Post-election Congressional action might not be so 'lame'

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor

Like a pedestrian at a dangerous intersection, long-term care providers find themselves waiting for the stoplight to change when it comes to reimbursement policy. The Nov. 5 elections should “push the button” for them to start walking in the right direction.

What's going to happen, nobody really knows, acknowledges Mark Parkinson, the leader of the American Health Care Association. As the president and CEO of the nation's largest nursing home group, Parkinson is immersed in the study of what might happen during a lame-duck session of Congress as few are.

He discussed three possible scenarios with McKnight's editors Tuesday at the AHCA annual convention in Tampa. Call them green, yellow and red, or simply the likely, less likely and least likely outcomes. Each has potential pitfalls and benefits for providers, he pointed out.

The most likely occurrence will be an extension of the hugely expensive physician payoff, er, “fix” — combined with an extension of Medicare Part B therapy caps and their exceptions process.

The latter would be especially helpful for long-term care operators and residents. But the doctors' bill will indeed be expensive. That's where the “challenge” comes into play, Parkinson pointed out. Lawmakers will be looking for a place to cut funding in order to pay for the physicians' raise. Staying out of the cross-hairs during such "pay-for" calculations is long-term care's goal.

Overall, the “small” package could cost $20 billion, according to some estimates. One way or another, the docs are going to demand a lot of money, and in some eyes, nursing home operators are ripe for getting trimmed under a “pay-for” provision.

The second scenario would involve simply delaying planned 2% sequestration cuts by about six months. That, however, would cost regulators about $50 billion. Like the first scenario, it also would force lawmakers and policy masters to look for someone's pocket to pick to pay the outsized tab.

The third possibility is that lawmakers would put off cutbacks in a bigger way, yet mandate there be a solution to pay for it by, perhaps, next July. Otherwise, truly draconian cuts then would have to be triggered. Sounds a lot like the sequestration deal that was forced into play last year after politicians played hot potato with their fiscal duties, doesn't it? There's nothing like governing by kicking the can farther down the road again.

Of course, that not so creative maneuvering would bring about a nearly unfathomable bill, and even more nail-biting for providers.

Parkinson believes some sort of green light will be giving to the first scenario. Then, it would just be a matter of keeping fingers crossed about “pay-for” provisions. (“We have to avoid them.”) It's a fine time for further development of relationships with CMS regulators and policy makers.

Contrary to some high-profile maligning recently, Parkinson maintains, LTC lobbying and education efforts over the past year have shown operators to be open and transparent with federal regulators.

“We've made progress with our quality initiative and we've dramatically improved relationships with CMS on the regulatory and reimbursement sides,” he said.

It would be good to be right about that, with a lame-duck Congress looking for ways to foot the bill for sins of past budget inaction.  In fact, with so many influential people sharpening very long knives for budget negotiations, it's going to be a good time to have friends in as many high places as possible.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.