover, NH. AHCA and the New Hampshire Health Care Association (NHHCA) were the lead local media sponsors of WBIN, the regional television station that aired the debate throughout the New Hampshire, Vermont, and Massachusetts regions—regions that are ripe with political action, independent thinkers, and voters who are concerned about the future of long term care in this country.

New Hampshire Health Care Association President &
CEO John Poirier in the Post-Debate Media Spin Room
Prior to last night’s debate, NHHCA President John Poirier last week posed difficult questions to the candidates through interviews with the media, urging the candidates to consider how they would address issues such as Medicare and Medicaid funding, the onslaught of baby boomers who are aged 65 and older and their multiplying health needs, and the protection of the jobs and economic boost that the long term care sector provides.  AHCA submitted several questions to the debate moderators for consideration that focused primarily on those matters closest to the core of the long term care profession.  

On the topics of Medicare and Medicaid, Governor Perry stated last night that he supports a Medicaid block grant program—a program that AHCA has always found inadequate to fully serve the people dependent upon Medicaid for care. Proposals that convert the Medicaid entitlement into a block grant tend to eliminate the current formula under which states receive federal dollars based on a set percentage of incurred costs. Instead, block grants provide a fixed dollar amount each year that is based on an arbitrary baseline, which does not take need into account.

AHCA will continue to fight on the behalf of its members and those frail, elderly, and disabled individuals who rely on the programs for continued health care.  Every eight minutes, an American turns 65. And as these individuals age, more than 1.5 million turn to Medicare and Medicaid for care every single day—and these people need not only to be heard, but to be continually involved in the political conversations that determine the future of their access to quality health care.

Former Senator Rick Santorum in the
post-debate media spin room 
The majority of last night’s debate was focused on jobs and the economy, a topic that will continue to be of particular concern to AHCA, as the long term care industry is the nation’s 10th largest employer and contributes 3.1 million American jobs. In 2010, as the nation continued to slide into unemployment frustration and a dreary economic forecast, the long term care industry provided 63,000 new jobs—jobs that helped Americans provide for their families, continue to support their communities, and secure their health care today and for the future. As candidates continue to consider jobs plans and a strategy for economic gains and a full recovery, AHCA will continue to promote the position of this sector as a lynchpin of a successful plan. A secure economy requires industries and professions that are secure, that provide successful, fulfilling jobs to Americans, and that are investing in future growth. 

As the race to the presidency progresses, AHCA will continue to provide its members and the long term care community the facts they need to know about the issues that mean the most.

Tuesday, October 4, 2011

"Rehab" Highlights Post-Acute Care

AHCA today launched the latest television spot in its nationwide informational ad campaign, “Care Not Cuts.”

The second ad, "Rehab," features a senior who, after being in the hospital, received his post-acute care from a nursing home and then returned home.

The Care, Not Cuts informational campaign will continue throughout the remainder of 2011 to draw attention to the fact local nursing homes and assisted living facilities are a critical part of the health care continuum. This second flight will also include radio, online and Metro transit ad placements throughout the Beltway.

To learn how you can take action against possible cuts to nursing and assisted living facilities, visit

Squeezing Medicare = Squeezing Access

By Justin Sullivan, Getty Images
In yesterday's USA Today, reporter Richard Wolf offered five possible areas the federal government could look to in order to “squeeze Medicare” and address the rising costs of the program. But as Wolf points out, Medicare continues to be considered “one of the most popular programs ever devised by the federal government,” and faces a tough battle in undergoing substantive changes through Congress.

Wednesday, September 28, 2011

In Case You Missed It

by Governor Mark Parkinson
President & CEO of AHCA/NCAL

“What happens in Vegas, stays in Vegas.” While this may be the code to live by when visiting the City of Lights, the AHCA/NCAL 2011 Convention was just too great to not share with the rest of you who were unable to attend this year. It was a fantastic convention where we celebrated our successes while also preparing for our future.

I had the opportunity to meet with each of our constituency groups to talk about the challenges we have moving forward, and how we must work together to face this uncertain future for our profession. The entire week was highly productive, empowering and moving.

