IHCA congratulates American Senior Communities on deficiency-free survey

The Indiana Health Care Association (IHCA) would like to congratulate one of its members, American Senior Communities, on one of its facilities, American Village, becoming the first and only nursing home in the state to receive a deficiency-free survey by the Indiana State Department of Health using tough new federal criteria.

Indiana is one of more than a dozen states now using the federally mandated Quality Indicator Survey, initiated in January. The new two-stage survey process requires in-depth investigation, interviews with residents, staff and others and a review of residents’ medical records. It is far more comprehensive than previous surveys, making American Village’s deficiency-free status a significant achievement.

“Congratulations to American Village for all of its hard work and recognition,” said Scott Tittle, President of IHCA. “We are very proud of our members’ commitment to high quality care, and that one of our members is leading the way in QIS.”

American Village, 2026 East 54th Street, is a full-continuum campus offering a wide variety of premiere senior living options.

Indiana owned and operated, American Senior Communities is the largest provider of retirement living and senior healthcare in Indiana, serving fellow Hoosiers for over a decade. American Senior Communities operates over 25 locations in the Greater Indianapolis area and 57 across the state. For more information about American Village and American Senior Communities visit http://www.americansrcommunities.com/.

American Senior Communities is one of the IHCA’s 221 member facilities that care for more than 25,000 of Indiana's geriatric and developmentally disabled citizens, the majority of whom are low-income Medicaid recipients. IHCA is Indiana's largest trade association and advocate representing proprietary, not-for-profit and hospital-based nursing home and assisted living communities, adult foster care and adult day services. For more information on IHCA, visit http://www.ihca.org/.

Memo from AHCA President & CEO Governor Mark Parkinson: "We Must Fight On"

Friday’s news of the final PPS rule dealt us a severe and unnecessary blow. Severe because of the impact it will have on our members, their employees and most importantly, our residents. Unnecessary because AHCA put forth a solution that would have satisfied the goals of the government without threatening our profession.

How could this happen? Here is the CMS line of thinking: CMS intended to spend $31 billion on post-acute care in Fiscal Year 2011; CMS now believes it will end up spending $35 billion in FY 2011. So, for FY 2012, it is reducing spending back to $31 billion. Further, CMS claims that a large part, if not all, of the reason for the $4 billion overpayment was the profession’s behavior. CMS thinks we up coded, gamed the system, or whatever you want to call it. As a result, CMS just doesn’t see the big deal about immediately reducing payments by nearly $4 billion.

Of course, it is a big deal. Most of us find it insulting that SNFs are accused of incorrectly providing inappropriate care. Many of you have not experienced an increase of the magnitude claimed by CMS. We are all concerned that the CMS rule will over-correct for a flawed payment system and result in the government actually spending less than $31 billion in the sector next year. And none of this accounts for the challenges we face with increased costs, drastic Medicaid cuts and the looming threats of additional cuts.

Despite Friday’s result, we must fight on. We cannot allow the impact of this blow to stop us. Our need to work hard, strategically and as a united front has never been greater.


I have directed AHCA staff to take all possible steps to minimize the impact of the rule. Every idea is on the table, and we will thoroughly examine each option, including our legal and legislative options.

Further, we must make certain that this is the last hit that we take this year. Unfortunately, there are still three serious risks that we face. They are:

1. Attempts on the Hill to claw back any unintended payments we received this year.

2. Specific attempts to cut skilled Medicare rates because of persistent arguments that our margins are too high.

3. General cuts to both Medicaid and Medicare that would impact the sector, like cuts in provider taxes and the blended Medicaid rate proposal.

As we develop specific strategies, we will share more information with the membership. At the time, there are at least two ways that you can help us accomplish our goals. First, please continue your political support and activity. Over the last 60 days, our members’ response to our requests for involvement has been stunning. You have sent over 100,000 emails and letters. We have lobbied virtually every Congressional office. This culminated in significant bipartisan support for our balanced approach on the Hill.

The need to exert our political pressure has not diminished just because the final rule has been announced. We need political pressure now, more than ever.

Second, we need examples from members of the economic impact of this rule. CMS states in its rule that it does not believe we will lay people off, freeze wages, stop construction of new buildings or renovations of older ones. We need real world examples of what you have to do to absorb these drastic cuts. Please send those examples to Julie Painter in AHCA Member Services so that we can ensure policy makers understand the effect of this action.

If we let this rule deflate us, it will have beaten us twice. We can’t let that happen. We can’t give up.

It has been said that adversity doesn't build character, it reveals it. How will we react in the face of adversity? Will we give up, walk away and sulk? Or will we channel our disappointment and frustration into an energy to rise up and fight on?

AHCA is ready to rise to the occasion, and with your help, I have no doubt that we can succeed.

CMS Issues Final Rule on Medicare Payments to SNFs

The Centers for Medicare & Medicaid Services (CMS) issued its Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule for FY 2012 this afternoon. The American Health Care Association (AHCA) is conducting an in-depth analysis of the final rule, but AHCA's initial review shows cause for concern and extreme disappointment. The rule ignores a unified message from members, caregivers, lawmakers and stakeholders to find a responsible solution to Medicare payments.

