One-on-one with…Cynthia Morton

Much of the long-term care industry spent 2016 adjusting to new regulations from the Centers for Medicare and Medicaid Services (CMS), but plenty more changes are coming down the road. Editor-in-Chief Pamela Tabar sat down with Cynthia Morton, Executive Vice President of the National Association for the Support of Long Term Care (NASL), the leading national organization for legislative and regulatory matters that affect ancillary services and systems within the long term/post-acute and home care sectors, to talk about what the industry accomplished this year and what’s coming in terms of new regulations in 2017.

What progress have we made in 2016?

The biggest thing is that we began to carry out the first aspect of the IMPACT Act, which is collecting standardized data. We’re now collecting data in the IRF setting and in the skilled nursing (SNF) setting under Section GG. We’ll begin collecting LTACH and home health data January 1. Then, the standardized data elements from those settings will feed into quality measures that will allow quality care data across those settings to be compared with each other. We’ve never been able to do that before.

We also had big additions to the quality measures under the five-star rating system. A couple of them were functional changes, but the others were new measures.

What does everyone in LTC need to focus more on in 2017?

The importance of nursing and administrative leadership, especially in this new era of data collection. Judi Kulus [Vice President of Curriculum Development, AANAC] talks about constantly encouraging your staff to realize why they’re doing what they’re doing, and why they’re documenting thoroughly every day. Don’t train them to just “check the box,” because later on, when it matters as a quality measure, they may not be doing enough. That’s a culture change and that’s a very operational change, too.

The reporting period runs every quarter, and if you don’t complete 80 percent of your MDS with a 100 percent completion, you’re going to lose your 2 percent. So, the stakes are high.

What else is changing in 2017?

Another big change will be the CPT code sets under Medicare Part B. CMS is about to adopt completely different physical therapy and occupational therapy evaluation codes and re-evaluation codes. These won’t be “timed codes” anymore, they’ll be per session. The new policy will be in the Physician Fee Schedule effective Nov. 17. So, everyone needs to get busy training on that now.

Meanwhile, the therapy cap exceptions process expires on December 31, but we don’t think Congress will wait until the end of the year to either extend it another year or maybe try to repeal the cap. Or else they’ll deal with it early in 2017 because they’ll want to attach it to something else moving ahead early in the year.

Any heads up on additional quality measures coming from CMS?

CMS may continue to propose quality measures in the April payment rule for Part A. We could see a quality measure around transfer of data and care preferences.

How might the Trump Administration affect Medicare/Medicaid?

There’s always the chance of Medicare and Medicaid changes, including the entitlement part and reform of Medicaid. A Trump Administration could allow more of a pathway for the House Republicans to reform Medicaid and maybe block grants or make per capita caps.

How can LTC organizations get involved in what CMS is doing?

CMS has been rather transparent about the draft measure formulas, and there’s a clear process to rule-making. I would encourage everyone to listen to the CMS “open door forums,” and when a proposed rule is announced, send in comments. CMS really does read those comments. But don’t wait—the comment period can go by quickly, and then CMS will go into the formal rule-making.

Want to learn more on what’s ahead for 2017? Join us at 1 p.m. Dec. 7 to hear Morton talk about CMS policy under a Trump Administration and how LTC can position itself for success. Register for the hour-long webinar, eligible for 1 CE credit, here. 

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.