Leaders of the nation’s largest nursing home association say they are planning “dramatic” organizational changes in response to the possible withdrawal of 15 national chains. The chains, members of the Alliance for Quality Nursing Home Care, say they want to concentrate on a more focused agenda, primarily consisting of intense lobbying on funding and quality issues.

American Health Care Association Board Vice Chair Angelo Rotella called the situation “one of the larger crises we have encountered in recent years” in a letter to members this week. He assured them that many structural changes are being contemplated, though responses may depend on just how many of the 15 firms fully pull out.

Stephen Guillard, the chairman of the Alliance for Quality Nursing Home Care, told McKnight’s on Tuesday that his members  – representing as many as 3,000 of AHCA’s 10,000 facilities – would stop paying national AHCA dues soon. Alliance members also would gradually step out of AHCA leadership roles and decrease their involvement in association matters over r the next four to five months, he said. Alliance members, however, do plan to continue paying state dues to retain influence locally.

At least three alliance members have confirmed they would take part in the pullout, according to interviews and published reports: Guillard’s HCR Manor Care, Kindred Healthcare and Sun Healthcare Group. Others are expected to follow suit, Guillard said.

He tried to down play the notion of a major split, which AHCA officials nonetheless clearly fear. Guillard called the 6-year-old Alliance’s move a “win-win” for lobbying efforts, and a natural business progression. The group soon will hire an executive director and staff members, but the situation remains fluid and many details are still being worked out, he added.

Although major chains have chafed at AHCA’s relatively broad agenda in the past, sources familiar with the situation say the straw that broke the camel’s back was AHCA’s conciliatory tone about RUGs refinements in July. AHCA President and CEO Hal Daub praised federal officials for not making cuts that would be too damaging. Meanwhile, Alliance leaders – and top execs at the American Association of Homes and Services for the Aging — criticized the refinements as being too harsh.

Guillard said the Alliance would focus solely on skilled nursing issues, and not other areas such as assisted living and therapy, which AHCA has branched more into in recent years. In a statement, AHCA’s Daub stressed his association’s duty was to a wide range of providers while acknowledging there are  “differences of opinion among some of our members about how to achieve public policy outcomes and we are working to address those concerns.”