LeadingAge PA Calls on PA to Overhaul Senior Care System
On January 19, LeadingAge PA called on state government officials to overhaul how the delivery of senior care services is provided in Pennsylvania as part of the next budget process.
Despite being one of the grayest states in the nation, Pennsylvania’s senior care funding is spread out across several agencies, including the Pennsylvania Department of Public Welfare, Pennsylvania Department of Transportation, Pennsylvania Department Aging, Pennsylvania Tobacco Settlement Fund, Pennsylvania Office of Long-Term Living, Pennsylvania Lottery, and the Center for Medicare and Medicaid Services.
“It’s virtually impossible for seniors to work through the labyrinth of bureaucratic line items,” said LeadingAge PA President Ron Barth. “When they can find the programs they need, there are often times waiting lists or enrollment caps because the funding in that particular agency silo is maxed out. For many families, they simply throw up their hands in frustration.”
Pennsylvania also bases funding for many of the programs on outdated 20th century care models. For example, more than $3 billion is set aside for nursing home care, but personal care and assisted living are not funded.
“In fact, we should eliminate the term ‘nursing home’ because they are no longer places where people stay for years,” Barth said. “They’ve become temporary settings for rehabilitation or end-of-life care. The vast majority of the residents will transfer from theinstitutional setting to the community, whether their own home, a personal care home or an assisted living residence, but funding isn’t following them to these settings. Pennsylvania must create a funding system that is centralized andsimple for seniors to use in order to meet their needs in the 21st century.”
Satisfaction surveys help organizations collect data that measure quality; identify areas of improvement…
These are difficult times. Not-for-profit senior care providers have to continuously be aggressive in ensuring their competiveness in a tough market. Good, solid metrics are essential in improving services and marketability, including finding attractive matches for possible collaboration with other health care and service providers. One of these key metrics is the level of satisfaction of residents, resident families, and staff.
Satisfaction surveys help organizations collect data that measure quality; identify areas of improvement; identify performance indicators and key drivers of satisfaction; and provide employee/resident comments and feedback.
Most top flight organizations already do these types of surveys. Many other organizations would like to do well-done professional satisfaction surveys, but find the cost prohibitive.
To help all of our members to be able to do this in a professional manner, LeadingAge PA has partnered with Holleran, a national research firm out of Lancaster, PA, to develop a very affordable, yet professionally driven consumer and staff satisfaction survey.
Members currently taking advantage of this program are enthused. Fran Kuhns, former LeadingAge PA Board Chair and CEO of WRC Senior Services headquartered in Brookville, says, “WRC Senior Services was very pleased with Holleran’s LeadingAge PA satisfaction survey product. We were able to complete a comprehensive and scientific survey of our customers and employees within a very reasonable budget. We had a better response rate than when we completed our surveys in-house! The reports were very easy to read and understand and gave us great benchmarking data as well. I want to encourage more LeadingAge PA members to use this service and product”.
Current LeadingAge PA Board Member, Pat Savage, CEO of Allegheny Lutheran Social Ministries (ALSM) which serves eight counties throughout West Central PA, says, “ALSM has used both the Holleran staff satisfaction survey as well as the resident satisfaction survey product provided by LeadingAge PA. The surveys are comprehensive and address the areas for which we seek feedback. The process and the final product have more than met our needs and provide us with a better baseline to develop a plan of action to address those areas that are not meeting our standard. We appreciated the ease of use of the surveys and the professionalism and positive attitude of Holleran consultants. Thanks to LeadingAge PA for yet another needed product that met our needs in quality and affordability.”
Actual cost for conducting a survey will vary depending on the size of the sample and other varying factors, but I am certain that members will be surprised at how affordable this can be. Every LeadingAge PA member, regardless of size, will now have access to a key metric previously only available to larger organizations.
I encourage every LeadingAge PA member, to seriously investigate this opportunity. For more information on this program, please contact Jocelyn Martin at Holleran at jmartin@holleranconsult.com or 866-736-0474.
CLASS Act in trouble…
It was good seeing so many LeadingAge PA members at the LeadingAge national conference in D.C. As many of you have heard either through attending the conference or through email communications, the CLASS Act is in trouble. HHS is having trouble finding a credible, actuarially sound way to make this successful. The basic problem is that everyone can sign up, but not all need to. Younger, healthier individuals can opt out leaving the program with a top heavy number of older, less healthy beneficiaries. Either premiums would have to be excessively high (which would result in more people opting out) or there would have to be some sort of underwriting to have different premiums based on age and health (which is problematic under the current law).
