This Week In Sweeping Victories…

Parkinson is all smiles this week after a clean sweep of Capitol Hill, White House.

Parkinson is all smiles this week after a clean sweep of Capitol Hill, White House.

Good morning, ProviderNation.

What a week they’re having: The fine folks at AHCA/NCAL had barely sipped their celebratory bubbly after the doc fix vote when CMS announced a $500 million bouquet. That’s a 1.4 percent increase from fiscal 2015, which ends in October.

“The announcement today comes as somewhat of a surprise because CMS typically releases the rule just before May 1,” AHCA/NCAL honcho Mark Parkinson told his members on Wednesday, after the proposed rule came out. “Based on our initial analysis, however, the announcement is welcome news. Skilled nursing providers can expect to see a 1.4 percent increase in their reimbursements beginning October 1, 2015, representing $500 million for the profession. Additionally, there will be no changes to the therapy categories, cut points, or any of the other changes many expected to see.”

And, not that Parkinson wants to seem ungrateful, but the amount could have been even higher. CMS docked skilled nursing because of 0.6 percent “productivity adjustment” under Obamacare, and another 0.6 because of fiscal 2014’s “forecast error,” Parkinson says.

“It’s important to understand that the increases our sector have seen this year and in previous years are not automatic,” Parkinson adds. “Soon after the CMS rule is announced each spring, we begin working immediately on the next year’s rule, employing every resource we have at our disposal to ensure that we get the best outcome we can. This is a good win for our profession.”

Meanwhile, AHCA’s inestimable board chairman, Len Russ, took a star turn before the Health subcommittee of the House Energy & Commerce Committee on Thursday. Russ, a former newsman and current New Yorker, told the panel that he was in favor of post-acute care reform, but that he hoped that legislators would remember just how important his sector was to rehabbing patients.

“We believe PAC reform efforts in today’s health care environment are much more likely to succeed if they recognize the nature of skilled nursing facility patient and resident characteristics and service delivery which differentiate us from other PAC providers,” he testified.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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Don’t Miss The Launch Of Provider’s LED Talks On ProviderTV

LEDTalks2015_AnnaOrtigara

In her LED Talk, Ortigara tells the audience caretaking is “not work just anyone can do.”

Francis refuses to take her pills. George rages about how he was moved from his usual dining table. Eleanor screams for help while she is getting a shower.

Just another day in a nursing home? It doesn’t have to be, according to Anna Ortigara in her LED—Lead, Engage, Discover—Talk titled, “Power: Who Has It, Who Doesn’t, And Why It Matters.”

Ortigara’s talk, and eight other 18-minute Provider LED Talks featuring provocative, inspirational topics, are now available online on the providermagazine.com video extension, ProviderTV. The LED Talks were held in conjunction with the recent AHCA/NCAL Quality Symposium in Texas.

Regarding caretakers and providers, “this is not work just anyone can do,” says Ortigara, who is an organizational change consultant for the Paraprofessional Health Institute in Bronx, N.Y. She calls for a second phase of the culture change movement, in which management personnel coach caretakers who work and have relationships with residents. “Power is when a person in a relationship … acknowledges the relationship and can make things different.”

In the cases above, Francis’ anger is validated, George is consulted before being moved, and Eleanor chooses when to take her shower.

Want to learn more about how to help yourself and your residents? Then watch one or all nine Talks. You may find something that sparks an idea!

Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com. Follow her on Twitter, @ProviderMag.

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The Doc Fix Paddlin’ Machine…

The unresolved doc fix legislation has providers caught in a paddle machine of their own.

The unresolved doc fix legislation has providers caught in a paddle machine of their own.

Good morning, ProviderNation.

You know by now that the doc fix victory has been deferred, even if it hasn’t exactly been denied. Provider advocates we’re talking to are still upbeat: As they see it, the Senate simply didn’t have enough time to pass a permanent fix, but there was clearly overwhelming support for it. (One super-lobbyist we talked to, a Hill veteran, said that senators have referred to the annual doc fix drama as “the paddle machine,” and they are plumb tuckered out from all the paddlin’.)

Whatever happens with the doc fix April 13, when the Senate reconvenes, an unintended consequence of the stall is that providers and families find themselves facing a paddle machine of their own. Because the doc fix legislation expired, Medicare reverted to its old, bad therapy caps, starting Wednesday, April 1. Or as AHCA/NCAL’s inestimable Dan Ciolek puts it, “it puts beneficiaries and therapy providers in a very difficult position.”

CMS has reassured government and provider types that it can belay any automatic doc fix cuts at least until April 14, the day after the Senate comes back from its Easter recess. But the agency hasn’t said what it will do about $1,940 therapy caps that are automatically resumed by the expiration of the last doc fix patch.

