Providers shake off gloomy forecasts with pride, optimism
James M. Berklan
First, the crowd of top-flight nursing home operators took the punch to the gut in silence. Then, they shed the stoicism and got even.
The opening day of the annual LTC 100 conference featured hard-hitting early-morning analyses that left many in the crowd of about 250 shaking their heads. Key researchers and a market analyst emphasized a skeptical outlook for skilled nursing in the near term, with possible further "bearish" implications in the long view too.
Providers in the audience murmured among themselves but didn't take it passively. They spent the rest of Monday and Tuesday detailing and learning about creative ways to improve and even thrive in a regulatory environment that is moving faster than ever. The prevailing mood seemed to exude, “Yes, it's going to be tough, but we know how to leverage our positives, too.”
The picture had been painted of a profession in crisis. Many providers would be too slow to respond to survive. The numbers are not in their favor, and so on.
It all sounded logical. Ominous, but logical.
Then again, as any provider can attest, there are many things about long-term care that can be illogical. Take, for instance, operators' continual ability to smile in the face of steep odds.
So when it was the “other” side's turn to speak, a sunnier disposition – both figuratively and literally at the picturesque oceanfront Ritz Carlton resort at Dana Point, CA – began to prevail.
“To the CEOs here, don't panic. There are so many reasons to be hopeful,” intoned Dava Chief Operating Officer of Aliso Viejo, CA-based Covenant Care.
“Look at ways to leverage your clinical strengths,” she advised. “Then give resources to those (operations) that need your help” to strengthen overall company performance.
“You have the opportunity to make lemonade out of lemons,” emphasized Golden Living President and CEO Neil Kurtz, M.D. He called what could become a bruising battle for business over “site-neutral” payments “an opportunity to prove relevance.”
“Site-neutral is a chance to say we can do better. It allows us then to have a different discussion [with care partners],” he added. “But we must be up to the task and do a great job.”
Also pushing optimism tempered with doses of pragmatism were Dan Mendelson, president and founder of Avalere Health, and Brian Fuller, vice president , Value Based Care, at naviHealth.
“It is unacceptable in this environment not to be adding quality. That requires investment,” obsered Mendelson.
“Data are necessary for proof of value — no one will take your word for it,” he added with a wry grin. “Your investment in analytics is the linchpin to all of this.”
The “this” is networking confidently and profitably with other care providers, both upstream and downstream, as the federal government is forcing in its faster-than-expected value-based purchasing campaign.
If anything was an overriding theme at the LTC 100 conference, it was the creation and improvement of fellow caregiver relationships. The LTC 100 gathering was an eager-to-absorb crowd, featuring mid- and large-size provider groups, as well as vendors who want to serve them.
“We have headwinds AND tailwinds,” reminded naviHealth's Fuller before turning to strategy. “If you're under a 3-star facility, there is no hope — like it or not, you will not be included in any networks. Think about getting rid of them and reinvesting the human capital. If you can't elevate them, divest.”
He also, however, pointed out opportunities for skilled operators to take advantage of chronic care management and conditions that hospitals almost exclusively handle right now. And he stressed the importance of leveraging performance data to help highlight superior standing in one's market. He urged creating partnerships that produce revenue — but only with other partners that can result in a very “sticky,” interdependent relationship. Partners must not be able to do without you, he explained, implying that opportunities exist for those willing to pursue them.
Even Sheryl Skolnick, the “bearish” Mizuho Securities analyst who was the culprit for most of the gloomy attitude Monday, gave one hopeful exhortation.
“The answer is not to run and hide. The answer is not to pray,” she opened with. “The answer is to get to work.”
It's sound advice, given the expected flurry of regulatory activity that could be coming the rest of the year. While Congress is stalemated and without the will to pass significant legislation because of an election year, there's also a final-year administration bent on burnishing its legacy. Moreover, it has cover to increase activity, given the framework already in place due to the Affordable Care Act.
Bundled payments, accountable care organizations, Medicare Advantage, managed care initiatives, self-insurance schemes, pilot projects to transfer more risk to providers … there are a lot of balls in the air.
The emerging message out of California this week was that providers might be a bit taken aback by the challenges. But they are also definitely ready to play ball, even if the rules of participation keep changing. Pride and indignation can be a fortunate combination that way.
Follow James M. Berklan @JimBerklan.