Proof election year is no time to take anything for granted

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James M. Berklan
James M. Berklan

It seems you can't count on anything for certain in an election year — just ask any Trump skeptic – and that could mean special things for long-term care.

Conventional wisdom holds that not much will get done in an election year. Politicians spend tons of time courting the public — and one another — for votes. This year, the Senate's time could be soaked up scrutinizing a Supreme Court nominee. In addition, the national political conventions will add to Congressional recess time.

Often, it all adds up to not a lot of legislative progress.

Until it doesn't.

Barbara Gay knows that better than anyone. Even though 2014 didn't have national political conventions, it was an election year. Surely nothing big or complicated would be passed, thought Gay, LeadingAge's vice president of public policy. Most of the rest of us shared her conviction.

Then, the House and Senate both found tricks to passively advance the IMPACT Act. Complicated and complex took a giant leap forward.

The Improving Medicare Post-Acute Transformation (IMPACT) Act of 2014 is now taxing providers, regulators and policy makers with finding better services and reporting methods.

So what's the next legislative goal, despite a deeply partisan, grudging Congress? One hope, albeit thin, is that the overuse and abuse of hospital “observation” days will be reined in. Too many individuals are still spending time in the hospital — fed, cared for and tended to for multiple days — but still not being given inpatient status, and therefore not eligible for Medicare skilled nursing coverage upon discharge.

Worse, they often lack skilled nursing eligibility without knowing it.

More and more exceptions are being granted to release beneficiaries from the three-day requirement. Collaborative efforts such as accountable care organizations are just one example where the three-day requirement is waived.

Last year, hospitals were put on notice, well, with the passage of the NOTICE Act. The measure mandates that hospitals inform patients of their admission status — inpatient or just observation stay, for example — to help avert confusion farther down the line.

But it's still not enough.

Long-term care providers and lobbyists will be pushing HR 1572, also know as S. 843, this spring. The bill(s) call for quicker accrual of hospital time toward skilled nursing eligibility. More than 100 members of the House and 21 Senators have co-sponsored the legislation thus far.

Provider association promoted visits to Capitol Hill in March and May should boost awareness.

Providers also will be campaigning with their local legislators to block further funding cuts to post acute care. President Obama's budget proposal calls for a 1% market basket reduction. This would come on top of a standing 2% reduction due to sequestration cuts that extend through 2025. Last year, there was a 2% raise, which effectively meant neutralized payments, but under the new Obama budget, rates would go south.

This is hardly fair, given accommodations granted other providers. Home health, inpatient rehab facilities and long-term acute care hospitals, for example, are absolved of cuts that would take them into negative reimbursement territory.

Once again relegated to pressing its nose against the window, long-term care is not offered the same protection.

Another thing providers are sure to get noisy about this spring is additional value-based purchasing proposals. They are being tossed about, even though the Centers for Medicare & Medicaid Services already has a VBP effort started. The current program withholds pay by 1% to 2%, with opportunities for high performers to earn it back.

A newer proposal would cut payments to providers by 3% to 8%. The kicker to this is providers that score well in quality care could then earn back just 50% to 75% of what was taken away.

“It's a pretty big chunk out of your payments,” Gay says warily.

This has led providers to worry about the big question: How much can regulators cut before providers don't have the resources needed to deliver quality care?

Here's one vote for hoping we never find out.

James M. Berklan is McKnight's Editor. Follow him @JimBerklan.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.