The basic idea behind CLASS is a good one. People need to take some personal responsibility to plan for future needs for services when they age. Right now, the vast majority of people either think Medicare will take care of everything, or are willing to let Medicaid be their backup plan. The good news about CLASS is even if it is eventually repealed or at least not implemented, it has put the issue of how to fund senior services on the front burner. Congress and the Executive Branch cannot credibly get rid of CLASS without talking about an alternative.
LeadingAge National and LeadingAge PA will be there with ideas when these discussions happen.
Negotiations yield positives for MA participating NFs
We’re officially in the ‘Dog Days’ of summer. Its vacation time for many, and while it might seem that there’s not much happening in Harrisburg, that couldn’t be farther from the truth. As the FY 11-12 budget was being finalized in late June, the Department of Public Welfare (DPW) and the Associations representing Medicaid participating nursing facilities (NFs) were in negotiations (with yours truly and LeadingAge PA playing a prominent role in the deliberations, as always) on a number of issues impacting MA participating NFs. The discussions yielded a number of positives for MA participating NFs. In exchange, we collectively agreed not to oppose an extension of the Budget Adjustment Factor through June 30, 2013 and allow DPW some additional time (until June 30, 2012) to develop and publish a final regulation on ‘Participation Review’ (aka, Bed expansion and/or exception requests) .
In exchange, we got the following:
- DPW’s commitment to update MA rates for the ‘missing quarter’ of claims from July-September 2010, which were still being paid at the April 2009 levels until the recent catch up.
- DPW’s commitment to offer the same payment and recovery schedule when the final FY 10-11 rate adjustments are completed as they allowed when adjusting the FY 09-10 rates.
- DPW’s commitment to send a letter to MA participating NF providers on Hospital Bed Hold Payments, since the revisions to the payment policy (e.g., facilities w/ <85% occupancy will no longer receive Bed Hold Payments) are in effect but the funds have yet to be ‘recouped’ from those facilities who don’t meet the 85% threshold.
- DPW’s commitment to separate out the funding for NF MA rates into a separate line item so we can again more easily track the money appropriated for NF rates in the budget.
- DPW’s commitment to share the actual days of care with the Associations on a periodic basis as the fiscal year progresses.
- DPW’s commitment to engage in additional dialogue around the proposed regulations on Participation Review (e.g. , Bed Need/Exception requests) before moving forward with publication as final.
- DPW’s commitment to begin dialogue with the NF Associations on a potential re-tooling of the BAF and/or re-design of the Case Mix system since the projected BAF of .88595 for July 1, 2011 and .86825 for October 1, 2011 further demonstrate the increasing inadequacy and volatility of the current rate setting system.
These discussions will begin in August and September, and LeadingAge PA will be keeping members posted along the way. Please send your comments or thoughts to russ@leadingagepa.org.
Government – An Unreliable Business Partner
There is no question that the U.S. deficit is a huge problem. For the past several weeks we have been witnessing the twists and turns and the political gamesmanship where both sides seem to be more interested in placing the blame on the other or positioning themselves for the next election rather that seriously dealing with what almost all concede is a crisis.
And who ultimately is always left holding the bag? It is those who have relied on the government as a business partner. Although not directly related to the debt ceiling ruckus, this past Friday, senior care providers certified for Medicare were told that they would receive an 11.1% reduction in reimbursement on October 1. Just like that!! No reduction in requirements for providers, no change in eligibility…government solves the problem by simply reducing reimbursement while assuming – in fact requiring – that its partners will continue to do more with less. Wouldn’t it be great if you could treat your business partners the same way? Let’s see what happens if a provider goes to its utility company or food vendor or medical supply vendor and in essence says “there must be a mandatory 11.1% reduction in what you’re charging me. No, we’re not going to cut consumption, in fact we may require even better service, but we can’t afford to pay you your cost. Just do more with less.” Think that would work?
What is the answer for providers? We know that many providers, especially in very rural or very urban areas, serve fewer clients who can pay privately and currently must rely on government funding. So in the short term the answer is working with LeadingAge PA and LeadingAge (national) to continue our advocacy efforts to get legislators and policy makers to be more familiar with your organizations and show them how impractical these types of cuts are. But in the long term, the answer must be to strategically shift the way services are provided in order to be less reliant on payment from a very unreliable business partner – government.
Value First Group Purchasing Now Available to LeadingAge PA Members
Pennsylvania’s senior care providers have a new option for purchasing supplies and services through an innovative group purchasing organization called Value First, Inc., which is owned by LeadingAge PA along with 25 similar state associations and LeadingAge, our national association.
“Having access to contracts for goods and services negotiated on their behalf by Value First gives our members the ability to stretch their resources and, in turn, better serve older adults in Pennsylvania,” said Ron Barth, CEO LeadingAge PA.
