Managed care contracts, surveys and success stories tackled at start of AHCA convention

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Hooper, Lundy and Bookman, PC's Mark Reagan, Mark Johnson, with AHCA's Mike Cheek, talk to attendees
Hooper, Lundy and Bookman, PC's Mark Reagan, Mark Johnson, with AHCA's Mike Cheek, talk to attendees

In the two years since an 11.1% reimbursement cut for skilled nursing facilities hit, providers have regrouped and have achieved modest successes, the president of the American Health Care Association/National Center for Assisted Living told attendees at the 64th annual convention, which is being held in Phoenix.

“We are bigger, better and stronger,” said Mark Parkinson, the top executive for AHCA/NCAL, at the meeting's opening session. “At every level, we have more members than ever. We are starting to see results. Our goal is to win for you.”

Members have made gains in improving quality of care, specifically reducing rehospitalizations and use of antipsychotics for residents with dementia, and resident satisfaction also is up, he said. In addition, there have been promising market basket increases.

In a callback to a musical call-to-arms two years ago, when Tom Petty's “I Won't Back Down” played, Parkinson noted, “You refused to back down.”

“What's next is that we must work harder,” he said. “The folks who were after us three years ago are still after us.”

Other highlights from Monday's convention:

  • Keynote speaker Benjamin Carson, M.D., a renowned pediatric neurosurgeon who recently retired from Johns Hopkins, interspersed stories of his childhood and path to success. There is a need to encourage the next generation and to “not utter words like I can't,” he said.
  • “It's about understanding your costs of care and what business relationships look like,” he told McKnight's. “To do that takes work. You need to build and nurture relationships that are backed up by performance.”
  • In a crowded session on Medicare-Medicaid Program Integration, Mark Reagan, a managing partner at San Francisco-based Hooper, Lundy, and Bookman, PC, spoke about the need for skilled nursing providers to manage relationships beyond an agreement or contract.
  • Mark Johnson, also a managing partner at Hooper, Lundy, and Bookman, PC, said providers must not only read but also understand the contracts.
  • “People often skip through parts of the contract,” he said. One example is the area of “medical necessity,” where the provider may need to push for that explanation to reflect Medicare or Medicaid guidelines. Another area to zero-in on is legal provisions related to cases involving arbitration. If possible, the contract should say that if the plan loses, they'll pay the provider's legal fees, he advised.
  • Some in the audience noted that as the number of managed care residents in a facility grows, they will need to hire a full-time person to address administrative tasks related to these contracts. Larger companies, Johnson noted, have started hiring managed care directors to oversee areas such as approved length of stay.
  • Margaret Leoni, a consultant and technical adviser to the Centers for Medicare & Medicaid Services, spoke about specific skilled nursing forms that can cause confusion, such as CMS Form 671. Providers must remember to use a two-week period to calculate hours worked, she said.
  • One aspect to note is to accurately document who has done what, she said. An MDS nurse, for example, may be called in to do direct care in a given time frame. “You don't have to go by titles, but by what they worked in those two weeks,” Leoni noted.

Tuesday highlights are expected to include the National Quality Award Reception. Presenters at top sessions will include Lyn Bentley, the senior director of Regulatory Services and Survey at AHCA; Michael J. Yao, M.D., the chief medical officer at Golden Living; Alice Bonner, Ph.D, RN, the former director of the division of nursing homes at CMS; and Henry Gordinier, vice president, strategic planning, at Kindred Healthcare. The annual meeting concludes Wednesday.