The mating call of senior living/senior housing/skilled nursing/trade associations is:

Cry, Cry, Cry . . . give me more money.

 Trade associations are hugely important to the senior housing industry, but most of the time they are so self-serving and unaware or uncaring about the well-being of rest of the country, that it is frustrating, infuriating and nauseating. As I write articles at Senior Housing Forum I find myself on one hand wanting to express this frustration and on the other hand feeling cautious about biting the hand that feeds me. So here is the mind bending story For the last couple of years skilled nursing Medicare reimbursement has been untouched.  Today there are well grounded fears that this is about to change.  There are two areas of concern:

  • Because long-term care has not had cuts the past couple of years, there is a sense that it is “our turn,” to feel the pain.
  • Several years ago the government implemented a plan to reduce physician payments. However, every year the implementation of that plan has been delayed.  This meant and continues to mean that someone else needed to pay for the delay and long-term care/post acute care looks to be a prime target.

AHCA’s Proposal

ACHA has proffered a 10-year proposal that includes the following elements:

  • There will be no cuts to the “market basket” rates for long-term care services for the next 10 years.  What this means is that the current reimbursement rates would remain stable except for market basket cost of living increases.  So no “doc fix cuts”, no “reduce the deficits cuts”.
  • The Promise:  Skilled nursing facilities would reduce the number of hospital readmissions from skilled nursing that would achieve a 2 billion dollar savings by 2022.  Further this reduction would include planned readmissions for things such as chemotherapy.
  • If for any reason, the skilled nursing industry did not meet the targets, the shortfall would be extracted from future market basket payments.  In other words, the skilled nursing community is willing to go “at risk” for the remission reduction. They are willing to put their money where their mouth is.

Shocking . . .

  • The industry is saying “here is a proposal that is good for the country . . . for our children and grandchildren”.
  • They are saying,  “We need adequate reimbursement to stay healthy in return we will do our part to reduce costs.”
  • It will force, or at least strongly encourage, providers to really focus on superior resident care.  Skilled nursing communities will need to focus on quality to effect the 15% cut.
  • In order to reach this goal there will need to be a continued focus on quality improvement.

In talking to Greg Crist of AHCA, they are getting an amazing level of reception from Capitol Hill.  It may very well be the first time a trade association has actually put forward a proposal that includes mutual responsibility. Are you as impressed as I am? Steve Moran Article last updated: October 9 8:45 pm PDT