Similar to what was first proposed by CMS in late April, the agency will cut Medicare payments by 11.1 percent starting October 1, totaling $3.87 billion. As you know, these reductions are an attempt to return the Medicare system back to budget neutrality for CMS after implementing RUG-IV and MDS 3.0.
CMS also implemented modifications to group therapy and to Change of Therapy (COT) and End of Therapy (EOT) Other Medicare Required Assessments (OMRAs), virtually without any modification from the proposed rule.

Unfortunately, CMS has disregarded AHCA's sound and reasonable approach to implement modest reductions to SNF payments over multiple years. AHCA's proposal would have protected long term care for seniors, while also achieving the government's goal of a budget-neutral payment system. CMS' action also failed to acknowledge the tens of thousands of letters, emails, and phone calls all of you made to let the agency know how damaging such a drastic proposal would be to the profession and the economy.

These are only the initial findings, and the AHCA team is combing through the 300 plus page final rule. But AHCA have already issued a strongly-worded statement demonstrating its disappointment with CMS for issuing such irresponsible public policy. In the coming days, AHCA will provide an overview and let you know what this means for the Association and the profession. But one thing is certain - AHCA will continue to work with CMS and lawmakers on Capitol Hill to implement regulations and policies that are fair to all involved.

Please keep watch for more detailed information very soon. If you have any questions, please contact Elise Smith, esmith@ahca.org, or Bill Hartung, whartung@ahca.org.

Accountable Care Organizations

By Ellen Ferringer, CPA, CAPPM, Katz, Sapper & Miller, IHCA Associate Member
The face of healthcare is changing. "Accountable care organization" is becoming a common term in the industry. What exactly is an accountable care organization? On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, which empowers the Secretary of Health and Human Services to create a shared savings program to promote accountability of patient care through Accountable Care Organizations (ACO). As defined by the Centers for Medicare and Medicaid Services (CMS), an ACO is an "organization of healthcare providers that agrees to be accountable for quality, cost and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.” Ultimately, Medicare is trying to create an incentive program to reduce its costs while increasing the quality of care provided to patients.

The regulations regarding ACOs are still in proposed form and 427 pages in length. At a very high level, these proposed regulations provide the following requirements of ACOs:

• Provide care for at least 5,000 Medicare beneficiaries (based on their primary care physician)

• Participate in the program for three years, beginning Jan. 1, 2012

• Self-report 65 quality measures to the CMS

• Meet various anti-trust regulations

Under the proposed rule, Medicare would continue to pay healthcare providers for specific services under the Medicare payment systems. The ACO would then receive a share of the cost savings based on their Medicare patient population spending compared to benchmarks determined by CMS. The concept is that by better coordinating patient care between the primary care physicians and the specialists, there will be more information sharing and quality of service will increase, thus reducing costs.

Currently, many physician groups and hospitals are weighing the pros and cons of forming an ACO. Included in this mix are also long-term care facilities. Since they play an important role in keeping hospital readmissions down, long-term care facilities appear to be a perfect partner to hospitals and physicians. CMS estimates there will be 75 to 150 ACOs formed by Jan. 1, 2012. Even with this relatively small number, a huge change in patient care is expected as a result of this Act.

Ellen Ferringer is a director in Katz, Sapper & Miller’s Healthcare Resources Group. For more information, contact Ellen at 317.580.2013 or eferringer@ksmcpa.com.

DOL Issues Bulletin Offering Temporary Solution For Minors Operating Lifts

AHCA/NCAL has been working with the U. S. Department of Labor, Wage and Hour Division (WHD), and State Executives Patti Cullen (MN), Tom Moore (WI), and Shelly Peterson (ND) to obtain clarification to the Child Labor Regulations, Orders and Statements of Interpretation: Final Rule, released on May 20, 2010 that essentially prohibits individuals under 18 years of age from using mechanical lifts in healthcare facilities. View the July 2010 Fact Sheet # 52—The Employment of Youth in the Health Care Industry here.

After a year of discussion, WHD has finally released a Field Assistance Bulletin 2011-3, which states: "While continuing its review of this issue … WHD will exercise its enforcement discretion, and not assert child labor violations involving 16- and 17-year-olds who assist a trained adult worker [someone 18 or older] in the operation of floor-based vertical powered patient/resident lift devices, ceiling-mounted vertical powered patient/resident lift devices, and powered sit-to-stand patient/resident lift devices (lifting devices);" as long as the following conditions are met:

• The child has completed at least the 75 clock hours (if not more) of nurse aide training required under OBRA.
• The child is assisting in the use of the lifting device as a junior member of at least a two-person team that is headed by someone 18 or older.
• As a junior member, the child can set up, move, position, and secure the lifting device. The child may assist a trained adult employee in attaching slings to and unattaching slings from the lifting device prior to and after the lift is completed. The child also may assist an adult in operating the controls. The child may act as a spotter/observer and may position items such as a chair, bed, etc., for the person being lifted.
• As a junior member, the child may not independently engage in "hands on" physical contact with the patient during the lifting process; but instead can only assist in these "hands on" activities when assisting a trained adult.
• The child is not injured while operating or assisting.
• The employer has provided to each child who will assist in the operation of a lifting device a copy of this bulletin.