But two moments stood out especially for me: the acceptance speeches of our Developmental Disabilities (DD) Hero of the Year, Beth Atkinson, and Mary Ousley, recipient of the Friend of Quality Award.

Tuesday, September 20, 2011

Day 2 Ushers in Fun and More

Day 2 of the AHCA/NCAL Convention and Expo brought a full day of multiple educational offerings, multiple messages and multiple chances to have fun.

The education sessions had an early start as hundreds of providers took advantage of countless opportunities to earn CEUs. While there were certainly too many great sessions to count, of particular interest was a breakout session on using social media for advocacy. Experts were on hand to highlight the latest trends in consumer use of sites like Facebook, Twitter and YouTube and staff members shared tips and insights on how AHCA/NCAL is using social media for advocacy. Download our tip sheet to see how we’re using social media.

The Opening General Session kicked off with a number of highlights and information on what AHCA/NCAL is doing to make sure that our message is heard and our public image in intact. President and CEO Governor Mark Parkinson reviewed the past year, highlighting the “ups” like improvements in quality indicators and the “downs,” such as the recent 11.1 percent SNF PPS cut that begins next month. With Tom Petty’s “Won’t Back Down” playing in the background, attendees got on their feet and cheered as Parkinson encouraged all to not back down in the face of adversity and tell their story to Members of Congress and the media. To see all this year’s highlights, watch the AHCA/NCAL Public Affairs Video.

AHCA Board of Governors Chair Bob Van Dyk reviewed the findings of the association’s Public Education and Communications Campaign, (PECC) which seeks to change perceptions about skilled nursing care.  Attendees got a first hand look at a series of educational commercials and were also directed to the campaign’s future website,  Attendees then heard from best selling author Daniel Pink, who delivered a great message on human motivation through his latest book, DRIVE: The Surprising Truth About What Motivates Us.

The AHCA/NCAL PAC fired up the night at Mandalay Bay beach with great food, great music and lots of excitement. Attendees danced the night away to Jimmy Buffet-style music and some quality time with friends.

Were you at the AHCA/NCAL Convention today? Tell us what you thought.

Monday, September 19, 2011

Assisted Living Wins Big in Vegas

Chief Richard Picciotto (left) with NCAL Day 
attendee Van Moore
The AHCA/NCAL 62nd Convention & Expo kicked off with a bang on Sunday with a number of activities that kept attendees bustling around the halls of Mandalay Bay. Both NCAL Day and DD Day had a full agenda of general meetings, education sessions and a leadership training for not for profits. 

Early birds attending the NCAL opening session heard from Chief Richard Picciotto, the highest ranking firefighter to survive the World Trade Center attacks on 9/11. He detailed how he walked out of the collapse of the Trade Center towers and left the audience with the message that we all need to be united. 

The NCAL education sessions provided a great opportunity for assisted living providers to learn about the latest and greatest in culture change, leadership and customer service. Of note was "New Media and Older Adults: Bridging the Gap" session, which stressed that, when it comes to social media, everyone is doing it, just at different speeds. Futhermore, having an online strategy to engage older audiences is essential to staying relevant into today's 24 hour internet age.

Attendees received a special treat while enjoying a delicious lunch during the NCAL Awards Ceremony. The best and brightest in assisted living received a special salute and delivered heartwarming remarks that inspired all.

Ross Shafer, author of "Nobody Moved Your Cheese," entertained and invigorated the crowd at the NCAL closing general session. He challenged providers to stay creative in today’s unstable economic environment by serving today’s “on demand” customer. “If you don’t like change, you’ll hate extinction,” said Ross, as he shared practical tips to staying on top of consumer culture by staying focused, nimble and concentrated.

While today was mostly a set up day for exhibitors, tomorrow the Expo Hall will be buzzing with fun activities and cool giveaways. Be sure to check out the Expo Hall when it opens at 11:30AM with lunch. Don't forget to tweet about your Convention experiences using the official hashtag #ltc11.

Friday, September 16, 2011

Honoring Those who Honor Others

Every day, care providers go to work with care, compassion and an eye toward quality. AHCA/NCAL proudly recognizes that commitment and all those who serve others in long term care, post-acute care, assisted living and other settings. So it’s only appropriate that each year we take time to honor those who stand out from the rest.

