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Giving with one hand, taking away with the other

August 20, 2012
by Bob Gatty
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The skilled nursing facility (SNF) community is breathing a sigh of relief with the late July announcement by the Centers for Medicare & Medicaid Services (CMS) of a 1.8 percent market basket update for SNFs for 2013, effective October 1.

While 1.8 percent isn’t a lot, it’s a sight better than last year’s 11 percent reduction for SNFs, pointed out Rachel Reeves, manager of public affairs at the American Health Care Association (AHCA). Overall, it will mean a $670 million increase for SNFS for 2013.

“After years of reimbursement volatility, today’s update to Medicare payments is welcome news to skilled nursing providers,” said Mark Parkinson, AHCA president & CEO. “AHCA appreciates CMS’ balanced approach to this year’s Medicare payment system after recognizing the many rounds of government reductions the profession has already endured. Stable Medicare funding will help ensure America’s seniors continue to have access to high quality, post-acute care.”

But wait. That 1.8 percent increase might not really materialize after all.

That’s because of the automatic sequestration provision of the Budget Control Act, which will require a two percent across-the-board Medicare reimbursement cut for SNFs—estimated by the Alliance for Quality Nursing Home Care at about $782.3 million.

Unless Congress does something to prevent those cuts from taking effect, it will happen beginning January 1.

“While we appreciate CMS’ effort, we are still facing those cuts imposed by Congress,” said Reeves. “We’ve already faced several rounds of reductions in recent years.”

Given the fact that elections are coming up in November, organizations representing the LTC community are urging their members to get active, to support members of Congress and candidates who understand their concerns and who actually act in their favor.

The Alliance put out a press release August 8 saying it has obtained a 50-state analysis of the effects of those looming Medicare cuts, noting that various federal laws and regulations could impose a total of $65 billion in cuts on nursing homes and their patients over 10 years, with some $4 billion slated during FY 2013.

Those cuts, the Alliance says, will affect jobs as well as patients, noting that nursing homes employ about 1.7 million people. Thus, the Alliance is using its analysis to “help inform U.S. senate and House candidates how the successive battery of funding reductions undermine facility operations, disrupt staffing and threaten seniors’ care amid the growing influx of older, higher acuity patients.”

AHCA has urged its members to invite their congressmen and senators and candidates to visit their facilities so they can see for themselves the care that is being provided and the need for adequate funding that exists.   

“If we can show them what is going on, hopefully they will understand and vote in a way that is advantageous to our facilities and patients,” said Reeves. “This is the time. We can look back and see if they were really with us or not. We are looking at not just their words, but their actions.”

In mid-August, Rep. Joe Courtney (D-CT) spoke to residents at a rehabilitation center regarding legislation he has co-sponsored to help resolve the Medicare “observation days” problem, which results in increasing numbers of Medicare beneficiaries discovering their post-acute SNF stays were not covered because they were kept in the hospital for observation rather than being admitted as patients.

Rep. Courtney sponsored the Improving Access to Medicare coverage Act of 2011 along with Rep. Tom Latham (R-IA). Sens. John Kerry (D-MA) and Olympia Snowe (R-ME) sponsored a similar bill in the Senate. The bill specifies that a Medicare beneficiary hospitalized under observation for more than 24 hours be deemed to have been an inpatient and considered to have been discharged upon leaving the hospital. Under these circumstances, the patient would be eligible for Medicare Part A coverage of post-acute care.

“We’re seeing a lot of facilities open up their doors to lawmakers and candidates,” said Reeves. “We are seeing a number of meetings between members of Congress and residents, which is really good. Members of Congress and candidates appreciate the opportunity to meet with seniors, especially during the campaign season, and this is a great opportunity for us to generate support.”

Meanwhile, both AHCA and LeadingAge applauded CMS for issuing a three-year rebilling demonstration project for up to 380 hospitals as part of an effort to streamline access to care.

“CMS’ demo is an important first step in distinguishing the differences in patient classification and allowing proper access to care,” Parkinson said. “The next step is passing legislation that will easily fix this injustice for Medicare beneficiaries.”   

Bob Gatty has covered governmental developments for the trade and business press for more than 30 years. He is founder and president of G-Net Strategic Communications, Sykesville, Md.    

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