James M. Berklan

A broad family of providers has largely enjoyed a show of unity — and success — lately due to their common opposition to recent bills aimed at repealing and/or replacing the Affordable Care Act.

One should never forget that some of the most brutal fights occur between brothers or sisters.

I sense that when the time is right, we’ll be seeing one of those between long-term care providers and their hospital counterparts.

All ACO kumbaya-ing aside, nursing homes aren’t hospitals, and hospitals aren’t nursing homes. That might sound a bit ridiculous, but it isn’t to the acute and post-acute care providers who may one day soon find themselves scrapping again over billions of dollars of federal reimbursements.

The Medicare Payment Advisory Commission (MedPAC) has proposed a unified post-acute payment system, and the American Hospital Association hates it. Hates it so much, it commissioned a report to make it look like disinterested others also think it’s bad.

The operative phrase that came from our coverage of it this week was ‘unworkable.’

And what did the nation’s top nursing home lobbyists have to say about hospitals’ boldnes on this post-acute payment proposal?


At least not officially. Mike Cheek, the astute reimbursement guru at the American Health Care Association offered only that the nation’s largest association of nursing home providers “appreciates the commission’s work.” AHCA would like to be kept in the loop, he added, and maybe sometime in the future there will be comment or info to contribute.

Such a response stands right up there with, “I like the color” when your wife asks you what you think of her new dress and “You’re really working hard on that drawing, Junior,” when your young son asks for appraisal of his latest artwork.

So AHCA either doesn’t have a stomach for the plan, or a stomach for squaring off against the AHA yet.

But there can be no doubt that nursing homes’ most powerful lobbying arm doesn’t know enough or have an opinion on this. Yet at least AHCA chimed in.

LeadingAge officials said they had no comment at all.

Maybe everyone’s become used to not taking MedPAC too seriously on some of its high-minded pronouncements. (Can anyone remember the last time Congress actually followed the panel’s annual advice to totally shut down or cutback Medicare raises to nursing homes?)

But this is a payment system we’re talking about. Long ago, we learned that if there’s anything that gets a long-term care provider’s ears to perk up, it’s money talk — no matter how fanciful it might be.

So something’s a fishy here. Either your dues-supported lobbyists are keeping their powder dry for a bigger fight down the road, they think this proposal will sink on its own or there’s a bigger undercurrent swirling than they want to tip off.

It will definitely, well, pay to stay tuned to this one.

Follow Editor James M. Berklan @JimBerklan.