Thursday, June 27, 2013

AHCA Reacts to CMS’ Proposed Rule on Observation Stays

AHCA has responded to CMS’s recent proposed rule which aims to, in part, minimize the increasing number of lengthy observation stays. In a letter to Ann Marshall of CMS, AHCA said:

“Under the proposed rule, Medicare would presume that an individual is an inpatient if the physician documents that the patient requires more than two midnights in the hospital following an inpatient admission. The ‘starting point for this time-based instruction would be when the beneficiary is moved from any outpatient area to a bed in the hospital in which the additional hospital services will be provided.’ 78 Federal Register at 27648.”

This is the second of two proposed rules from CMS involving observation stays in four months. Currently, a three-day in-patient hospital stay is required for patients to be admitted to a skilled nursing facility under Medicare Part A.

CMS has acknowledged that the current process for dealing with observation stays is problematic and generally unsustainable.

AHCA feels that the only and best way to provide Medicare-covered post-acute access to beneficiaries is for CMS to count ALL days in observation toward the 3-day stay requirement. AHCA believes that CMS has both the authority and obligation to change policy on whether time spent in observation status is considered when determining eligibility for skilled nursing facility coverage.

AHCA/NCAL Announces 2013 Bronze & Silver National Quality Award Recipients

The AHCA/NCAL National Quality Award Program honors skilled nursing and post-acute care facilities across the nation that have demonstrated their commitment to improving quality care for seniors and individuals with disabilities. The program has three distinctions that build on each other—Gold, Silver, and Bronze. In order to become eligible to apply for a Silver award, a facility is required to have already received a Bronze award; likewise, facilities must have attained both Bronze and Silver awards in order to qualify for a Gold award

AHCA/NCAL recently announced its 2013 Bronze and Silver National Quality Award Program recipients. The 2013 Gold recipients will be announced in the coming months.

This year, 360 facilities earned a 2013 Bronze- Commitment to Quality National Quality Award, while 59 facilities earned a Silver- Achievement Quality National Quality Award

“Though this achievement these award recipients have demonstrated to their residents, their communities, and the long term and post-acute care profession at-large that they are not only committed to quality, but they are exceling in that commitment,” said Ed McMahon, Chair of the AHCA/NCAL National Quality Award Board of Overseers.

Bronze Award recipients have developed an organizational profile including vision and mission statements, demonstrated an awareness of their environment and customers’ expectations, and improved a process within their facility.

To view the full list of Bronze Award recipients, click here.

Silver Award recipients have demonstrated a level of achievement in their quality journey through good performance outcomes that have evolved from how they embrace the core values and concepts of visionary leadership, focus on the future, resident-focused excellence, management by innovation, and focus on results and creating value.

To view the full list of Silver Award recipients, click here.

Congratulations to all of the 2013 Bronze and Silver National Quality Award Program recipients!

Tuesday, June 25, 2013

Facing the Issue: Observation Stays

When it comes to politics, it’s often easy to forget the men and women who are impacted by decisions made in Washington. But at the heart of every issue there are people – lives that are affected by laws, rules, and regulations. So we’re putting faces, names, and stories to the topic at hand. Each of these stories comes from an individual who has voluntarily chosen to become an advocate for this issue by sharing his/her own personal experience.

The Issue: Under the Medicare statute, patients must have an inpatient hospital stay of three or more consecutive days, not counting the day of discharge, in order to meet Medicare criteria for coverage of post-acute care in a SNF. As a result, although the care received by patients in observation status is indistinguishable from the care received by inpatients, outpatients in observation who need follow-up care in a SNF do not qualify for Medicare coverage. Hospital stays classified as observation, no matter how long and no matter the type or number of services provided, are considered outpatient. These hospital stays do not qualify patients for Medicare-covered care in a SNF. Read more about observation stays

Billie Frost
White Oak Manor

South Carolina
When Mrs. Billie Frost entered White Oak Manor, she was coming off of a four-day stay at the hospital. As happens with all incoming patients, Mrs. Frost’s medical discharge papers were reviewed by the receiving staff at the skilled nursing center. According to these documents, Mrs. Frost had been under in-patient status at the hospital. Given that in-patient was recorded on her discharge papers, the skilled nursing center billed her stay at the facility to Medicare. That claim was denied. When White Oak Manor inquired about the denial with the hospital, it was revealed that Mrs. Frost was admitted to the hospital under observation status, but after a case management team reviewed her situation, Mrs. Frost’s status was changed to in-patient for the final two days of her hospital stay. Because her first two days at the hospital were categorized as observation, Mrs. Frost’s Medicare claim was denied on the basis that she did not meet the three-day stay requirement of Medicare.

