Long-term care wants its own 'fix' if docs get one

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

If you hang around long enough, you learn there are only two things long-term care providers fear after Republicans and Democrats. That would be hospitals and doctors.

Why the bother over these frequent partners in care? Simple: Uncle Sam has only so much money in his sack and nursing homes get their share only after hospitals and docs are taken care of. (That's a good mapping of how your basic Accountable Care Organization hierarchy will play out, too, but that's a column for another day.)

Make no mistake: Hospitals and docs work hard to gain their influence. It's not easy raising all those millions of dollars to put into lawmakers' favorite causes. Nursing homes do well in their own right with fundraising, but they are still dwarfed by the physician lobby, which in turn is dwarfed by the hospital lobby.

So nursing home operators' fears are not misplaced. That's why a certain press release recently from the American Health Care Association, “Skilled nursing providers prepare for Doc Fix Proposals,” came as little surprise. Anxiety stuck between the lines like thick grease. The release was timed for the same day as a Senate Finance Committee hearing exploring options for dealing with the so-called “doc [pay] fix.”

“We hope Congress can devise these solutions without looking to long-term and post-acute care providers as a ‘pay-for,'” said American Health Care Association President and CEO Mark Parkinson. “Tapping one group of providers to assist another doesn't strengthen the system.”

LTC  lobbyists, however, seem to have been preparing themselves for it. They almost seem resigned to the fact that something has to give and it's liable to be a part of their funding. In a textbook case of trying to make lemonade out of possible lemons, however, the LTC lobby is demanding a “therapy cap fix” to go with any “doc fix.”

That could certainly sweeten any bitter aftertaste a bit.

The bottom line, however, is that long-term care stakeholders still know that someone always will have to come up with dough for docs. It is going to be hard to give physicians their desired increase without taking back somebody else's funding.

That's where long-term care's insecurities come into play. The good news is the LTC client base will be powerful for many years into the future. There's no getting around the boom. It might be the strongest leverage long-term care providers have.

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