Tag Archives: Congress

Health Policy Change Coming in Waves, Ready or Not

700Patrick Connole

By now, early in the Trump administration, it is clear that any and all policies are up for grabs. But even as issues like immigration and border security can be altered quickly with the stroke of a pen on an executive order, the changes coming to the Affordable Care Act (ACA) and other health care rules and regulations will take longer to unravel—measured in months and possibly years rather than weeks because Congress must act first.

What these reforms will mean to long term care (LTC), post-acute care (PAC), and assisted living is of course not known. If anyone can figure out how Congress will replace the ACA, and what if anything they decide will be to the liking of President Trump, is beyond a betting person’s capabilities. But one expert in analyzing the LTC-PAC universe says even with D.C.-based changes looming, the attention of providers, especially PACs, should not waver from two fundamentals that will survive: to get your clinical house in order and to get your costs down.

This is because the march toward value over volume and the trend for hospitals to tighten their PAC networks is only going to continue, no matter who resides at 1600 Pennsylvania Avenue, says Shawn Matheson, manager for Leavitt Partners. That doesn’t mean, he notes, that Congress and the administration won’t overhaul existing CMS bundled payment and related demonstration pilots. What it means, instead, is that hospitals and managed care payers will be narrowing networks even if policy goes in new directions.

“In the rapid shift to value-based payments, many hospitals and medical groups are shifting referral patterns and creating PAC value networks,” Matheson says. “I see two main ways of change that have brought about these shifts for hospital-to-PAC referral patterns. The first wave began since fiscal year 2013 when the Medicare hospital readmissions reduction program began and the second wave, a much bigger and much more sudden one, began in April 2016 with the advent of Medicare’s Comprehensive Care for Joint Replacement bundled payment program.”

These policies helped put hospitals on alert to partner with top PAC providers, those that demonstrate high-value outcomes, low-cost spend, and clinical specialization in order to reduce readmissions, he says.

“Bundled payments are creating winners and losers in the PAC space,” Matheson says. “Referrals are going to the high-value providers that can demonstrate value, and those actively willing to work on lowering their length of stay.” There is an inherent risk and reward for a PAC provider participating in bundles in that decreasing your costs has to be offset by the volume of referrals from the hospitals,” he says. “The key is to get hospitals to compensate with volume,”

This is happening even as skilled nursing care centers are being left out of some of this planning in favor of home- and community-based care in many cases. The pendulum, Matheson says, will likely swing back to using PAC providers as the first site of care. This is because more and more anecdotal evidence is emerging that too many patients are coming back to the hospital from the home- and community-based settings who should have gone to PAC care first.

With much of the ACA being eyed by Republicans for replacement, there is still an expectation the pay-for-value movement will survive, albeit in some new forms.

“We think bundled payments will continue in the new administration. CMMI [Center for Medicare and Medicaid Innovation], for example, has significant statutory authority to test payment models. We feel like the Trump administration will use that authority to test the models that appeal to them,” he says.

“Indications are favorable for more state control [under the Trump administration], with states implementing programs through Medicaid system bundles and advanced payment models.”

With this attention to new payment models continuing, the onus will be on providers to state their case to acute care entities. The key idea, Matheson says, is it pays for PAC providers “to really reach out to hospitals, MA [Medicaid Advantage] plans, and managed Medicaid to build stronger relationships.” And with that outreach comes the need for hard, cold data showing real outcomes success in an efficient manner. “Data talks in this new environment,” he says.

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A Capital Month…

Congress is looking at a furious month, and provider advocates are looking at Congress, looking at its furious month.

Congress is looking at a furious month, and provider advocates are looking at Congress, looking at its furious month.

Bill Myers

Washington, D.C.—Good morning, ProviderNation. You know the old joke, that if “con” is the opposite of “pro,” then is the opposite of “progress”—“Congress?”

Dry your eyes (I gotta million of ’em). Because, as AHCA/NCAL’s inestimable Drew Thies points out, Congress is going to be a hot spot this month. The federal budget expires Sept. 30, and, there are some, um, complications to getting a new one done, Thies says:

“There are only 12 legislative days this month when both chambers are in, and schedules are crowded with everything from the papal visit to the contentious Iran deal.

“Making negotiations even more tense are a group of conservative Republicans who are pushing for a showdown over federal funding of Planned Parenthood. Party leaders on both sides of the aisle are hoping to avoid a government shutdown similar to the one in fall 2013, but nothing is off the table.”

Semper Vigilans

Overall, provider advocates have already had a great year in Washington, what with the doc fix and the NOTICE and IMPACT Acts and all. But advocates hear “nothing off the table” a lot differently than you or me. So the watchwords around AHCA/NCAL world headquarters these days is “semper vigilans,” super-lobbyist Clif Porter tells Your Humble Correspondent.

“We’ve had some great early victories this year,” Porter says, “and we’re really pleased that our constructive approach to Congress has created some much-needed space and even friendships on the Hill. But you never rest in Washington. So we’ll be watching the budget battles closely.”


Speaking of the fine folks at AHCA/NCAL (et vigilans), mad props to Caroline Haarman, who has just been appointed chair of the Partnership for Medicaid’s Policy Committee. The partnership is a coalition of 23 groups that represent those providers who rely on Medicaid—the only such industry group of its kind. Haarman’s mission is to help the group look after the least, the lost, and the last.

