Watch a very young child play hide-and-seek for the first time and you’re guaranteed a grin or two. It’s sweet and innocent, if misguided.
Invariably, the little one will sit somewhere out in the open and “hide” by covering his eyes with his or her hands. “If I can’t see me, then nobody else can, either,” is the apparent logic.
Such a flawed strategy is, unfortunately, not confined to tykes. There are still too many healthcare providers covering their eyes and hoping for the best when dealing with the omnivorous Medicare Advantage movement.
Like some kind of fiscal necrotizing fasciitis, MA plans have charmed beneficiaries with lower premiums and eaten into providers’ reimbursements. The plans are gaining increasing market share, north of 50% in many cases.
Yet some long-term care operators continue to cling to the notion that mysteriously reappearing “regular” Medicare pay rates will save them. This drives Travis Palmquist crazy.
The former director of operations over hundreds of facilities for one-time nursing home giant Beverly Enterprises said the above scenario exists all too often.
“They’re still hoping to get Medicare, the same as before,” he told me last week. “Hope is not a strategy. Tech is a strategy.”
He said that providers need to improve connectivity and the transparency of their electronic health information. Stakeholders need to confidently gather and then show their capabilities and successes, he explained. Often, that will mean banding together with others to flex critical mass in value-based care systems.
Federal regulators also need to get their act together, stressed Palmquist, now the senior vice president and general manager of the senior care division of PointClickCare. The behemoth data platform and strategy provider fuels its positions with figures from more than 26,000 skilled nursing facility, senior living community and home health agency provider clients.
Recently, it had the ear of the Centers for Medicare & Medicaid Services during a video meeting. CMS meets with many parties as sounding boards, but perhaps none with PCC’s market share — or stance.
“We met with CMS a few weeks ago and told them we don’t need money,” Palmquist explained. “We have the conviction that they (CMS) need to invest in the (facility) proprietors. There is nobody that’s done more with less better than LTPAC providers, as far as outcomes and quality.”
‘Golden’ warning to CMS
Palmquist and colleagues warned the agency that letting a third-party such as the MA plans, which doesn’t distribute funds “equitably,” grow so strong is dangerous. The agency can’t hide from real sector-wide implications.
“We run the risk of killing the golden goose,” he said, referring to the relative efficiency and outcomes that nursing homes provide.
Palmquist noted that hip and knee patients cost CMS about $1,600 a day in hospital settings back in the 1990s, when he was entrenched as a provider. At the time, it compared to just $450 to $550 in nursing homes — with no difference in outcomes.
“The bottom line is, long-term care post-acute providers could drive significant outcomes and do it more efficiently, and if we don’t watch it, it could be a tough run.”
The meeting’s remote, video hook-up limited the ability to read the room, especially with typically non-committal CMS counterparts on the other end. But Palmquist said he “felt like the message landed.”
Stakeholders had better hope so. The agency’s plans to implement minimum staffing standards for nursing homes also came up during the call. Palmquist believes there will be pilot programs or other kinds of testing before any mandate would be imposed.
“If they just pull the ripcord” and mandate certain thresholds, his group warned, colleagues could predict the percentage of facilities that would close.
Covering one’s eyes and simply hoping for the best isn’t going to shield anyone from realities like these.
James M. Berklan is McKnight’s Executive Editor.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
