A famous line within many wedding vows includes taking a spouse “for better or worse.” That is what it means “to marry.”

As it turns out, it also means to be Mary — Mary Ousley, that is. The luminary long-term care leader was honored as the 2021 McKnight’s Women of Distinction Lifetime Achievement Award winner in May. It was a more than fitting choice.

More recently, she distinguished herself with the type of insight that has earned her industry plaudits for decades. Speaking recently at the LTC 100 conference, Ousley — a former board chairman of the American Health Care Association — told it like is … for better or worse.

As the current chief strategy officer for long-term care at PruittHealth, she hardly is an impartial observer. Yet she is not afraid to tell some hard truths. Even if it might make some fellow providers occasionally wince.

Take, for example, her comments about the rise of home care and home- and community-based services. Less secure skilled nursing pros might see it as a threat.

“This is not a competition between HCBS and skilled nursing; it’s complementary,” she reminded the LTC 100 session audience.

Yes, operators are going to have to invest more in skilled staff, the credentialed registered nurse also pointed out, sounding more like a union boss than a nursing home chain executive.

“We must further develop skilled nursing to include infection preventionists in every building and registered nurses around the clock,” she continued. “As a profession, we must establish what is the right thing to do and let policy follow.”

Mary Ousley headshot
Mary Ousley

The good news? She says about $15 million would cover the above and, “relatively speaking, that’s not a lot of money.”

Granted, I don’t have an extra $15 million stashed between the eggs and orange juice and you likely don’t have it in your fridge, either. But Ousley is a policy pro who knows of which she speaks. My bet is that more money will be found, if providers remain up front with themselves — and earnest about making Ousley’s described improvements.

Lest you think she’s one of those masochistic eat-your-own-kind observers, she gives equally in all directions. In fact, providers may have no better advocate. That’s why she has testified before Congress and in so many other instances on the industry’s behalf.

She knows, for example, how to matter-of-factly call the Centers for Medicare & Medicaid Services on the carpet. Take the agency’s insistence that its new Patient Driven Payment Model is calibrated too high, resulting in unintendedly high provider reimbursements.

Ousley, among others, reminds that a certain pandemic produced unexpectedly high needs. When she recalls that CMS wanted every admitted resident to be treated as if they were COVID positive, the argument against the overpayment theory makes more sense. What first seemed like the industry doing a knee-jerk “the numbers are lying” response becomes more plausible.

“How do we attribute the $1.7 billion to the cost of care? CMS attempted, but did not go far enough,” she matter-of-factly told the LTC 100 crowd. “The cost of isolation, both physical and emotional, and PPE are just some examples.”

Keep in mind that there’s no more persuasive politician than a sweet-talking Southerner, and Mary qualifies there — when she remembers to include the sweet part, and even when she purposely doesn’t.

After chastising CMS on its spending analysis, for instance, she quickly added, “Keep in mind that this rule is not written in ugly language. It’s reasonable and collaborative. That’s hopeful.”

And that is how we leave this week’s installment: hopeful. 

As long as there’s a Mary Ousley around and she’s in there swinging in the name of candor and care, there is plenty of reason for hope.

Follow Executive Editor James M. Berklan @JimBerklan.