Next week at our annual Convention and Expo, we’ll recognize the nearly 500 recipients of the AHCA/NCAL Quality Awards, and the following individuals who honor others with their time, talents and care:
Braden Stover
Young Adult Volunteer of the Year
  • Adult Volunteer of the Year:  Doyle Smith, Mountain View Healthcare, Mountain View, Missouri
  • Young Adult Volunteer of the Year:  Braden Stover, Clarksburg Nursing and Rehabilitation Center, Clarksburg, West Virginia
  • Group Volunteers of the Year: Maplewood Volunteers-In-Partnership, Elderwood Health Care at Maplewood, Cheektowaga, New York
  • DD Hero of the Year: Beth Atkinson, Seven Hills Pediatric Center, Groton, Massachusetts
  • Not for Profit Facility of the Year: Maple Leaf Health Care Center, Manchester, New Hampshire
  • NCAL Award Winners
    • Administrator of the Year: Robin Aman of Rock Cove Assisted Living in Stevenson, Washington
    • Assisted Living Nurse of the Year: Rachel Ellis, The Gardens at Osage Terrace, Bentonville, Arkansas
    • Noble Caregiver in Assisted Living: Eugene Ring,  Heritage of Dover, Dover, Delaware
    • National Assisted Living Week Programming: The Ponderosa Assisted Living Community, Yakima, Washington
To meet our profession’s heroes in person, be sure to attend the Closing General Session and Awards Ceremony on September 21st. You’ll also hear a great music performance from our Young Adult Volunteer of the Year, Braden Stover. He is an avid country singer and songwriter who often performs at Clarksburg Nursing & Rehabilitation Center, where he volunteers several times per week.

Thursday, September 15, 2011

See more than the bright lights of Vegas

Next week, AHCA/NCAL members from across the country will gather in “Fabulous Las Vegas” to be inspired, informed and connected. Beginning September 18th through September 21st, care providers will be learning, networking, and earning valuable continuing education units (CEU)s. Here are some of the highlights coming up next week:

  • Participants will have a chance to catch up on all of the transitions taking place on Capitol Hill, with the administration and at AHCA/NCAL during the Opening General Session. New York Times Best-Selling Author, Daniel Pink will be on-site discussing his latest book, Drive: the Surprising Truth about What Motivates Us, which uses 50 years of behavioral science to overturn conventional wisdom about human motivation. Convention participants can meet Pink in person inside the Expo Hall at booth 1221 on September 19th at 1:00pm.

    If you’ve ever ordered shoes online, you’ve heard of the highly successful During the Closing General Session on September 21st Zappos CEO Tony Hsieh will challenge providers to think about how a different kind of corporate culture is a powerful model for achieving success.
  • Attendees will have multiple opportunities to learn more for industry experts.  The 4 day event covers over 70 education sessions in 15 different tracks including culture change, care practice, survey and more. Back by popular demand is the regulatory MEGA Session, which will cover preventable hospitalizations, a hot topic in today’s health care discussion circles. And if you serve individuals with disabilities, attend “DD Day” on September 18 to learn about behavior management, ethics and best practices in DD settings, and medication management. 
  • The Expo Hall will be in full swing beginning September 20th. This year brings a new wave of “Meet up” sessions, where attendees can meet up informally and discuss topics like staffing, pain care education and electronic medical records.  Follow AHCA/NCAL’s Twitterstream to be the first to know about giveaways and special events in the hall. And if you’re tweeting about Convention, be sure to use the hashtag #ltc11 so we know to follow you.
If you’re attending Convention, we hope you’re ready to be invigorated and enlightened.  LIVE tweeting and blogging from the Convention floor starts this Sunday, so stay tuned! 

Wednesday, August 31, 2011

"Care Not Cuts" Launches

In case you missed it, AHCA and the Alliance for Quality Nursing Home Care launched their new informational ad campaign, "Care Not Cuts," this week.

