Feds' new pay-for-quality goals are OK, except ...

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James Berklan
James Berklan

Long-term care providers weren't outwardly jumping for joy when it was announced that Medicare is going to start paying for quality, and not quantity, of services.

Oh, they're fine with the quality part. They have, after all, been beating the drum for a while to receive pay based on outcomes.

But they've been down this road before. They know the government makes noble gesticulations about quality. And often it tends to dramatically wave with arms too short to reach far enough into its own deep pockets. Providers want quality just like everyone else, but they also want to know they'll get paid appropriately.

It would not be unprecedented if Uncle Sam were to call for better results while paying less. That's why the leader of the largest nursing home association in the country described the late-January announcement of the administration's new goals as “aggressive.” (“We're with you, but just make sure you give us the funding we need to keep up quality,” Mark Parkinson, CEO of the American Health Care Association, seemed to be saying.)

The foot soldiers just want to know they'll be well supplied during the battle ahead.

Comments from other provider groups also expressed caution about the big, new plan. While nobody will say pay based on outcomes is a bad idea, providers of all stripes want to make sure they get their piece of the pie. And they want reasonable expectations.

The devil will, indeed, be in the details. Talk of saving dollars and lowering lengths of stay is fine, but how will officials measure quality? Will risk-adjustment factors and operators' specific characteristics be taken into account?

Also, government payers will have to own up to the fact that nurses, aides and everyone else who works in a long-term care also have bills to pay. Fund them, and you fuel the quality that is, after all, the whole point of this healthcare gig.

The good news is that LTC advocates were not caught off guard by this shift toward value-based purchasing. It's been a mantra at conferences and trade shows for what seems like a couple of years.

That means refrains about quality outcomes need to be paid more attention. LTC providers need to build even stronger relationships with hospitals, physicians, rehab providers and other potential partners for accountable care organizations and other alternative payment models.

It's the new reality. And the clock is ticking.