Golly, and to think we knew her when she was just a senior director for Medicaid policy at some trade association.

AE Is Ready For Their Close-Up, Mr. Chianese

In other news, the fine folks at Advancing Excellence are hosting a world premier right here in the Capital next week. AE has cut nine videos starring Dominic Chianese (best known, of course, for his role as George Mallick in the 1976 “Kojak” episode, “A Hair-Trigger Away”), and Alice Bonner (best known, of course, for her role as secretary of Massachusetts’ Executive Office of Elder Affairs). There’s even a cameo by a managing editor of a certain long term and post-acute care magazine.

AE is using the videos to promote its nine quality goals.

Anyway, if you’re passing through the nation’s capital on Monday the 21st (and really, where else would you rather be?), swing by Forest Hills on Connecticut Avenue NW, or drop a line to indefatigable event organizer Carol Scott.

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

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Play Ball…

The Senate will take up the doc fix "patch" today.

The Senate will take up the doc fix “patch” today.

Happy Opening Day, ProviderNation.

The Senate is scheduled to take up the “patch” to the doc fix today around 5:30 p.m. Eastern time. You’ve already heard that House leaders pulled a bit of their own Fake Out last week with an argument-free voice vote. The House text merely extends the current law (including therapy cap exceptions) until next year.

Lobbying-American types doubt that the Senate will scuff up the bill, because this thing has been in extra innings since 2003. So look for Lobbying-American types to make a call to the pen. Because they could use a little relief.

Play ball, indeed.

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

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Stuck in the Middle…

Good morning, ProviderNation.

Reports of the doc fix’s birth appear to have been greatly exaggerated. American Health Care Association wunderkind Drew Thies breaks things down in yesterday’s Long Term Care Leader and finds that things are, um, stuck in the middle.

“Despite optimism from some on the Hill,” Thies says, “many think that the chances of repealing and replacing the Medicare physician payment schedule this year are uncertain.”

The Senate Finance Committee has already reported its version of the bill out. But things appear to have been gummed up on the House side, as Republicans try to condense three separate versions (one each from the Senate Finance, House Ways & Means, and House Energy & Commerce committees) into one glorious law.

U.S. Rep. Charles Boustany (R-La.) came out publicly last week and said it: Progress “seemingly has stalled.”

“We’re running out of time,” he said.

As you know, Congress has until March 31, either to extend the current system, or repeal and replace it.

“One of the major points of contention,” Thies says, “is where the repeal effort would receive its funding. The Congressional Budget Office found that the Ways & Means version would cost $121 billion over 10 years while the Energy & Commerce and Senate Finance versions are in the $150 billion range.”

Does the doc fix need an injection?

Does the doc fix need an injection?

(Bill Myers)

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Doc Fixins…

Good morning, ProviderNation.

Had a chat with some of My New, Favorite Lobbyists. They’re saying that it’s highly unlikely that Congress will come up with a permanent solution to the vexing “Doc Fix,” this year or even next.

The problem is, Congress can’t even agree on legislation that has already been passed (or something). And now, the super-committee has just a few remaining weeks of the congressional year to fix a problem that has bedeviled legislators for at least a decade? One of MNFLs says that the chances are “slim to negative” of that happening.

That’s good news for providers, at least, because it’s unlikely that they’ll be bled to save the doctors this year. But no one doubts that it will be back.

In other news, researchers say they’ve found a correlation between sleeplessness and Alzheimer’s disease. The fine folks at the American Association for Long-Term Care Insurance say they’ve come up with a handy-dandy guide for all you loyal consumers out there. And providers here in the nation’s capital are making strides in quality care, the George Washington University says in a new study.

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Washington Week in Preview…

Good morning, ProviderNation.

There’s that old, lame joke about the opposite of progress being Congress, but still… Things are In Motion.

Today, House Ways and Means will hold hearings on the so-called “doc fix.” The witness list shows it to be heavy on the physician and hospital association side, but long term care advocates will probably be listening to make sure none of the magic words (like “offset”) pops up.

Also, we’re hearing that U.S. Rep. Fred Upton (R-Mich.) and Sen. Orrin Hatch (R-Utah) are plotting to launch a bill that would overhaul Medicaid. Among other things, the bill would reduce the provider tax to 5.5 percent and vastly expand managed care in exchange for (or do I mean, “to offset?”) more state flexibility. The lobbying types we’ve talked to say the bill’s chances of becoming law are slim (because the Democrats control the Senate, and bills of this type have usually been non-starters), but it’s worth noting because these ideas (like the snail in that other lame joke) keep coming back at the oddest times.

Finally, the long-awaited national immigration bill looks like it’ll be marked up this week. Long term care advocates have pushed hard on this one, saying that they need fresh workers to brace for that Silver Tsunami that we keep hearing about.

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Lest We Forget…

By the way, ProviderNation, amid all the hubbub about yesterday’s sequestration vote, there was something that didn’t happen: Congress didn’t approve a relief package to help the Northeast come back from Superstorm Sandy.

Maybe this will get fixed, and maybe not. (Though I might give Peter King a little personal space for a bit…)

But in the meantime, there are a lot of people in long term care who could use a hand up. You can help New Jersey here and New York here.

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