The first ad, "Nurses," features actual caregivers talking about how potential additional cuts threaten access to long term and post-acute care. Check it out:

To learn how you can take action against possible cuts to nursing and assisted living facilities, go to

Tuesday, August 30, 2011

Supercommittee Watch: Henslaring gets briefed by local skilled nursing facilities

This week, AHCA and the Alliance for Quality Nursing Home Care launched their nationwide informational campaign, “Care Not Cuts,” to educate lawmakers about the impact of additional cuts to long term and post-acute care facilities.

But some of the profession’s best messengers are its members.

Last week, Congressman Jeb Henslaring held a roundtable discussion with about 25 local residents in Gun Barrel City, Texas. In attendance were two AHCA/NCAL members: Sonny Humble of Cedar Lake Nursing Service in Malakoff, and Ronald Payne of Southwest Long-term Care Management, owner of Green Oaks Nursing Home in Athens.

Humble and Payne took the opportunity to discuss how rounds of reductions have impacted their facility and caution against additional cuts to their facilities to a key Member of Congress:
Humble and Payne are concerned with the cuts skilled nursing homes will be taking, come Oct. 1, 2011. The cuts involve the rehabilitation part of the nursing facilities. According to Humble and Payne, no other industry is regulated as much as a skilled nursing facility. Humble and Payne said their facilities have already suffered enough cuts, and another cut is due to come in October.
Rep. Henslaring is one of the 12 members of the Deficit Reduction Committee, also known as the Supercommittee, that is charged with coming up with recommendations to reduce federal spending by November 23. Medicare and Medicaid cuts may be on the table, making many AHCA/NCAL members take action.

But Humble and Payne weren’t at the roundtable to just warn against additional cuts, they helped offer solutions to the budget crisis.
According to the literature they presented Hensarling, their plan is a relevant policy proposal that meets the needs of patients, and address the threatening financing crisis by streamlining the post-acute care-payment system in a sustainable patient-centered and cost-effective way.

Their proposal states this plan reduces the Federal spending by an estimated $15-$20 billion over a 10-year budget window.
AHCA/NCAL encourages more of its members to follow the example of Humble and Payne, and take advantage of any local meetings with their Members of Congress while their at home in their districts.

To find about town halls or events in your area, contact AHCA’s Meredith Freed, find sample questions and talking points on AHCA’s website.


Thursday, July 28, 2011

Congressional Briefing 2011 – A Phenomenal Accomplishment

U.S. Representative Tom Price (R-GA)


The 2011 AHCA/NCAL Congressional Briefing was, in the words of Governor Mark Parkinson, AHCA/NCAL President & CEO, “a phenomenal accomplishment.” Equally impressive was the scope of impact that attendees made on Capitol Hill. As Governor Parkinson noted, “Over the course of 48 hours we were in nearly every Congressional office making our voices are heard.”

With over 400 highly motivated attendees, this year’s Briefing was able to convince several Members of Congress to contact the Centers for Medicare and Medicaid Services (CMS) and the White House regarding the problems with the Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule for FY 2012. These advocates were, after all, well informed constituents who either own or operate nursing homes or other long term care facilities and many included caregivers on their teams to give a first hand account of what it takes to give quality hands-on care. Major national issues on the day’s agenda included: Medicare (SNF PPS), Medicaid (block grants, provider taxes) and assisted living (proposed new HCBS rules). Delegations from many states also had local issues to discuss with their Member of Congress.

Attendees listen during the Briefing.

A sub-theme of all the core issues concerned employment. Long term care is the 10th largest employer in the nation, contributing 5.4 million jobs and supporting $529 billion in economic activity. Drastic short or long term cuts to Medicare or Medicaid can be very disruptive to a local economy.

Specific issues aside, attendees were ready to make an impact on Capitol Hill. AHCA/NCAL prepped all advocates the day before with special sessions for not-for-profit members, assisted living members, “first timers,” and “Future Leaders” of long term care. At the pre-visitation briefing, participants were updated on issues and received materials to help them explain complex issues. This session included positive encouragement by Members of Congress Andy Harris, M.D. (R-MD); Tom Price, M.D. (R-GA); and Diane Black (R-TN).