I’ll let Ciolek explain:

“For providers, they can either do nothing different and continue to treat beneficiaries for services above the $1,940 cap threshold, and risk not being paid if the bill does not pass, or they can decide to issue an advance beneficiary notice (ABN) to the beneficiary indicating that if Medicare does not pay for the services above the cap threshold, then the beneficiary would be responsible for payment,” he says.

He adds: “For beneficiaries, they—or their caregivers—may need to make a difficult decision whether to continue needed therapy services while hoping the bill passes and Medicare will pay, or they may decide to forgo the needed therapy services until the law is enacted due to concerns that they could not afford it.

“While this unintended consequence may be temporary,” Ciolek says, “it could have a real impact on beneficiary access to needed therapy services until the legislative delay is resolved.”

Again, most observers are optimistic that the Senate not only will pass a permanent doc fix, but will make its action retroactive, meaning the caps won’t matter. But we’ve been close before, only to see the scenery collapse. It would be a real shame if, after all this work, providers were once again asked to assume the position.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

 

 

 

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March Madness…

What, he worry? Boehner hopes for a doc fix buzzer-beater.

What, he worry? Boehner hopes for a doc fix buzzer-beater.

Good morning, ProviderNation.

The doc fix is on the clock. You’ll have heard by now that House Speaker John Boehner, R-Ohio, and House Minority Leader Nancy Pelosi, D-Calif., have worked out an in-principle deal that would repeal Medicare’s sustainable growth rate. But, as AHCA/NCAL top gun Clif Porter tells us, time is running out.

No sooner had those words left Porter’s lips, then Sen. Ron Wyden, D-Ore., called a time out. He said he was worried that some language in the grand bargain would be an attack on abortion rights, which the Distinguished Gentleman referred to as a “non-starter.”

And that’s before the play had been properly diagrammed. One of our Hill reliables tells us that the bill also doesn’t settle that nasty question of who picks up the $170-billion some check. The legislation would try to “limit” the cost of repeal-and-replace by, among other things, cutting post-acute care providers’ Medicare “market basket” to 1 percent starting in 2018.

So much time, so little to see: it’s unusual for this sector to have such attention paid to it, but Fox News’ inestimable Chad Pegram thinks this is the week “that could break the House.”

Then again, it’s the season for shot clocks, what?

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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Fire Sprinklers Once Again Prove Effective

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Stan Szpytek

I would like to yield my blog space to my good friend and colleague, Tom Lia, executive director of the Northern Illinois Fire Sprinkler Advisory Board (NIFSAB). His team produced an excellent press release on fire sprinkler effectiveness  during a recent fire in a skilled nursing facility:

 ORLAND PARK, Ill., Feb. 19, 2015 This morning, a single fire sprinkler controlled a mattress fire at Ballard Rehabilitation, a skilled nursing facility (SNF) at 9300 Ballard Road in Des Plaines, Ill., until North Maine Fire Protection District crews provided final extinguishment. The fire sprinkler system contained the fire to a single room on the second floor and prevented major damage and possible deaths, thereby validating a Centers for Medicare & Medicaid Services (CMS) decision to require fire sprinklers in all new and existing long term care facilities nationwide.

The CMS federal rule requiring fire sprinklers in long term care facilities became effective on Aug. 13, 2013, following a five-year phase-in time frame after publication in 2008. The rule, which applies to SNFs that are regulated by CMS for Medicare and Medicaid licensure, is a direct result of two deadly nursing home fires in 2003—one in Hartford, Conn., and the other in Nashville, Tenn.

“The success of the fire sprinkler controlling the fire should be a reminder to the state of Illinois to follow up on any remaining skilled nursing facilities that have deficiencies,” says Tom Lia, executive director of the nonprofit Northern Illinois Fire Sprinkler Advisory Board.

If cited for deficiencies, SNFs must submit a plan of correction and achieve fire sprinkler installation within three months. After the three-month period, the Social Security Act requires that any facility that is not in substantial compliance will be subject to a denial of payment of new admissions and termination from Medicare participation at the end of six months.

“Fortunately, the Ballard Rehabilitation facility was compliant with the federal rule and protected by a fire sprinkler system,” says Lia. “This successful fire sprinkler activation proves the value of the federal rule and the ability of quick-response fire sprinklers to save lives and property.”

Unfortunately, the effectiveness of fire sprinklers is not fully appreciated until ignition occurs. I would like to thank Tom Lia and other fire and life safety professionals around the country who continue to “beat the drum” every day promoting the importance of installed fire suppression systems in buildings of every type of occupancy classification. While it is purely speculation, the fire that Tom wrote about could easily have been a catastrophic event. Now, it will likely be written up as a health care success story in a future edition of the National Fire Protection Association (NFPA) Journal.

