In another life, in another millennium, on another continent, your faithful scribe was an auto factory worker. This led to many unexpected insights into human nature that I still recall decades later.

Take, for example, Hans and his wife (name since forgotten), who rented me a room for a short while in the former East Germany. These sweet senior citizens spoke no English and were loyal to the workings of their communist state, especially the way it purported to look after the interests of its masses.

By contrast, the US was considered an adolescent with hedonistic tendencies and too many millionaires. This, of course, was all expressed amiably enough over coffees or beers, with none of the rancor or disrespect that is apparently required among two disagreeing parties nowadays.

That’s probably why I can so clearly see Hans’ twinkling eyes, enlarged bulbous nose and proud smile when he told me and his wife there was one thing he admired about America. Over there, he gestured to his wife, you don’t get a job just because you have a diploma or some paper that says you ought to be qualified to do the work. You had to prove your value.

The dedicated engineer obviously had been passed over in the apparatchik-filled system too many times.

Hans was on to something then, and so is the Centers for Medicare & Medicaid Services now. 

CMS’s undeniable push toward value-based care is at a point of no return. It is in full flight from a fee-for-service system that rewards doing in favor of one that rewards the production of value, or quality.

By 2030, CMS has said, everyone should fall under a value-based payment system. That drum has been beating for a number of years now. But the goal is no longer some vague point in the distant future. Rather, it is just six new calendar purchases away.

Long-term care leaders and their many advisors have latched onto the value-based concept pretty well. I think. The sector’s leading figure, AHCA/NCAL President and CEO Mark Parkinson openly reminds nearly every month that providers that can show good outcomes will do very well under such a system.

But if we’re honest with ourselves, the rank-and-file — as well as an uncomfortably high percentage of higher-ups, I’d wager — still could use a firmer grip on just what “value-based” means.

It can admittedly be a loaded phrase. And besides, doesn’t everyone seek value? One recent survey found that while many people said they like the phrase “value-based care,” many were clearer when it was called “quality-focused care” or “patient-first care.”

I simply like to describe it as incentivized pay for bringing home good grades.

But even that can kick off a brouhaha about whether providers should be graded at all, or given stars, or judged more with regard to acuity levels of their patients, etc. Each argument has its own merit.

The important thing now is simply to make sure everyone understands the terms we’re operating under. To that end, CMS has done providers, and other stakeholders, a solid.

Earlier this week, the agency launched its Value-Based Care Spotlight website. 

Visitors there will discover the government’s aims for value-based care “as a cornerstone of transforming healthcare.” Among other features are “real world” vignettes from patients and providers in a wide array of healthcare situations. If nothing else, the site illustrates this value-based care stuff is not just for nursing homes and long-term care providers.

In fact, that’s one of my beefs with it. There are no first-person accounts from anyone long-term care-related in the “patient and provider voices” section. Generally, the site seems pretty light on things long-term care-related. 

If you look hard enough, you’ll find mention of accountable care organizations and some other familiar terms. Yet you have to click your way through a digital maze to finally land on the skilled nursing facility reference page. This is perhaps one of the trials that is inevitable with a behemoth like CMS.

But let’s give it time. This is just a start. Maybe all it will take is an amiable sit-down over a beer or two to come to a meeting of minds between different-minded folks to get things better sorted out. It’s happened before.

James M. Berklan is McKnight’s Long-Term Care News’ Executive Editor.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.