All speakers shared the same message with participants: “advocating for quality long term care is as simple as telling your story." As Governor Parkinson stated, “We’re the experts in long term care and Congress needs to hear from us.” Perhaps the best example of putting this practice into action were the 2011 recipients of the Joe Warner Patient Advocacy Award -- Angelo Rotella of Rhode Island; Dion Sena of Florida; and Sally and Roland Rapp of California. These outstanding advocates were recognized by Members of Congress for their contributions to preserving quality care for America’s seniors and individuals with disabilities.

Did you visit with your Member of Congress during the Briefing, or at any other time this year? Leave a comment about your experience talking with a Member of Congress.

Wednesday, June 1, 2011

Meet “Giff”

AHCA’s new Senior Vice President of Quality and Regulatory Affairs, Dr. David Gifford, was featured in an article in McKnight’s Long Term Care News today.

McKnight’s takes us through his early years, where he grew an appreciation and respect for the elderly through his grandparents. “Giff” also talks about his first experience working within a nursing home as a medical director:

“It was incredibly rewarding not only to get to know the patients and families, but also to work in teams and be able to influence policies and practices,” said Giff.
In his latest role before AHCA, director of the Rhode Island Department of Health, Dr. Gifford had to deal with crippling budget cuts that prevented him from advancing his passion for finding innovative ways to improve quality.

And his reputation for high quality follows him wherever he goes:

“…he doesn't have much patience for people who don't strive for quality improvement,” comments Virginia Burke, president of the Rhode Island Health Care Association in the piece.
Learn more about Dr. Gifford’s history and fervor for long term care by reading the article.

Wednesday, May 25, 2011

Setting the Record Straight

After an article in the New York Times was published last week regarding the upcoming effect of the employer mandate on nursing homes and home care services, many outside groups mischaracterized AHCA as opposing health care reform and seeking exemptions on the provision.

Governor Mark Parkinson, President & CEO of AHCA, sat down with Phil Galewitz of Kaiser Health News and had the opportunity to set the record straight. As the governor points out, the employer mandate provision will be challenging for a minority of nursing facilities, especially those that overwhelming serve Medicaid populations. These facilities are typically in rural areas or poor, urban areas.

With many states implementing or proposing large cuts to Medicaid, this makes it all the more challenging for facilities to provide insurance coverage to employees. So as Governor Parkinson clarifies, AHCA is working through the regulatory process to make sure these facilities can continue to serve those in need:
“…we are working with the [Obama] administration to figure out if there is some accommodation that can be made for these very high-Medicaid-population facilities so that they can be also in compliance with the law.”
Governor Parkinson also talked about the many other issues the long term and post-acute care profession is facing currently and moving forward, including state Medicaid cuts, managed care plans and the overall financial health of the profession.

Here’s the interview, as printed by Kaiser Health News:

Galewitz: What is the position of the association on the employer mandate and the impact it will have on the nursing home industry?

: We supported the Affordable Care Act and we continue to do so. The employer mandate is very manageable for the vast majority of our members. I think all of our providers want to provide health insurance for their employees. The challenge is that a minority of our members -- those nursing homes that tend to be in rural areas or very poor urban areas and have a disproportionate share of Medicaid residents (which frankly they lose a lot of money on) -- those are the members that find it challenging to provide health insurance, insurance that would meet the standard of the Affordable Care Act.

So we are working with the [Obama] administration to figure out if there is some accommodation that can be made for these very high-Medicaid-population facilities so that they can be also in compliance with the law.

The employer mandate issue is a challenge not just for restaurants and retailers, but for a small segment of the nursing home population, it is an issue as well. The administration has indicated that it is interested in our comments and our thoughts.

Galewitz: Why did your association support the health care law, particularly as the industry doesn’t gain by the reduction in uninsured? And do you have any regrets?

: No. There are no regrets. On balance the membership felt the Affordable Care Act was an improvement on the current health care delivery system. Whether you support the Affordable Care Act or not, when you look at the status quo you know the growth we have had on health care costs is simply not sustainable. We have to make efforts to bring those costs under control because there is a limited amount of money that society is going to be willing to spend on health care financing whether on Medicare or Medicaid.

Although we did not receive some of the direct benefits that you may argue that other sectors of the health care industry received, we are part of the overall health care world and if costs don’t come under control generally, then our sector can’t succeed either.