 About NIFSAB

NIFSAB, http://www.firesprinklerassoc.org, is a nonprofit organization dedicated to promoting progressive legislation, raising public awareness, and educating code officials and governmental policy makers by demonstrating the proven performance of fire sprinklers in saving both lives and property.

 Stan Szpytek is the president of Fire and Life Safety (FLS), and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. FLS, www.EMAllianceusa.com, provides life safety and disaster planning consultative services to health care and senior living providers around the nation. He can be reached at Firemarshal10@aol.com.

 

 

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Guest Blog: States Step Up For Safety…

Stan Szpytek

Stan Szpytek

As a life safety/disaster planning consultant having the privilege of working with several state associations affiliated with the American Health Care Association, I have personally witnessed the outstanding work that these organizations are doing to better prepare LTC providers for emergencies and disasters. State affiliates that have developed robust disaster planning and emergency management programs for their members clearly provide a valuable service by not only ensuring that facilities will be better prepared for crisis but will also be in a position to comply with the proposed CMS rule change on emergency preparedness.

A recent project that I completed with the Utah Health Care Association illustrates the type of comprehensive resources and consultative assistance that many state affiliates are providing to their members. This past November, two workshops were scheduled in Salt Lake City and St. George where members and other providers in the state were given the opportunity to review disaster planning concepts and emergency management trends, including the use of the Nursing Home Incident Command System (NHICS).

The morning session of the all-day program was designed to review essential disaster management information, including review of recent real-world events like the fertilizer plant tragedy in West, Texas, where a nursing home was directly impacted by a catastrophic explosion. In the afternoon, attendees participated in an interactive tabletop exercise where they were able to put the concepts learned into practice by simulating the management of a complex scenario involving a hazardous materials incident occurring near their property, first requiring the facility to shelter-in-place and subsequently requiring complete evacuation.

The final part of the day included an overview on how to address a situation involving an armed intruder/active shooter in the health care environment. Attendees learned essential concepts that focused on resident safety as well as personal safety when confronting these types of dynamic events.

The Utah Health Care Association (UHCA) has been a leader in disaster preparedness by providing its members with educational opportunities as well as tangible resources for the past several years. Some of those tangible resources were clearly evident at the November workshops, where every facility in Utah received an NHICS management board (tactical dry-erase chart) and associated tools to help manage incidents that may impact their operations. Additionally, each facility was given a complete triage kit and triage canopy (tent) to enhance their capabilities during mass casualty incidents. All of this material, as well as coordination of the workshops, was provided by UHCA in partnership with the Utah Department of Health with grant funds they receive from the Hospital Preparedness Program (HPP).

While Utah is an excellent example of some of the fine work that state affiliates around the nation have been providing their members, I have been able to see first-hand what other states, including Arizona, California, Colorado, New York, North Dakota, Rhode Island, and Texas have done to help prepare LTC providers for disaster. Disaster planning and emergency management are initiatives that should be high on the priority list of every state association. As we say in Arizona, it is essential that we make sure that our facilities are “Disaster Ready” (which is the name of AzHCA’s disaster preparedness program).

Stan Szpytek is the president of Fire and Life Safety (FLS) and is the life safety/disaster planning consultant for the Arizona Health Care Association (AzHCA) and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 35 years of experience in life safety compliance and emergency preparedness. Email Szpytek at Firemarshal10@aol.com.

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Get Premier Kisov On The Hotline…

The doc fix has become a Stragelove-ian script.

The doc fix has become a Stragelove-ian script.

Good afternoon, ProviderNation. The fine folks at the Congressional Budget Office have gone to the Big Board and done the math on the doc fix. You’ll recall that Congress, after a lot of sound and fury earlier this year, signified little.

That means that docs are facing a 21.2 percent hair cut when the current law expires April 1. (Like all great Doomsday Machines, you see, the doc fix goes off automatically….) You can be sure that Congress-types will be on the wrong end of the hotline for a while.

Some, including Rep. Kevin Brady, R-Texas, are scrambling to avoid Doomsday for the docs in the lame duck session of Congress. That’s probably a long-shot, according to the Lobbying-American types I talked to. Just in case, though, the CBO has run the numbers on some of the proposals that were floated earlier this year. The scores (see for yourself here and here.)

The cost estimates for a permanent fix range from around $119 billion (freeze payments at their current rate for a decade) to more than $204 billion (increase rates by Medicare Economic Index—a kind of inflation calculator for Medicare—for year one, then use MEI to increase physician rates every year thereafter).

The figures are important for a few reasons. First, both parties think the CBO has some astonishingly good ideas; second, the numbers are consistent from last year’s near miss effort at a permanent fix; third, it’s at least some indication to Lobbying-American types about how much will have to paid (if not, sadly, who stays up and who goes down).

In any case, the target is in sight. Now, where the hell is Major Kong?

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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