Tuesday, January 25, 2011

State of Reimbursement Shows Need for Sustained, Stable Funding

January 24, 2011

The State of Reimbursement is the fifth installment of our series The State of Long Term and Post Acute Care. Today’s statement features the current climate of reimbursement in long term and post-acute care facilities, specifically focusing on Medicare, Medicaid and the future of funding.  Among the highlights:
  • Medicare is often at risk for significant cuts, threatening the delivery of high quality care and services.

  • A typical Medicare beneficiary returns home or to the community after a relatively short, rehabilitative stay of 36 1/2 days in a skilled nursing facility.

  • Medicaid – the largest payer of long term care & services – covers 64 percent of nursing home patients and 13 percent of assisted living residents. A recent report from Eljay found Medicaid across America to be underfunded by $5.6 billion in 2010.
Get the full picture in today’s one-pager. What is the state of reimbursement at your facility or in your state? Share your story with us in the comments section.

Monday, January 24, 2011

Embracing Person-Centered Care

January 21, 2011

The fourth installment of AHCA/NCAL’s informational State of the Long Term and Post-Acute Care series finds that with nearly 40,000 residences across the nation, assisted living communities are a viable and welcome option for many older Americans.

“For many Americans who are making decisions about long term care, assisted living is often their first exposure to our world,” stated Governor Mark Parkinson, President and CEO of AHCA/NCAL. “As we enter 2011, we now have more long term care options than ever before. That speaks directly to the strong state of our profession and how we are meeting residents needs every day.”

With residents who, on average, need help with two activities of daily living, assisted living communities across the country strongly embrace the concept of person-centered care. The State of Assisted Living takes an in-depth look at how these communities embrace a philosophy of care that meets the social, emotional, cultural, intellectual, and spiritual well-being of these Americans.

Do you work or have a loved one in an assisted living community? Please share your story with us.

Thursday, January 20, 2011

Nursing Homes, Assisted Living Communities Offer a Secure Career for the Unemployed

January 20, 2011

The State of the Long Term Care Workforce is third in our series on The State of Long Term and Post-Acute Care. Today’s statement features the pipeline of dedicated, caring staff who commit themselves to serving those patients and residents who need them every day. Among the highlights:

  • By 2050, 6.6 million caregivers will be needed to care for the 27 million Americans who are projected to need long term care and services.
  • Despite the economic downturn, long term care facilities offer an ever-growing, rewarding and stable career.
  • Career ladder programs and education training programs engage employees, enhance the workforce, and reinvest into the long term care community.

Get the full picture in today’s one-pager. In communities across America, nursing homes and assisted living communities offer a secure and rewarding career for unemployed and dislocated workers. Do you have a story to share? Tell us about it in the comments section.

Working Toward a World Class Organization

Governor Mark Parkinson
President & CEO, AHCA/NCAL
January 20, 2011
By: Governor Mark Parkinson, President and CEO, AHCA/NCAL

I’m happy to report that I started my position as President and CEO of AHCA/NCAL last week.  My wife Stacy, my daughter Kit, our ridiculous number of pets, and I are now settled in Potomac, Maryland and I am fully engaged at work.

At the outset, I want to thank you for this remarkable opportunity. This position provides me the chance to have an enormous impact on the field that we love. That it came open at just the right time, that our family situation came together to make it work, and that the Board selected me for it, have me convinced that this is exactly what I’m supposed to be doing.

Our Opportunities and Challenges
I am a policy person. I try to be strategic and I’m results oriented. So, let me get down to business and outline our situation, as I see it, and our plan to prevail.

Very few professions have the opportunities that we do. The aging of the population means that we will have many more customers in the future. According to Census Projections, there are currently 11.5 million Americans over the age of 80, there will be 12.8 million in 2020, 18.9 million in 2030, and 27.6 million in 2040.

Finding customers is not going to be the issue.

The challenge that we face is how our federal and state governments will pay us fairly to take care of those customers – and do so in a manner whereby quality care is always a given, not just a goal. It’s a big problem. Approximately 65 percent of our reimbursement comes from federal and state governments and currently all levels of government are out of money or running out.

The condition of the federal debt is so bad that it compels me even more to take action. We have just gone through 40 years with a comparatively young population, working through their productive years, and with a very small older population to support. These should have been the years when our country was developing surplus funds to take care of the very demographic challenge that we now face. But this did not happen.

Our job now is to navigate through this the best we can.

How We Are Going to Prevail
First, we must continue to be the solution to health care costs. Not part of the problem, but the actual solution. We do that by being the low cost, high-efficiency, quality providers of care to the frail and elderly. We do it by demonstrating that no other part of the delivery system can achieve the results we achieve for the cost that we achieve them. Cutting skilled nursing facility (SNF) funding? You will see massive re-hospitalizations, higher costs to taxpayers, and other budgetary strains on the system.

