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AHCA/NCAL: New CMS nursing home regulations 'simply too much'

September 22, 2015
by Bob Gatty
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Bob Gatty

A set of proposed regulations that would impose sweeping new requirements on long-term care (LTC) facilities would be “simply too much” necessitating at least a five-year phase-in period, according to Mark Parkinson, the president and CEO of the American Health Care Association (AHCA), who also owns three facilities in Missouri.

The 403-page proposal was released in July and is designed to slash unnecessary hospital readmissions and infections, increase quality of care and improve patient safety. The estimated compliance cost to the industry would be $729,495,614 in the first year, or approximately $46,491 per facility. The second year cost would be $638,386,760, or $40,685 per facility.

In its summary of the proposed rule, the Centers for Medicare & Medicaid Services (CMS) said the changes are needed “to reflect the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety. These proposals are also an integral part of our efforts to achieve broad-based improvements both in the quality of health care furnished through federal programs, and in patient safety, while at the same time reducing procedural burdens on providers.”

But Parkinson is leading an industry effort to convince CMS to at least phase in its new requirements over five or more years and to give the industry time to figure out how to pay the tab.

Parkinson Video

AHCA/NCAL is urging its members to send letters to CMS explaining the impact of the new rules on their operations. Parkinson also posted a video linked from AHCA’s website, explaining the situation.

“I’m coming to you because this is really important,” Parkinson says in the video, adding that “while there are some good things in the rule, there are some very bad things.” And, collectively, he stressed, “They create too much of our burden on all of our providers.”

Parkinson called for thousands of responses to CMS so the agency understands why the industry cannot accept the new rules. “When you add it all up, it’s just more and more regulation and nothing good for our residents,” he said.

Meanwhile, Parkinson fired off a letter to CMS explaining why the regulations would have a devastating impact on his own company’s operations. He and his wife, Stacy, are part owners of three facilities that offer skilled, long-term stay, assisted living and dementia care.

Letter to CMS

Here’s the text of Parkinson’s letter, which contains key points that AHCA/NCAL is urging other members to use in communicating with CMS about the new rules:

“Most importantly, I am concerned about the residents. The cost in time and expense from this rule will not show up at the bedside. There is an opportunity cost issue. We work to maximize time focusing on resident’s care, resident satisfaction, reducing unnecessary hospitalizations, and other direct-care issues. But, to the extent we are required to spend funds on administrative requirements, no matter how well intended, there is a cost to our residents.

“The burden of implementing these new requirements, when you factor in all the other changes that are already taking place, is simply too much. As a result, I suggest that you phase in these new rules over a five-year period.

“We are already undergoing enormous changes in both delivery of care and in reimbursement. Most of these changes are good. They will lead to a heightened focus on quality. But there is a capacity to our ability to implement change within short time frames. Already we face:

  • Preparing for VBP and the 2% withhold in 2018
  • The advancement of Accountable Care Organizations
  • The voluntary bundles in BPCI
  • The dual demo projects
  • Growth in Medicare Advantage
  • The new bundle project (All of these buildings are in the selected MSAs)
  • Our commitment to the AHCA Quality Initiative and the four goals it sets

“There is a capacity to what we are capable of implementing. As a result, I request a reasoned phase in over at least a five-year period of time.

“CMS has estimated a cost at over $700 million, which I am told averages about $50,000 per building. I believe this is a low estimate. There are several provisions that will require new staff. In the area of infection control there is a requirement of a person who would spend more than half time on this role. But in the CMS cost estimate, there is a salary estimate that only assumes 15% of an FTE time on these functions. Frankly, if the requirement is more than 50%, this cost alone will meet the CMS estimate.

“While I don’t argue with the importance of infection control, or for that matter many of the other provisions in the rule, how are we supposed to pay for this? There is no funding. As a result, CMS should either pay for these new requirements or at the minimum implement the expensive portions of the rule at the back end of a five-year phase in. That way we can work with Medicaid and others to figure out how to pay for this.”




I have lived in nursing homes for almost 20 years under the nursing home regulations from the late 80s and early 90s. Since I spent some time in respite care in a nursing home in 1978, there is a difference.

It would be great if new CMS regulations would actually change the way nursing homes are run. But it probably won't at least not initially.

I have read an e-book written by a woman who was a nursing home aide for 30 years. She said she felt the care was better before the regulations changed and nurses and aides had to document their care. She said doing paperwork required her to spend less time with the residents.

Nursing homes are changing because they have to. Most of the greatest generation – the quiet, giving ones are no longer alive. The baby boomers are and will be coming in to nursing homes.

I wish there were a way to do more and better care and have all long-term care facilities follow the rules.