What Isn’t Happening In AL Regulation…

Our author, wearing his Serious Face, searching for evidence of things not seen… (Photo courtesy Andrew Harnik.)

Bill Myers

Good morning, ProviderNation. Sorry to distract you from all the mesquite and margaritas down Texas way,* but the fine folks at the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services (say that 10 times, real fast) have done some thinking on state regulations of assisted living centers.

The short version seems to be: There’s a lot of them. The full report is here and the executive summary is here.

Most folks agree that the business of elder care is in its revolutionary age (and many assisted living advocates see their sector as the vanguard of that revolution), so it’s interesting to note what isn’t happening even as the profession grows.

Regulatory Certainty

In many other areas, as the businesses grow and diversify, it’s reasonable to expect that at least some of the bigger players advocate for federal regulations. The shibboleth here is, of course, “regulatory certainty,” in which bigger players argue simplifies political economy for everyone. Take whatever you like about the argument, what’s fascinating is the extent to which you just don’t see that kind of advocacy from assisted living providers.

Part of it, a Royal Smart Person tells me, is that, having taken a look a good look at what “regulatory certainty” means for their skilled nursing cousins, many assisted living providers offer a polite, “No, thanks.” (There’s also the fact that, however large assisted living companies have grown, no single player—or even combination of players—is big enough to warp the market.)

But part of it goes to the very revolutionary character of the profession, the smart person adds. Assisted living providers pride themselves on person-centered care, above all else. However you define person-centered care, the essence of it is flexibility. Therefore, any effort to govern from On High jeopardizes the very innovation, dynamism, and rapid-fire responsiveness that many advocates feel defines assisted living.

Alphabet Soup

Speaking of the alphabet soup of regulatory agencies, the good people of CMS and the National Coordinator for Health Information Technology have released final rules that backers say will “simplify requirements and add new flexibilities [cq] for providers to make electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange that information.”

CMS’ version of the rules is here and the coordinator’s rules are here.

*And, if you’re not following all of the white-hot, provider-on-provider action as reported by our Managing Editor, the Formidable Jackie Oberst, on Twitter, well,  you go to penalty box…

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

A Series Of Tubes…

 

The Interwebs will be busy this week, our Humble Correspondent reports (Photo courtesy fine folks at Wikimedia Commons.)

Bill Myers

Washington, D.C.—Good morning, ProviderNation. The fine folks at AHCA/NCAL are taking to the Interweb Thursday for one of those elephant-in-the-room conversations about workplace violence.

As AHCA/NCAL’s Divine Adrienne Riaz-Khan points out*, nearly 70 percent of workplace assaults occur in health care settings, and the fine folks at OSHA have taken a harder look at the problem. The Webinar will be held at 2 p.m. EST and will feature Jackson Lewis P.C. superstar Nickole Winnett.

Very, Very, Very (&c.) Important

Speaking of Thursdays and people who are Very, Very, Very, Very, Very, Very Important, Your Humble Correspondent is looking forward to his grand entrance at Unique Residential Care Center’s Fifth Anniversary Gala, wherein the fine folks will celebrate their whole shelf of awards here in our nation’s capital.

Mazel tov, kids. Mazel tov.

Minnesota’s North Stars

Meanwhile, the fine folks at the Sabo Center for Democracy and Citizenship and Bipartisan Policy Center will host a Webinar of their own (why didn’t I copyright this whole Webinar thing?) next Thursday, Sept. 24, from 1 p.m. EST until 5 p.m. EST.

They’ve got themselves a star-studded lineup, including former Sen. Byron Dorgan (D-S.D.), former U.S. Rep. Martin Sabo (D-Minn.), and former U.S. Rep. Vin Weber (R-Minn.), who’ll wrestle with the policy challenges of an aging population.

MedPAC Recycling

Whatever else one thinks of the fine folks at MedPAC, let’s give them credit for reducing their carbon footprint by their willingness to recycle ideas. The group’s next congressional report is due next summer, but this week they released some initial data. AHCA/NCAL’s unsinkable Dianna Dorman quotes MedPAC as follows:

“… the Commission has long been concerned that the existing payment system does not encourage quality care and creates wasteful spending, noting there is substantial overlap of patients across settings, skilled nursing centers have incentives to encourage unnecessary therapy services and avoid certain patients, and a common assessment tool does not exist…”

Why does Your Humble Correspondent have this sinking feeling that MedPAC is going to harp on skilled nursing’s Medicare margins, and recommend even more managed care?

*I recognize that she’s dealing with workplace violence, but if you do not kneel before Adrienne, I will fight you.

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

 

I Didn’t Get a Harumph Outta That Guy…

Good morning, ProviderNation.

If you missed it yesterday, CMS took a chunk out of the long term care industry. Testifying before the Senate Finance Committee, Melanie Bella, director of CMS’ dual-eligibles effort, took aim at rehospitalizations, which she said “could be disruptive, dangerous, and costly.”

Sen. Max Baucus, D-Montana, had a follow-up. “What are you doing to help minimize providers gaming the system?” he asked Bella. “There’s a lot of gaming going on, I suspect.”

“It is part of the problem, and what we’re trying to do is establish accountability for the dollars,” she replied. “Today, they might be able to play Medicaid and Medicare against each other … but when they’re responsible … you take away some of those incentives for gaming those two payers.”

This didn’t sit well with industry types. “There’s no question that dual eligibles are a cost driver in today’s system,” said Jeff Myers, AHCA’s top lobbyist. “But we need solutions and are committed to helping find them. Unfair accusations serve no one, especially those elderly who need this care the most.”

Sen. Jay Rockefeller, D-W.Va., also wasn’t hip to CMS’ vibe. He said he didn’t trust CMS’ assurances that they were merely testing “proposals” for managed care. “This is a losing situation for dually eligible beneficiaries as well as federal and state programs trying to deliver the effective, high-quality care they need and deserve,” Rockefeller said.

There are a lot of subtexts here. The Obama administration won a decisive victory, but the Affordable Care Act remains its most unpopular piece of legislation. And Republicans, though wounded by last month’s elections, aren’t dead. What better way, then, to reassure the budget conscious, than with a good, old-fashioned harrumph against “gaming?”

Meanwhile, industry is fighting a multi-front battle against further spending cuts. To some insiders we’ve spoken to, these accusations of gaming—are, shall we say, curiously timed.