“Aging services is a broad arena, ranging from assisted living to adult day health care to long-term care for the frailest elderly. Value First will help providers who strive for efficiency while providing high quality care in times when healthcare costs are a national concern,” Ron Barth added.
LeadingAge PA is an affiliate of LeadingAge, which represents 5,400 not-for-profit organizations dedicated to expanding the world of possibilities for aging. LeadingAge PA alone has membership of over 350 aging services providers.
“This is an innovative business model that not only makes buying easy and affordable for older adult services providers of all sizes, it helps strengthen the shareholder associations, which advance policies, promote quality services and conduct research that supports, enables and empowers people to live fully as they age,” said Value First President Steve Nielsen, St. Paul, Minn. Value First is managed by shareholder Aging Services of Minnesota, an association similar to LeadingAge PA.
Value First, Inc. is expected to manage $100 million in sales in its first year. Its contracts are being negotiated by MedAssets, Inc., (NASDAQ: MDAS) a national leader in healthcare group purchasing based in Atlanta, Ga.
LeadingAge PA members were sent a packet of information from Value First that included a letter explaining the Value First program as well as some forms that you were asked to sign and return solidifying your participation in the Value First program. If you have not returned these signed documents, please do so. If you have any questions concerning participation or these forms feel free to contact Mario Marchi at 717-790-3952 or e-mail to mario@panpha.org.
Assessing your Readiness for Version 5010
By, Iara Woody, Sr. Finance & Health Policy Associate – Advocacy, LeadingAge
In preparing for Version 5010, facilities should be working with their vendors on their plans, conducting tests, evaluating partners who will be affected and making sure everyone is ready. It is less about making the technical fixes and more about checking in with key people, doing a test and making sure everything is ready.
Below is a checklist provided by CMS to help facilities prepare for the January 1, 2012 compliance date:
- Current transaction versions must be upgraded to Version 5010 and D.0. Medicare has performed a side by side comparison of the current 4010A1 and 5010 base formats. The side by sides do not include errata changes and do not replace the TR3s. To purchase TR3s and access Technical QuestionsX12 please go to www.x12.org or for NCPDP D.0 go to www.ncpdp.org.
- Software must be modified to produce and exchange the new formats (e.g. trading partners must be able to read incoming 277CA transactions sent from Medicare).
- Review business processes to ensure changes are not necessary to capture additional data elements not previously required (e.g. impact of patient registration, billing, and claim reconciliation).
- Contact your vendor and/or clearinghouse to ensure products and processes are updated (e.g. license includes regulation updates, and will the upgrade include acknowledgement transactions 277A & 999).
- Trading Partners should contact their local Medicare-Fee-For-Service contractor (MAC) for specific testing schedules. See www.cms.gov/ElectronicBillingEDITrans/ under downloads, to find a MFFS contractor in your state, or find your operational MAC on this list. For details on testing requirements see the 5010 National Call presentation on Provider Outreach and Education – Transition Year Activities.
- Do not wait to begin testing with your MAC because the MACs will not be able to accommodate large volumes of trading partners seeking production status all at once. Be sure to start testing Version 5010 and D.0 as early as possible in 2011. Be prepared.
To download readiness checklists from CMS and a resource card with helpful web links go to www.cms.gov/Versions5010andD0/40_Educational_Resources.asp#TopOfPage .
LeadingAge PA – moving forward with members
I hope many of you were able to attend our recent Annual Conference in Hershey June 15 -17. Once again it was a great time to hear nationally renowned speakers such as Robert Duvall and best-selling author Tommy Spaulding, learn from experts in breakout sessions, see the latest products and services at our exhibit hall, and make and renew friendships with other LeadingAge PA members.
A major event at the conference was the installation of our new LeadingAge PA Board Chair, Phil DeBaun, Executive Director of Crosslands in Kennett Square. During his installation speech, Phil talked about the fact that our members are going to need to change in order to continue to be vibrant organizations. Medicaid is not going to be a long term solution. Each and every year, our members’ costs to provide nursing home services rise much more than the Medicaid rate. Government is running or has run out of money, and as successful as LeadingAge PA has been in limiting rate decreases the past few years, it will be nearly impossible to continue to protect the status quo.
At our event, I also had the privilege of addressing members. I stressed that LeadingAge PA recognizes that some of our members are currently limited to nursing home services and serve areas where there are few seniors who can afford to pay privately, particularly in very rural or very urban settings. These members don’t rely on Medicaid by choice but out of necessity and we at LeadingAge PA need to be mindful of that. But, the unfortunate reality is that if a member is relying on high Medicaid census for their continued survival, it ultimately won’t work. Medicaid is falling further and further behind in meeting costs. Providers, even those in very rural or very urban areas, MUST act now to think in terms of creating new revenue sources and new types of services for seniors, not just focus on Medicaid reimbursement.