Second, we must continue to drive quality. We won’t be just part of the solution on quality, we will be the driver. We know that we have made dramatic improvements in quality – and we must let consumers and policymakers know this -- but we can do more. And it’s time to change the perception that we are reluctantly going along with change, to the reality that we are actively leading change. We will do this by continuing to make our quality programs substantive, measurable, and cutting edge.

Third, we must change our image. We are all too aware of the perceptions of this industry. They are so out of whack with what is really happening in our modern health centers that we cannot afford to sit back quietly any more. Now is the time to show the public the reality of the care we provide and begin the process of erasing the stereotypes that have plagued us.

Finally, we must become a political and lobbying powerhouse. Unfortunately, in this town you can be right about all the issues, as we are, and lose out if you don’t have the tools to ensure federal and state lawmakers – and the public at  large – hear our message. That will not happen to us. You have created an Association, with broad based membership that gives us the ability to become what we need to and we will.

A World Class Organization
On my second day of work we had a meeting with all of the employees and I outlined that it is our objective to create a world class organization. I defined it as one that:
  1. Meets the needs of our members, and meets the needs of our residents and patients;
  2. Puts our members in a position to succeed with adequate reimbursement and a survey environment they can live with;
  3. Is a great place to work; and
  4. Endures beyond any of us.
I challenged the employees to think about an organization where the goal was to meet the needs of our members, but that our real objective was to provide results so favorable that they are shocking. That is what we are striving for--shocking results.

It’s going to take some time, but we’re going to get there. I like to take on tasks that are difficult, but not impossible. I see no point in working on tasks that are easy, because someone else will take them on. Similarly, I have no interest in working on tasks when they are impossible, because it’s just a waste of time. This task suits me perfectly. Our challenges are difficult; in fact, they are very difficult.

But overcoming them is possible and the consequences of not overcoming them are so great that failure or accepting the status quo is simply not an option. As I said at the outset, you have given me a great mission and I’m fully engaged.

From time to time, I’ll update you on what we are doing. In the meantime, please contact me any time you have suggestions or comments. This is your association, and the best ideas always come from you.


Wednesday, January 19, 2011

State of Post-Acute Care Spotlights More Services, Faster Rehabilitation

January 19, 2011

“The integration of post-acute care services in America’s skilled nursing and rehabilitation facilities has exclusively altered the long term care community,” begins the second statement in our series on The State of Long Term and Post-Acute Care. Trends in medical, rehabilitative and therapeutic care services, as well as payment methods, point to this evolution while the increased demand for these services following a hospital visit have propelled it forward.

Recent data indicates that over 50 percent of Medicare beneficiaries in need of post-acute care following a hospital stay are discharged to a skilled nursing facility, making nursing homes the largest single provider of post-acute care in America. That may come as a surprise to some. More importantly, nursing homes are also treating and discharging patients at a higher rate today than ever before with 39 percent of Medicare patients returning home within 100 days of admission.

Read more in today’s one-pager on post-acute care. Then tell us what you think in the comments section below.

Tuesday, January 18, 2011

State of Quality Reflects Strong Improvements, Satisfaction

January 18, 2011

The State of Quality is the first installment in The State of Long Term and Post-Acute Care. Today’s statement features milestones in patients’ medical conditions, consumer satisfaction, and the commitment to quality by skilled nursing and rehabilitation facilities across America.  Among the highlights:

•    The Centers for Medicare and Medicaid Services (CMS) confirms that nursing homes made measurable quality improvements in 16 of 26 quality indicators between 2000 and 2009, with positive trends continuing in 2010.

•    An 85 percent satisfaction rate among consumers in 2010 indicates that facilities have been utilizing quality improvement programs more broadly, resulting in improved quality of life for residents.

•    In 2010, more than 500 skilled nursing and rehabilitation facilities were recognized for their unique and ongoing commitment to quality improvement, which is a sizable increase from the 15 facilities recognized the first year AHCA introduced the Quality Awards program in 1996.

Get the full picture in today’s statement. What is the state of quality at your facility or in your state? Share your story with us in the comments section.

The State of Long Term and Post-Acute Care -- What do you think?

January 18, 2011

The State of the Union is one week from today.  In light of this annual occasion, AHCA/NCAL is launching a week-long informational series today on the State of Long Term and Post-Acute Care leading up to President Obama’s address next Tuesday, January 25th.

The series will include one-pagers and daily blog posts featuring national highlights in the areas of long term and post-acute care, including quality, workforce, assisted living, and reimbursement. Be sure to check out our website to access these resources and comment on the blog posts.

