Daily Editors' Notes

Former top Medicare official scalds long-term care leaders

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor
Tom Scully wondered privately before his keynote address at a seniors housing and care conference last week why he was being asked to speak. Afterwards, long-term care executives in the audience were probably wondering the same thing.

Scully scorched them. He returned time and again to the topic of excessive Medicare payments long-term care providers quietly accepted under a new payment system two years ago. Ultimately, the $5 billion was yanked back this year by embarrassed yet indignant federal regulators.

And they won't forget it, warned Scully, the former chief of the Medicare & Medicaid Services Administration. The galling take by long-term care providers didn't happen under his watch — he was CMS administrator from 2001 to 2004, one of the reasons he wondered why he was still being asked to speak — but he proved he still knew what was going on.

If nothing else, Scully is a hard-shooting investment and policy wonk who sharpened his skills, and tongue, in the Beltway and New York. When this lawyer talks, people listen — if they can keep up with his rapid, flow-of-consciousness delivery.

He was more analytical and thoroughly prepared with charts and facts than usual last Thursday. That's when he was the featured lunchtime speaker at the annual meeting of the National Investment Center for the Seniors Housing & Care Industry. His main focus was the future of healthcare financing and policy after the November elections. But he also took time to look back.

“I jumped up and down and begged them. I told them they can't say they ‘found' $5 billion [in extra Medicare reimbursement payments under a new system],” Scully said, referring to nursing home executives and lobbyists. “People in government are stupid, but they're not that stupid. You can't imagine how bad a mistake that was.”

He went on to say that brief episode — providers were called on the carpet just midway through the lucrative year — would sully nursing home lobbying efforts for years to come. He never mentioned the term “upcoding” but you sensed it wasn't far from his lips.

“It's a disaster they're going to live with for a while,” Scully said, noting that CMS' top nursing home officer is still fuming. “You are toast as far as credibility for a while.”

The former top regulator said a lack of candor and respect led to the undoing of nursing home lobbyists and other involved advocates.

“Not being straight-forward with regulators, even if you think they're stupid, is not a good idea,” he noted.

Scully knows how to poke a stick in a hive and then stand right in the path of a swarm of frenzied bees — whether they're embodied by irate lawmakers, providers or others.

On this day, however, there were no challengers.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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