The top lobbyist for a major national long-term care organization is optimistic there will be fewer mandates from the federal government and less bureaucratic control over the industry now that Republicans control both Congress and the White House.

“In many cases, our operators are focused on what we can get rid of because we’ve been so incredibly overburdened in recent years,” says Clifton J. Porter II, senior vice president, government relations at the American Healthcare Association/National Center for Assisted Living (AHCA/NCAL) to healthcare reporters in a post-election conference call late in November.

“We all thought it would likely be a divided government, so we had a game plan and strategy to more or less manage in that atmosphere. November 8 came as a shock to all of us.”

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Still, Porter says, AHCA/NCAL’s will continue to focus on quality care and developing solutions, “setting goals that our members can aspire to, to raise the watermark for all and most importantly for the patients we serve.”

Maintaining sufficient reimbursement for services has always and will continue to be top priority for the organization, Porter stressed. “To achieve excellence and improve quality results, we have to assure that we are funded appropriately.” That means funding streams of the Centers for Medicare & Medicaid Services must also remain strong.

Thus, the industry will closely watch the expected move to drastically change Medicare by some Republicans in Congress, including House Majority Leader Paul Ryan, R-Wis, and House Budget Committee Chairman Tom Price, the Georgia orthopedic surgeon nominated by President-elect Donald Trump as secretary of Health and Human Services (HHS).

A strong critic of the Affordable Care Act (ACA), Price has sponsored the Empowering Patients First Act, which would provide tax credits so beneficiaries can opt out of Medicare, Medicaid or Veterans Affairs benefits and purchase their own individual plans.

AHCA/NCAL applauds nominations

“We’ve had a long and productive relationship with Mr. Price over the years,” Porter says. “He has been unafraid to express concerns over oversight of CMS. We’re excited about him leading HHS (because of) his experience as a caregiver, as a physician and he understands in a great level of detail what’s required to deliver quality.”

Mark Parkinson, president and CEO of AHCA/NCAL, says “Chairman Price is known throughout the country not only for his medical expertise, but also his breadth of policy when it comes to the nation’s healthcare system. He is a champion of forward-thinking ideas that improve lives and deliver solutions, and our profession looks forward to working with him upon his confirmation.”

The organization also welcomed the nomination of Seema Verma, president, CEO and founder of SVC, Inc., as CMS administrator. “She will bring a smart, fresh perspective, and AHCA/NCAL is committed to working with her to help shape an effective healthcare system that improves lives and delivers quality care for millions of patients,” Parkinson says.

“We’re excited about these nominees,” said Porter. “Both will be proactive voices who understand the healthcare system. Price’s role in actually delivering care will add insight in that role that we’ve not had in the past.”

Issues in Play

Meanwhile, Porter told reporters he is optimistic that several of AHCA/NCAL’s key objectives will find success under the new regime.

Center for Medicare & Medicaid Innovation (CMMI)

AHCA/NCAL has strongly opposed CMMI’s mandatory bundled payment model for hip and knee replacements, which took effect in April. Noting that Price asked CMS in September to “cease all current and future planned mandatory initiatives under the CMMI, Porter says he expects the mandatory nature of these bundles to go away.

The center’s original purpose was to support new models of care and payments under Medicare and Medicaid, and Ryan’s plan to repeal the ACA would wipe it out. Some in the healthcare industry want to make the center more accountable to Congress while still providing solutions to help improve outcomes and reduce federal health spending.

CMMI is a part of the ACA, which is expected to be dismantled by the new Congress and President, but suggested Republicans may use its authority to their own ends. “They may see this as a way to advance their own ideas and use the agency to curb costs,” Porter surmised.

Requirements of Participation Regulation

On Sept. 28, CMS published its final rule on health and safety standards long-term care facilities must meet to participate in Medicare and Medicaid. CMS says the revised policies are intended to reduce unnecessary hospital readmissions and infections, improve the quality of care and strengthen safety measures for residents.

AHCA submitted extensive comments to CMS expressing concerns with some of the approaches proposed by the agency. In its comments, AHCA said the rule “asks for too much, too soon, and at too great a cost.” Porter says reversing the rule is a top priority.

Value-Based Purchasing Bill

AHCA issued a statement saying the proposed Medicare Post-Acute Care Value-Based Purchasing Act of 2015 (H.R. 3298), “while well-intentioned, does not represent the best way forward in implementing value-based purchasing policy for SNFs and across the post-acute space. The program would place an undue financial burden on SNFs and does not create the appropriate incentives for providers to improve quality.”

The proposal would withhold 8 percent of Medicare payments and redistribute 50-70 percent of the withholding as an incentive pool rewarding quality improvement.

“I don’t think this necessarily goes away,” Porter says, noting the effort to repeal and replace the ACA could affect the outcome of this legislation.

Arbitration Rule

The organization has opposed CMS’ arbitration rule, scheduled to take effect Nov. 28, but was blocked by a federal court’s granting of an industry-sought injunction. The rule prohibits long-term care facilities from requiring residents to sign binding pre-dispute arbitration agreements.

“We’ll see how the administration responds to the rule and the lawsuit,” Porter says, adding Republicans in the House and Senate oppose the rule and “we would hope the next administration would reflect the will of the Congress.”

Observation Stays

Porter hopes observation stays will be addressed in 2017, but how the administration may do so remains to be seen. The Congressional Budget Office has said fixing observation would cost a significant amount of money, Porter says. The question, then, is how will the new administration be able to fix the dynamic scoring at CBO.”

Robert Gatty has more than 40 years of experience in journalism, politics and business communications and is the founder and president of G-Net Strategic Communications based in Myrtle Beach, South Carolina. He can be reached at bob@gattyedits.com.

Robert Gatty

Robert Gatty has more than 40 years of experience in journalism, politics and business communications and is the founder and president of G-Net Strategic Communications based in Myrtle Beach, South Carolina. He can be reached at bob@gattyedits.com.