This effort cannot tell the whole story without your input. What are your thoughts on the “State of Long Term and Post-Acute Care” in your state or at your facility? Is there something specific that you think President Obama should address in his State of the Union speech? What workforce challenges do you foresee for 2011? Send us your thoughts, and throughout the week we will promote them on our website, blog, social media channels and other publications.

Send your comments here in the comments section, via email, Twitter, Facebook or even YouTube. For those of you on Twitter, you can tweet your comment using the hashtag “ltc state.” You can also post on our Facebook wall or upload a short video clip on YouTube and tag it with the keyword “ltc state.” 
We look forward to hearing from you.

Thursday, January 13, 2011

National Poll Shows Majority of Voters Oppose Medicaid Cuts to Nursing Homes

Results from a new online poll from Zogby International, a leading market research firm, show that the overwhelming majority of voters strongly oppose Medicaid cuts to nursing care facilities. 

As legislators work to finalize 2011 state budgets, this information about voter opinion to proposed Medicaid cuts might make a difference in how those funds are allocated.

Topline results from survey of likely voters:

•    65% of likely voters say they oppose policies that resulted in cuts to Medicaid funding for nursing home care for America’s poor and elderly.

•    66% say they would oppose policies that resulted in additional cuts to Medicare funding for nursing home care for seniors, with 39% saying they strongly oppose such action.

•    72% say the federal government’s role in helping states meet their financial obligations to cover programs such as Medicaid is important.

•    65% say they support extending additional Medicaid funding to state governments in response to state deficits and economic difficulties.

What does it all mean? The majority of voters oppose cuts to Medicaid funding for nursing homes then and now. They believe it is the responsibility of the federal government to protect state Medicaid funding for nursing homes, and they support extending additional funding.

As new data is released (see our recent Eljay study on Medicaid shortfall) it is becoming clear that outlook for Medicaid funding to nursing home care in 2011 is expected to be worse than previous years. The LTC community will need to band together if we hope to be heard by Congress and state lawmakers.

Note: the survey mentioned above was conducted by Zogby International via an interactive survey of 2,067 likely voters from 1/7/11 to 1/10/11 and has a margin of error is +/- 2.2 percentage points. For more information about this survey you can visit http://www.zogby.com.

Wednesday, January 12, 2011

Now Trending: Medicaid Pays Nursing Homes Less Than Minimum Wage

January 12, 2011

Medicaid programs in states across the country underfunded nursing facility care by $5.6 billion in 2010, according to a new AHCA study released today.  On average, Medicaid pays $7.17 per hour per patient, which is less than the nation’s current minimum wage of $7.25 per hour. Medicaid, which is a lifeline for many elderly and disabled, funds 64 percent of skilled nursing facility care provided in America’s skilled nursing facilities nationally.

“This report reveals a truth many would not believe – today’s nursing facilities are paid less than the minimum wage,” stated Mark Parkinson, President & CEO of the American Health Care Association (AHCA). “That must change if we ever hope to serve the needs of a Baby Boom generation that will only stress our care delivery system further.”

The study was compiled by the research group Eljay -- a nationally-recognized expert in long term care.  States with both the highest aggregate Medicaid underfunding and highest per patient per day underfunding include New York, Illinois, Massachusetts, Minnesota, New Jersey and Wisconsin.

So who fills the payment gap? Nursing home providers are often forced to rely on funding from other sources -- primarily Medicare. With so many of the nation’s governors facing difficult choices surrounding budget cuts, Parkinson cautioned at the danger of allowing an already squeezed Medicare system to prop up Medicaid payment rates. 

“There is a vast gap between the actual cost of providing quality eldercare and what the Medicaid program truly finances,” Parkinson stated. “As Baby Boomers begin to ponder their long term care needs in the future, it is simply unsustainable for Medicare to continue filling that financial gap.

States with Largest Aggregate Medicaid Underfunding 

1.         New York - $1,396,494,595
2.         Illinois - $378,779,709
3.         Massachusetts - $310,871,237
4.         New Jersey - $304,430,314
5.         California - $288,599,289
6.         Pennsylvania - $277,609,403
7.         Ohio - $248,513,290
8.         Wisconsin - $181,237,562
9.         Minnesota - $151,611,752
10.       Missouri - $137,412,649

States with Largest Medicaid Per Patient Day Underfunding

1.         New York - $47.95
2.         New Hampshire - $31.25
3.         Massachusetts - $31.22
4.         New Jersey - $29.29
5.         Washington - $28.18
6.         Wisconsin - $26.54
7.         Minnesota - $24.70
8.         Wyoming - $23.67
9.         Delaware - $22.86
10.       Illinois - $21.95

Read the complete report and share your thoughts below.  

