The hell with this guy

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James M. Berklan
James M. Berklan

Mark Parkinson.

No, not the hell with him. He's the guy who delivered the line in the headline above.

“The hell with this guy,” he calmly and defiantly pronounced in kicking off his association's annual convention earlier this week.

Speaking at the same Mandalay Bay complex in Las Vegas from which a “madman” committed the deadliest mass shooting by a single person in U.S. history just a few weeks earlier, Parkinson delivered a bold, unscripted edict.

Although he says none of his speeches are strictly scripted, this was clearly a departure for the typically conservative college debate champ, turned lawyer, turned diplomatic politician, turned leader of the nation's largest nursing home association.

Speaking to a sprawling crowd estimated at more than 2,500 in a cavernous ballroom, the president and CEO dropped the American Health Care Association's typical rah-rah opening. Instead, he dove right into recounting the moment when he realized that the horrific events unfolding in front of him on TV were taking place where his American Health Care Association would be holding its meeting in a short time.

“We can be here and feel guilty about it,” he told the rapt crowd. “We can go through the motions,” he added, “but that's what this madman would have wanted ... The hell with this guy.”

Combined with a moment of silence for the shooter's victims, it was a somber, yet terrific start to a conference that picked up speed.

Only about 15 individual members and two vendors canceled coming to the AHCA convention expressly because of the shootings, which left 58 dead, Parkinson told me. That's about the typical number of late cancellations any year, giving him the perfect segue to one of his favorite themes: the stout resilience of long-term care providers.

No doubt many were like my cab full of people coming from the airport. Cameras snapping shots of boarded up windows denoting the shooter's suite, high above the Mandalay Bay ground. Fingers pointing at the police presence still obvious at the concert grounds across the street.

But when it was time for business, the attendees traversed the smoky casinos and never-ending hallways to get down to work. And there is plenty to do, Parkinson emphasized in my interview with him.

First, he's sorry, but he has no solid prediction on whether the Nov. 28 Phase 2 deadline of the sweeping Rules of Participation will be delayed. He was “thrilled,” however, that 128 members of the U.S. House and 17 Senators were advancing letters to Centers for Medicare & Medicaid Services Administrator Seema Verma. The purpose was to ask for a halt, or at least slower adoption, of the new rules.

“That's impressive,” he said about the number of signatures gathered, declaring the campaign “hard [for Verma] to ignore.” He sounded like he might actually believe it too.

The most concerning element of the new Rules of Participation is the new survey system. “If history is any indication, at least in the short run there will be more deficiencies,” Parkinson observed.

Regardless, he expressed confidence that providers “will figure it out … but at a cost.” CMS estimated the cost of the new survey at $60,000 or $75,000 per building. Provider members themselves, however, have calculated losses of twice that much.

The Rules of Participation themselves aren't necessarily all bad. It's that too much is coming too soon, Parkinson lamented.

On other matters:

  • Repeal and/or replacement of the Affordable Care Act (“Obamacare”) isn't directly a threat to nursing facilities, Parkinson said. The killer here is that lawmakers are trying to make SNFs a “pay for” — or source of funding to pay for something else. The “crazy irony” is that SNFs were already a “pay for” when the ACA went into effect.

  • Efforts to try repeal/replace again would certainly bring Medicaid reductions onto the menu and, therefore, providers “into the crosshairs” again.

  • However, no further campaigns to riff Medicaid should come this year. If the administration's tax reform efforts advance and pass quickly, though, Parkinson thinks lawmakers might nose into attempting repeal and replace again, putting Medicaid in peril again in early 2018.

  • Federal tax reform efforts are not an active worry for skilled nursing providers.

  • Lengths of stay, however, are. What was once a 27-day average resident stay has dropped to 20 days where accountable care organizations are present and 14 days when managed care gets into the act.

“Census is down because length of stay is down,” Parkinson observed. “The penetration of ACOs and managed care have exceeded expectations.”

He expects their change-rate to slow, but the worry is that dropping lengths of stay will be faster than the influx of new residents/clients. “Right now we have a problem,” he admitted.

•   While the White House has been openly erratic on so many fronts, the administration has been genuine about its goal of reducing regulatory burden and that has been “beneficial to the sector.”

Reversing mandatory bundled pay programs and restrictions on arbitration clauses are two big ways providers have benefited under the new administration.

•  A big question mark is who will become the new Secretary of Health and Human Services. The SNF lobby had made inroads in working with Tom Price, M.D., a fellow medical provider by training and practice, Parkinson said. He is now gone, of course, a victim of his own travel indiscretions.

• Another is, of course, whether there will be yet another campaign to try to reform Medicaid.

Parkinson said we will know in the January-March time frame whether Republican lawmakers will take it up. If they don't do it early next year, that window could be closing since Parkinson figures Democrats will take back more than a handful of seats in the U.S. House during 2018 mid-term elections.

•  Next year's “huge, huge deal” is shaping up to be the administration's push for a new, unified therapy coding system for post-acute care providers. Officials' decision on what to do with/about the plan is due by May 1, Parkinson noted, adding, “We'll know by the end of this year what they're going to do. It's next year's big battle, but we're fighting it right now.”

With a leader who really knows how to get out in front and set the right tone.

Follow Editor James M. Berklan @JimBerklan.






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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 Emily Mongan.

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