Galewitz: What is biggest impact of the law on nursing homes?

Parkinson: The potentially largest impact has to do with changes in payment models that may be developed with accountable care organizations and the continued move by the federal government to shift to episodic payments for post-acute residents, perhaps on a bundled basis. That is really an area of the Affordable Care Act that offers an opportunity for a cost savings.

The current system of reimbursement is on a daily basis. The longer you are in post acute setting, the more it costs. The Affordable Care Act provides the Health and Human Services secretary an opportunity to develop regulations to shift those incentives to payments based on performance and quality. If we head to a system like that, it could reduce costs. With ACOs, it's very critical that our membership has a seat at the table because we are concerned that ACOs will be created that will leave out nursing homes as a post-acute provider and if that would happen it would be quite bad for the sector.

Galewitz: How is the nursing home industry faring as states move to cut Medicaid costs to balance their budgets?
Parkinson: Nursing homes are struggling with Medicaid payments. The headline news early in the year is that there would be dramatic cuts at the state level for nursing homes and unfortunately that headline has proven to be the case. I don’t think nursing homes havebeen targeted. It’s because of the general fiscal situation that states have faced. In many states, our association and members were able to reduce the initial size of those proposed cuts, but there are still states out there where cuts are very significant.

Galewitz: Do you welcome the growing trend of states to shift their Medicaid long-term care recipients into private managed care companies?

: Conceptually, it is both good and bad. Moving the program to a group of entrepreneurs who may have more ability at cost cutting and efficiency, that is attractive. On the negative side, what it is doing is creating another layer of infrastructure before payments get out to the facilities. There are mixed results.

Federal officials have said that because a new payment formula this year led to an unexpected spike in Medicare costs, it might cut nursing home rates 11.3 percent. But they have also said they may increase Medicare rates.

Galewitz: How would you describe the financial health of the nursing home industry?

: If we had some certainty about what our Medicare reimbursement rates would be at the end of year, I could answer in better way. Going into the year if we were to poll our membership, most would say we are doing OK for now. We are at our historical margins of 2 percent. For now, everyone is worried what happens this year and next year.

If we have a one-time 11.3 percent decline, then the state of the profession will not be healthy. If it is something less or something phased in over three years we will be back to a position where the profession is in OK shape.

Wednesday, May 18, 2011

Governor Parkinson Among the Top 100

Besides making the rounds at Fox Business and CNBC cable shows this week, Governor Parkinson is also getting the word out about the great work at AHCA/NCAL by recently joining the U.S. Chamber of Commerce’s Association Committee of 100.

The committee brings together leading association executives to network, build partnerships, and discuss current issues. Governor Parkinson and the other CEOs will represent association members before the U.S. Chamber’s board of directors, enhance Chamber lobbying and coalition work, recommend programming, and strengthen outreach to the business and association community.

The other new members include:
  • Paul Andrews, President and CEO, Western Stock Show Association
  • Nick Calio, President and CEO, Air Transport Association of America
  • Joe McClain, President, Beer Institute
  • Scott Melville, President and CEO, Consumer Healthcare Products Association
  • Mark Merritt, President and CEO, Pharmaceutical Care Management Association
  • Steven Wechsler, President and CEO, National Association of Real Estate Investment Trusts
“This Committee of 100 has a long-standing reputation as one of the most prestigious appointments in the association community,” said Bill Miller, senior vice president of Political Affairs and Federation Relations at the U.S. Chamber. “These new members reflect our continued dedication to naming diverse, high-profile leaders to serve on this important committee.”
Find additional members of the Committee of 100.

Wednesday, May 11, 2011

Recognizing nursing homes, celebrating people

Staff dressed up as clowns during “Clowning Around Day”
at TLC Nursing Center of Oneonta, Alabama.
This Sunday kicked off National Nursing Home Week®, a time to honor the residents and staff in our nation’s nursing homes and those that make a positive difference in their lives. Centered on the theme “Fulfilling the Promise,” nursing homes around the country are celebrating with parties, friendly competitions, and community events.

Residents of the Crandall Medical Center in Sebring, Ohio are celebrating with “Around the World in 5 Days.” Based on the longer Jules Verne novel, this cruise of exotic locations will include food, music, and entertainment from each “destination.” Residents are making stops in the South Pacific, African, Italy, China and Mexico.