Thursday, June 13, 2013

AHCA/NCAL's 2013 Joe Warner Patient Advocacy Award Recipients Announced

AHCA/NCAL proudly announced the 2013 Joe Warner Patient Advocacy Award recipients at its annual Congressional Briefing event last week. The following individuals were named this year’s award recipients: Doug Burr of Health Care Navigator, LLC; Phil Fogg, Jr., of Marquis Companies; Kelley Rice-Schild of Floridean Healthcare; and Craig Souza of the North Carolina Health Facilities Association.

AHCA/NCAL gives this award to association members who have worked directly to educate Members of Congress about the needs of long term care patients and residents and to advance quality long term care. The annual award recognizes caregivers who possess the same compassion for, and commitment to, the country’s elderly and individuals with disabilities that exemplified the work of former president and CEO of Illinois-based Heritage Enterprises, Joe Warner.

“It takes passion and conviction to be an advocate,” said Mark Parkinson, President and CEO of AHCA/NCAL. “This year’s award recipients not only stand up for these individuals who cannot advocate for themselves, but they have done so graciously and generously through their lifelong commitment to the long term care profession.”


Doug Burr is the vice president of finance, reimbursement, and government relations for Health Care Navigator, LLC. Mr. Burr also serves in several leadership committees for health care associations. Click below to watch Rep. Tom Price (R-GA) congratulate him below:


Phil Fogg, Jr., is continuing his family’s tradition of operating long term care facilities as president and CEO of Marquis Companies - a long term care company with 26 facilities across Oregon and the Northwest. Click below to watch Rep. Greg Walden (R-OR) congratulate him below:


Kelley Rice-Schild is executive director of Floridean Healthcare, which operates the oldest nursing home in Miami, Florida. She is also owner and partner of Partner Care Pharmacy. Click below to watch Rep. Joe Garcia (D-FL) congratulate her below:

Craig Souza has led long term care advocacy in North Carolina for 36 years, serving as president of the North Carolina Health Care Facilities Association since 1977. Click below to watch Senator Richard Burr (R-NC) congratulate him below:

Each of this year’s award recipients has demonstrated dedication to protecting the rights of seniors and advocating for long term and post-acute care.

Monday, June 10, 2013

Congressional Briefing Promotes “We are the Solution”

AHCA/NCAL members arrived in Washington, DC, last week for Congressional Briefing, an annual two-day event designed to encourage members to join forces and storm Capitol Hill with a cohesive message for their state representatives. 
AHCA/NCAL President and CEO Mark Parkinson asserted that, “In a town of dysfunction, we are the solution.” In his opening remarks, Parkinson encouraged members to rise above partisan divides and recognize the unique power that skilled nursing care centers and assisted living communities together hold. He outlined how SNFs are saving the government money by providing much lower CMS Medicare payments on average, as compared to other care settings.

Since 2009, AHCA/NCAL members have enjoyed a 23% increase in 5 Star Ratings from the CMS Five-Star Rating System, proving that quality care is one of the association’s top priorities. Parkinson also highlighted that nursing and residential care facilities are currently regarded as the tenth largest employer in the country. Government cuts, however minor, will therefore not only negatively impact thousands of LTC residents, but employees as well.

How could members most effectively reach their audiences on the Hill? Keynote speaker, Pulitzer Prize-winning writer and investigative reporter Bob Woodward offered simple yet insightful advice: “It’s hard to dislike someone who says they like you,” he said. 
Woodward encouraged members to view their representatives as resources rather than obstacles, fitting to the age-old adage “You can catch more bees with honey than vinegar.”
In her speech, Democratic Leader Nancy Pelosi (D-CA) echoed both Parkinson and Woodward’s remarks and declared that “Through collaboration and cooperation we can get this job done.”

See below some photos of AHCA/NCAL member visits on Capitol Hill from Monday, June 3 and Tuesday, June 4: