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.