But National Nursing Home Week isn’t just for residents. Take Hereford Nursing and Rehabilitation in Hereford, Texas. They’re inviting the public to satisfy their sweet tooth by helping bake cookies for staff and residents or stopping by on Friday for donuts and coffee. A local high school group has already agreed to chip in and help strengthen the bond between generations.

As residents, staff, volunteers, families and friends celebrate this special week, it’s also a great time to remind ourselves about the important role that nursing homes play in the larger health care delivery system. Governor Mark Parkinson, President and CEO of AHCA/NCAL recently shared his thoughts on “Fulfilling the Promise” to America’s seniors.

AHCA invites you to visit your local nursing home this week and find out how you can join in the fun. Check out the National Nursing Home Week Facebook fan page to see what others are doing or visit the National Nursing Home Week website.

Tuesday, May 10, 2011

OIG: Overstating the impact of antipsychotic drugs in America's nursing homes

by Dr. David Gifford
Senior Vice President, Quality & Regulatory Affairs at AHCA

The Health and Human Services Office of the Inspector General just issued a report that raises a number of questions about the use of antipsychotic drugs in nursing facility patients many with Alzheimer’s and other forms of dementia. Speaking as a geriatrician, I know that we can do more to reduce the number of patients in nursing homes that are on antipsychotic drugs, but this study oversimplifies the issues and implies greater misuse of these medications.

The majority of nursing home residents (86%) in this study from 2007 are not on antipsychotic drugs. Of the 14% receiving one of these mediations, only 22% were found to not meet CMS standards for medication administration (or 3% of all nursing home residents). Nonetheless, this is still too high a number and further efforts should focus on ways to manage nursing home residents with dementia and behavior problems without medications.

This study also found that when prescribed, these medications were given for so-called “off label” use 83% of the time. The use of medications for off label reasons is common practice. Off label use shouldn’t be misconstrued to mean inappropriate use.

I agree that we can do more to learn how to help our nursing home residents, in particular those with dementia with behavior issues. We need to look for ways to treat a person’s condition and behavior – ideally without medication. At AHCA, we will keep working with physicians, caregivers and family members to educate them on these issues and look for ways to improve the care for the 1.5 million Americans who need long-term services every day.

Wednesday, April 27, 2011

Now Playing at a Facility Near You

Look at the activity board for almost any nursing and assisted living facility in America today, and most likely, there is a movie being shown in the next week.

Going to the movies is a classic American pastime. Even during recessions and depressions, people are lining up to get a ticket to the next big show.

For those in long term care facilities, the same is still true. Whether timeless classics or the newest blockbusters, movies are a great way to bring residents together and socialize. However, showing a video at a nursing or assisted living facility isn’t as easy as popping in a DVD at home. For more than 20 years, the profession has had to negotiate video licensing fees with the Motion Picture Licensing Corporation (MPLC).

The latest negotiations between AHCA/NCAL and our friend LeadingAge with MPLC helped bring out an agreement allowing nursing and assisted living facilities to be exempt from video licensing fees.

With the last agreement expiring in 2000 and many facilities unsure about whether they needed to pay licensing fees, this is especially helpful in bringing clarity to the issue. It’s certainly a victory for the thousands of facilities that like we said before, show a video to residents almost every week.

While nursing and assisted living facilities are exempt, there are some exceptions within the agreement worth noting:
  • Any senior community or facility which has a closed circuit television system (such as an in-house channel) playing videos must obtain a license. 
  • Communities with independent living units, apartments or other similarly defined living quarters must acquire a license based on the number of independent apartments in the community. 
  • Since many long term care facilities incorporate a number of facets including nursing, assisted living, independent living and continuing care retirement communities, AHCA/NCAL and LeadingAge helped negotiate that member facilities can receive a 10 percent discount on all rates MPLC has applied to their facility.
So break out the popcorn, folks! It’s time to kick back and enjoy a good flick.

Thursday, April 21, 2011

Extra! Extra!

