Enjoy the good times—they won't last forever

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James M. Berklan, Editor
James M. Berklan, Editor
Does it seem like the job's been a bit extra stressful lately? Maybe the co-workers aren't stepping up to the plate enough? Is the pressure from above getting to you?

Or you're already (or still?) worried about your next visit from surveyors. Understandable. Totally. But whatever you think you're feeling, realize that these are the good times.

Almost as if it were as a “make-good” for announcing plans for a five-star rating system for nursing homes, federal health officials gave providers one of their biggest presents in recent years: They dropped plans to reset Medicare Part A payment rates for the next fiscal year. That means $770 million will not be pinched out of the nursing home funding stream.

On top of that, the annual market basket, or inflationary, payment update is going to be more favorable than first expected. Good times indeed on the funding front, even after taking into consideration that Medicaid funds about four times as much long-term care in this country than Medicare.

So rejoice, providers and your polished lobbyists. But also remember that officials with the Centers for Medicare & Medicaid Services never said they weren't eventually going to get back to recalibrating Medicare payment rates. The situation all but demands it.

And you would, too, if you learned you were paying almost 60% more than expected for something. That's what happened to CMS.

Forecasters predicted that patients would be classified into one of nine newly created high payment groups 19% of the time. In actuality, patients were coded for the highest payments 30% of the time. That's 58% more than they planned for. 

Try plugging that formula into your business's calculator. It doesn't work for you, either, does it?

Uncertain whether nursing-facility coders simply figured out how to get ahead of the game early, or a truly sicker resident population hiked up the numbers unexpectedly, federal officials “continue to evaluate” the situation.

The recalibration “has been delayed while CMS continues to evaluate the data” is how they put it. That's probably code language for “Plan on feeling a very, very hard yank on the reins around this time next year.” The bean counters are not going to let this one slip away twice. 

Be confident that, new class of lawmakers in place next year or not, the good times will not last forever. Enjoy them while they last.

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