Daily Editors' Notes

Will nursing homes be subcontractors to the stars?

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John O'Connor, editorial director, McKnight's Long-Term Care News
John O'Connor, editorial director, McKnight's Long-Term Care News

Nursing homes take care of 1.5 million residents each year. They pump more than $100 billion into the nation's economy. In many communities, they are the largest source of jobs. But as far as the Centers for Medicare & Medicaid Services is concerned, nursing facilities are little more than the help.

Sure, federal regulators say long-term care operators are important players. But as the old saw goes, actions speak louder than words.

Just take a look at the list of accountable care organizations CMS released last week. It specifically names 10 hospitals and 13 physician-driven organizations. Any long-term care operators in the mix? Uh, no. Turns out that's not really supposed to happen.

So this is the future of healthcare? Docs and hospitals calling the shots, while nursing homes get to act like subcontractors? Stop me if you've heard this one before.

Yet we're being told things will play out differently this time. According to the glossy pamphlets, ACOs will mean the end of fragmented, disconnected care. Medical charts will no longer vaporize, patients won't have trouble seeing a doctor and unnecessary medical procedures will be a thing of the past.

And by keeping the same people in charge and calling it something else, how will these dramatic improvements happen? For your information, “strict quality standards” will be put in place.

Let's just hope that's not another way to say stupid healthcare won't be reimbursed. By the way, have we not had “strict quality standards” in place until now?

I've lived long enough to see that government officials of both stripes tend to over-promise before they under-deliver.

Or do we really now live in a “Great Society” in which poverty has been removed? Has deregulation increased overall wealth and kept good jobs in America? And do we now have a nationwide educational system in which no child is left behind? We were surely promised those things before we let the people who insisted on tinkering have their way.

I do believe that our healthcare system will improve, if only because it can hardly get worse. We spend far more on sick care than any nation in the world, yet hospitals, clinics and skilled care settings are jammed full of people dealing with the residue of unhealthy living conditions and poor lifestyle choices.

And how did we get to a point where our per capita healthcare spending is twice as high as Germany's? The answer can get pretty complicated. But clearly, we've let insurance companies, doctors and hospitals pretty much call the shots. Is that going to change under ACOs — or some other bundled payment arrangement?

And how will nursing homes fit in to this grand new system? Here's my prediction: Hospitals and docs will tap you on the shoulder to help them out, if they think you are not too scummy to deal with.

So welcome to the big time, long-term care. Just don't forget to use the servants' entrance.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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