Peg Tobin

Concerned about the challenges facing our healthcare industry, I decided even though I am but one person, I should do something and let my voice be heard.

With laptop in place, I sat down and wrote my concerns in a letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services. In my letter I decided I should do what I have always asked my co-workers to do: “If you bring in a concern, bring in a solution.” For every concern I expressed, I offered one or more ideas of solutions. I mailed the letter certified.

Weeks passed, then months and after a while I figured my letter was going to be filed away with so many others that came through the doors of the administrator.

However, on March 27, 2019, my world was awakened. While at my office, I received a phone call from Seema Verma’s office. They were calling me regarding my letter and wanted to schedule a time and date I could come to her office to discuss the issues and solutions I had brought up in my letter.

Whoa! Talk about a surprise!  

I was floored, fortunately, I was able to maintain my composure and not sound like a giddy teenager meeting a celebrity. After a brief discussion and schedule review, we settled on April 18 as the date for our meeting at the CMS headquarters.

The day finally arrived. Our corporate compliance officer, Mary Taylor (RN, LNHA, Esq.), accompanied me to the meeting. When we arrived, we were told we could not take any pictures or make any recordings. We were escorted to a conference room where 9 top level CMS executives were waiting for us.  

My letter was in front of each individual. 

I asked them, “Why my letter?” They shared that they get thousands of letters daily and cannot possibly respond to all of them. However, my letter caught their eye because I did not focus on complaints but rather on solutions. They expressed they found the responses in my letter to be thoughtful, insightful and possibly achievable. 

After introductions, they turned the meeting over to me and asked me to share more of my thoughts on how ‘together’ we could help improve long-term care. I had set my thoughts into six categories with 25 points of interest:

  • Attract staff
  • Retain staff
  • Staffing acuity and ratios
  • Education/Mentor/Training
  • Survey Cohesiveness
  • My definite ‘no’s and recommendations.

As I shared, they listened, engaged and wrote things down. Some of their questions concentrated on the leadership training I was doing through the CMP Grant. They asked about the books I had written for leaders. At this interval, Mary pulled out every book and work book I have written and they accepted them (can you believe it all my published materials are now at CMS headquarters?!).

The meeting was phenomenal. At the end I was told CMS is collecting data looking for consistent trends and patterns. They then told me I had given them a lot to work with and some of the items I listed they could do and others they could not, but they were going to address each item.  

It was a great experience. I will be continuing contact with them and I am not at liberty to share everything, but I can rest assured my voice is, was, and will continue to be heard.

Having worked for more than 30 years to make a positive difference in long-term care, I think it’s important to share this experience. By the grace of God, CMS is listening, responding and committing to follow up. I am not a big shot, but I like to think I am a deserving “little shot.”

I am not arrogant enough to think my voice is so spectacular or my solutions are so unique. But I am confident enough to think my solutions are not ridiculous because I shared them from the viewpoint of the trenches.  

All voices have a right to be heard. Possibly it is time for you to set up your laptop and put your solutions down on paper. Share how you as an individual think we can make it better. Not everyone has to write CMS. You can write a senator, governor, healthcare association or nursing/administrator board with your idea.s

Just when you think your voice does not count, you find out it does!

Peg Tobin, RN, is president of Tobin & Associates.