The BIG Picture: Healthcare reform is coming. So who in LTC cares?

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John O'Connor, Editorial Director
John O'Connor, Editorial Director
The odds that Congress will enact significant healthcare reform may be better than ever.

As of this writing, newly released estimates from the Congressional Budget Office show that the leading plan in the Senate is very close to President Obama's goal of a healthcare bill that doesn't cost more than $900 billion.

Increasingly, people are asking how soon reform will be enacted. Here's my answer: Who cares?

Don't mean to sound flip, but if you're in the long-term care field, that probably should be your position, as well.

When the president, Congress, the media and others speculate about healthcare reform, they are not really talking about eldercare services. What they mean is change in the way hospitals and doctors perform and are reimbursed. These two players always take most of the oxygen out of the room, because they represent where most of our healthcare dollars are spent.

Yes, there are CLASS Act provisions in a Senate measure that will set aside some per diem funding for eldercare services. But even if these provisions actually are enacted, they are far too little, far too late.  

So if healthcare reform is not really about revamping long-term care, does that mean that providers should ignore what is happening in Washington? Absolutely not.

But, if you really want to view developments that are likely to reshape long-term care, my advice is spend less time watching C-SPAN, and more time reading the Federal Register. The daily digest of new rules, regulations and payment suggestions is likely to be a far more effective tool for divining the road ahead.

It also wouldn't hurt to remember Deep Throat's famous advice to Bob Woodward and Carl Bernstein in “All the President's Men”: Follow the money.

And what's happening with the money these days? Well, the dirty little secret is that Medicare is putting a lot of it into long-term care operators' pockets. So much so that some alert federal bean counters are suggesting that patient upcoding is taking place, and it's time to turn down the spigot, especially for higher-end rehab services.

It's fashionable to predict that the future will be much different. But I'm betting it will look a lot like the past. There's been a decades-long contest between operators and regulators about rules and payments. That game seems destined to continue in the coming years, regardless.