The need for long-term care to swarm the nation's capital

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Elizabeth Newman
Elizabeth Newman

To be a Texas nursing home provider is not for the faint of heart. I learned that firsthand this week.

Texas ranks 49th nationally in its Medicaid reimbursement (only Illinois has worse rates). While Texas facilities are looking at a Medicaid increase of 2% in 2014 and a 4% increase in 2015, most homes are still reeling from a 3% Medicaid cut a few years ago. Texas also has various facilities in rural areas that have been hit particularly hard, notes Texas Health Care Association president Tim Graves.

He is concerned, and with good cause.

“In Texas we have 1,100 nursing homes all over the state, and we have a number of rural areas. Many of those have high Medicaid ratios, and those are the ones I'm concerned about,” Graves told me between lawmaker visits. “The last two, three, four nursing homes that closed were in rural areas, and many times they were the biggest player in town in terms of the economy.”

The state has 147 rural facilities, with a third of them having 70% to 75% of their residents on Medicaid. Another 26 are in the 75% to 80% range and the rest — or slightly more than half of the rural facilities — bear even higher Medicaid census levels.

While Texas has specific challenges, it is united with other state provider associations and the American Health Care Association in promoting legislation such as HR 1179, said Ana Pico, the divisional vice president at Fundamental Clinical and Operational Services. That's the bill that means any time the senior spent in a hospital, either as an inpatient or under observation, would count toward Medicare's three-day stay requirement.

Pico and Graves joined their counterparts from other states in attending meetings with congressmen and staff on Capitol Hill this week during the AHCA Congressional Briefing to push long-term care providers' interests.

“We need to resolve this whole issue of observation days,” Pico said, referring to HR 1179. She noted how seniors can find themselves owing thousands of dollars to skilled nursing facilities because they incorrectly thought Medicare covered them after their initial hospital visit — which might have been deceivingly coded as “observation stay” instead of giving them inpatient status. “The whole scenario is preventing the elderly from accessing their Medicare benefits.”

Everyone involved in lobbying agrees that having providers like Pico talk with legislators about the good work in their facilities, such as quality initiatives and resident stories, makes a difference.

But there's a need for even more providers — from Texas and beyond — to attend the congressional meetings, organizers emphasize. It's no secret that it's more difficult for rural or independent Texas owners to make it up to the District of Columbia, and I am sympathetic to the administrator who doesn't want to shell out hundreds of dollars just to spend hours driving to an airport that then still requires two flights to D.C.

Yet House Majority Whip Kevin McCarthy (R-CA) wisely told an AHCA gathering on Monday that the best use of time is to “make it local.” That means the best meetings are the ones where an owner or administrator can say, “Let me tell you about Mrs. Jones here.” Or to remind the congressman that when the administrator's rural nursing home closes, not only will seniors be at loose ends, but that a major employer in town will be gone.

These visits are short, and the corridors of power can be intimidating, not to mention uncomfortably humid given the climate. But be clear about one thing: They matter, to people who matter.

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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 Emily Mongan.

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