One threat removed, but even bigger one remains

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James M. Berklan
James M. Berklan

Make no mistake: Long-term care providers will take a victory wherever they can, and the Trump administration's move to rescind the Obama administration's ban on pre-dispute arbitration agreements is a win with a capital “W.”

There were a few caveats tossed in by federal regulators, but by and large, it's going to be a deal providers can live with.

“What it does for the everyday operator is it eliminates what I would call an existential threat of extinction,” American Health Care Association President and CEO Mark Parkinson told McKnight's.

Arbitration won't cut the number of lawsuits brought, he added, but it should curb the “risk of a runaway jury verdict” that could draw a $5 million judgment for “fairly minor claims.”

Which brings us to the other, more substantial threat — potential Medicaid reductions. 

Democrats, and many Republicans, in the Senate openly criticized the House bill as being too harsh on Medicaid funding. As such, AHCA lobbying efforts turned to telling GOP Senators in particular to craft something kinder to Medicaid, and the sector. It didn't appear to work.

The stakes couldn't be higher, long-term care leaders emphasize. The House bill calls for more than $800 billion reduced over a 10-year period. If anything near that is signed into law, and the Senate version could be worse, it could be devastating for providers.

“If Medicaid is cut in a material way, it overwhelms any other positive thing that we can achieve for members,” Parkinson said.

Medicaid is far and away the top payer of nursing home services in the country, even though it reimburses providers below the actual cost of care.

“It's quite interesting that we're fighting to preserve the status quo when we're [already] losing $25 per patient day,” mused AHCA VP for Governmental Affairs Clifton Porter II in June.

“As we get closer to [Congress'] August recess, it's going to get ugly,” he predicted. “It's going to get messy.”

Parkinson and Porter agreed that no matter what happens before or after the break, efforts to substantially reform Medicaid will not go away.

“I think we're at a high degree of risk for at least the next two years for fundamental Medicaid reform,” Parkinson said. “These are tough and challenging times,” he admits, “but for folks who want to throw in the towel, I think it's a little too soon for that.”