Governor Parkinson chats with reporters April 19, 2011
President & CEO of AHCA/NCAL, Governor Mark Parkinson, is making the news this week after holding a roundtable with some leading health policy reporters in the DC area on Tuesday.

Governor Parkinson kicked off the roundtable by talking about how long term and post-acute care could help be a part of the solution to the growing federal debt and deficit challenge. He offered three areas AHCA/NCAL is focused on and continues to advocate our involvement to policymakers:
  • Site-neutral payments – to focus on more patient-centered care;
  • Accountable Care Organizations (ACOs) – to help move towards an episodic payment system and streamline health care; and
  • Improve quality – take advantage of new technology that can help lower costs. 
The discussion also led towards how the profession feels about possible Medicaid block grants, upcoming cuts to Medicare and certain provisions of health care reform, including the Independent Payment Advisory Board (IPAB).

Check out the stories featuring or including Governor Parkinson following the roundtable:

A Blog post by Governor Parkinson: Keeping the Promise to America's Seniors 
On The Hill's Congress Blog
By Robert Pear, New York Times
By Phil Galewitz, Kaiser Health News
McKnight’s Long Term Care & Assisted Living
By Amy Lotven, Inside Health Policy  
Subscription required 
By Jim Berklan, McKnight’s Long Term Care & Assisted Living

Thursday, April 14, 2011

And They're Off!

President Obama gave his speech on the administration’s new fiscal policies yesterday, following the Republican’s proposed FY 2012 budget announcement last week – marking the beginning of what is sure to be a tumultuous debate.
The president’s plan aims to reduce the deficit by $4 trillion over the next 12 years or less; find a combination of spending cuts and tax reforms; eliminate the Bush tax cuts to the wealthiest Americans; and form a bipartisan, bicameral Congressional team to agree on a legislative framework for comprehensive deficit reduction.
AHCA/NCAL was especially encouraged to hear the president mention “nursing homes” twice in his speech to America, given the enormous task nursing and assisted living facilities face in providing care to our nation’s frail and elderly:
“And so we contribute to programs like Medicare and Social Security, which guarantee us health care and a measure of basic income after a lifetime of hard work; unemployment insurance, which protects us against unexpected job loss; and Medicaid, which provides care for millions of seniors in nursing homes, poor children, those with disabilities.”


“It’s a vision that says up to 50 million Americans have to lose their health insurance in order for us to reduce the deficit. Who are these 50 million Americans? Many are somebody’s grandparents -- may be one of yours -- who wouldn’t be able to afford nursing home care without Medicaid.”
Since we gave you a briefing of how the Republican’s budget related to the long term care profession, we thought we’d give the president the same courtesy. Here are some quick highlights:
  • Strengthening the Independent Payment Advisory Board (IPAB) Seeks to “bend the long-term cost curve” by setting a target for Medicare cost growth per beneficiary to “GDP per capita plus 0.5%” starting in 2018 by bolstering IPAB. The intent is for IPAB to serve as the last line of defense though additional authority, and to improve quality of care and cost reductions without placing additional financial burdens on seniors.
  • Increase Scrutiny of Providers using Higher-risk Banking Arrangements to receive Medicare Payment To prevent fraud and abuse, providers would have to report the use of "sweep accounts" (accounts that automatically transfer funds to separate accounts) for receipt of Medicare payments, so that those accounts could be targeted for enhanced scrutiny.
  • Making Medicaid More Flexible, Efficient, and Accountable The framework uses the Patient Protection and Accountable Care Act as a foundation and seeks to save no less than $100 billion over 10 years, without employing block grants, eliminating the Federal-state partnership, or “reducing health care coverage for seniors in nursing homes, the most economically vulnerable and people with disabilities.” Further goals include better quality of care, additional fraud and abuse protections, as well as enhanced efficiency and accountability measures.
  • Provider Taxes The framework would “clamp down on states’ use of provider taxes to lower their own spending while not providing additional health services through Medicaid”.
As is the case with the President’s FY 2012 Budget, this framework only serves as a recommendation to Congress. Although the House and Senate are certain to consider the President’s recommendations, neither chamber is required to include any of the framework concepts in legislation.
Find out more about President Obama’s fiscal framework through his fact sheet.