Tuesday, January 11, 2011

Guest Post: Praise for MDS 3.0, from the Frontlines

January 4, 2011
Ladd Nichols
By:  Ladd Nichols, vice president of marketing for Gulf South Medical Supply

Despite some initial bumps in the road, I’ve heard positive feedback from many providers about the implementation of the new minimum data set (MDS) 3.0. According to frontline caregivers, this encouraging news comes not only from facility staff members, but also from residents.

Why are residents giving high marks to MDS 3.0 after just three months? The answer may be in the people connection. The new MDS requires more interaction with both residents and staff members to compile multiple assessments as determined by various schedules and resident status and condition. 

Elizabeth Beeson, MDS coordinator for Foss Home and Village, a skilled nursing facility in Seattle, Wash., found that the resident interviews have been the “best part of the whole MDS 3.0 process,” thanks to some training and preparation. 

To conduct resident interviews and gather the increased amount of information required with MDS 3.0, the facility takes an interdisciplinary approach. Social workers do mood assessments, activities workers do customary routines, and nursing staff do cognition and pain assessments. 

On the downside, there are some lingering concerns, like the overwhelming workload for staff and the possible impact on assessment accuracy. Says Beeson, “I see people talking about the fact that if you have a five-day Medicare assessment that’s done and a discharge three days later, we have to do two assessments only three days apart and collect the same information with a different end point. We basically have to re-do the same assessment but look at everything differently,” she says. 

On top of it all, the Centers for Medicare & Medicaid Services expects staff to conduct the interview again even though it’s three days later. 

Although some are hoping that there will be changes down the road in some of the requirements, staff have been surprised with how many residents can actively participate in the interviews.

At Elness Convalescent, a skilled nursing facility in Central Valley, Calif., Director of Nursing Pamela Powell says the staff transition is going much smoother after a rocky start with computer problems at the state level and the lack of return validation for data transmittals from the facility.  

“I had to go in and change all our assessment forms for our different departments that do input on the MDS and that made it easier for them.”
She also added another MDS staff person to help out because the first coordinator is overwhelmed.Powell and her staff learned how to create “I Care” plans for residents, which is even more inclusive of residents at every step of the process. 

Though facilities are now coping with several issues, in my estimation they are seeing improved resident care planning and positive organizational culture change. Is this the case at your facility?

Wednesday, January 5, 2011

112th Congress Brings New Faces, New Priorities

January 5, 2011

In a highly charged atmosphere on Capitol Hill today, all 535 Members of the House and Senate were sworn in during the opening of the 112th Congress. Among the new member make-up are 96 Representatives (87 R, 9D) -- constituting almost a fourth of the body -- and 16 Senators (13 R, 3 D), who will take their places alongside their incumbent colleagues. The balance of power has shifted in the House, reflecting the new Republican majority with 242 Members. The House majority will be led by Representative John Boehner (R-OH) as Speaker, Representative Eric Cantor (R-VA) as Majority Leader, and Representative Kevin McCarthy (R-CA) as Majority Whip. 

House Democratic Leadership has the same headliners as the last Congress, but with different titles—Representative Nancy Pelosi (D-CA) will serve as Minority Leader, Steny Hoyer (D-MD) as Minority Whip, and Jim Clyburn (D-SC) as Assistant to the Leader.  The Senate is still held by the Democrats, with 53 Ds, led by Majority Leader Harry Reid (D-NV); Senate Republicans will be led by Republican Leader Mitch McConnell (R-KY). And given the increase in GOP Senators to 47, the likelihood of Senate deadlock is high since a total of 60 votes will be needed to proceed on almost every issue.

House Republicans plan to kick off the session by tackling some of their highest priorities right away, including reducing the deficit and repeal of health care reform. The Senate will get started by looking inward with proposals to reform their chamber’s rules on the filibuster and bill holds, among other initiatives.

Monday, January 3, 2011

New House Member Brings Industry Perspective

Congressman Renacci (R-OH)
This month, Provider magazine will include a new feature space profiling new members of the 112th Congress. The first edition of Congressional Profile includes highlights of senior editor Patrick Connole’s interview with Jim Renacci, who will represent Ohio’s 16th district beginning in January. He is one of over four dozen new Republican members taking office in the House of Representatives.

Renacci comes from a strong background in long term care and identifies with providers on several issues. In Ohio he owned and operated nursing facilities throughout the state as part of his LTC Management Services company. While he is concerned about Medicare and Medicaid, he also plans to promote policies for growing the economy. He points out that over-regulation of the long term care industry is a problem and identifies with providers that see the need to change the survey process.

To read more from the interview, pick up the January edition of Provider.