At the conference, I was talking to a longtime PANPHA member who is operating a high Medicaid facility in Central Pennsylvania and he asked a very interesting question. He said “if we shut down tomorrow, would anyone in the State Government even care?”
I thought about that for a moment, and finally had to tell him that the answer was probably “no.” Yet he serves a vital need in his community. So what does he do?
I think this vividly demonstrates what we are saying – Medicaid is not going to be the answer in the long term and the time is short to find alternatives. To be sure, LeadingAge PA is not going to abandon members who are currently reliant on Medicaid. We will do our best to advocate for sufficient funds to allow providers to care for those who, no matter what services are available, will still need Medicaid nursing care. What we ARE saying is that the time to make these changes is NOW. We cannot maintain the status quo.
Many of our members are 100, 150, even 200 years old. Many started out as homes for widows and orphans of the Civil War. Our predecessors have faced major shifts in the past and I know we will be successful in making the necessary shifts now and in the future. But as always the most important thing is to focus on the mission. I believe our members’ mission is to provide quality senior services for those in the community that need them. Over the past 50 years, a major way to meet that mission has been through the Medicaid program and through nursing homes. That era is winding down – not disappearing — but being only part of the way we will meet our missions in the future.
Obviously, there is always going to be a need for the 24-hour seven day a week facility to meet those with extremely complex care needs. But we need to think of these as temporary settings where rehab or perhaps end of life care is done, but where the vast majority of the residents will transfer to a less institutional setting in a matter of months. In fact, I want to eliminate the term “Nursing Home.” It should be a rehab facility, a transitional care facility, maybe the old term “extended care facility”. There will always be exceptions, but the emerging model for what we now refer to as nursing homes, cannot and should not be a place where the majority of residents live for years at a time. When this change occurs, and providers can provide other types of services such as assisted living or personal care, home care, housing with services, this means that people will run out of resources less quickly and not utilize Medicaid. It also means that other, more equitable reimbursement such as Medicare can be utilized for the complex care needs.
LeadingAge PA is committed to providing assistance to all members that are going to change their services. We will provide members data and information on how others are creating new services. We will be available to talk to boards and staff about the need to think differently about services. And we will be changing some of our focus on advocacy.
We recently released a report on LeadingAge PA’s Public Policy Objectives for 2011-2012. In it we say that the time for incremental change is over – that the time is now to advocate for a complete redesign of Pennsylvania’s senior care and services funding. We openly state that this could even result in less of a percentage of state funds for nursing facilities and more of a percentage for other needed senior services. We see the need to transition to a funding system that is need-driven; with funding following consumers to the setting that can most cost effectively provide quality services to meet care needs.
LeadingAge PA will be with members every step of the way as we move into this new era of senior services. We will provide members with the strategic knowledge and the advocacy with government to make this transition a success. Working together, we firmly believe that the best is yet to come for not for profit senior care providers.
PANPHA’s annual conference happens this week in Hershey!
PANPHA’s Annual Conference & Exposition takes place this week, June 15-17, at the Hershey Lodge & Convention Center in Hershey, PA. This year’s event is guaranteed to pack a powerful punch!
On tap for general session speakers are:
- Robert Duvall, “Building Bridges: Relationships that Span the Ages” (June 15th morning general session)
- Dr. James Fowler, “Connected: The Power of Social Networks” (June 15th, afternoon general session)
- Andrew Jenks, “Room 335: Gaining a Different View” (June 16, morning general session)
- Tom Spaulding, “Relationships: A Worthy Investment” (June 16th, afternoon general session)
We’ve also got an amazing line-up of education sessions in store for attendees that will highlight: relationship-building; tools to improve the quality and coordination of care and services; the latest trends in design, operations, consumer preferences and capital markets; and legal and policy updates on critical issues.
On Thursday morning, we will also be honoring this year’s Distinguished Service Awards winners – employees and volunteers from our member communities who go above and beyond in their service to the seniors we all serve.
If you haven’t already registered for this year’s conference, we’ll be accepting registration on site Tuesday through Friday at the Hershey Lodge. For registration and event details, please visit www.panphaconference.org.
We look forward to seeing you there!
PA BUDGET DEBATE ABOUT TO HEAT UP . . . PANPHA ADVOCATES NEED TO BE READY TO MAKE OUR VOICES HEARD
As we noted in our early April webinar on the budget, Governor Corbett’s proposed state FY 11-12 budget proposed a $22.9m state/$51m total cut (roughly a 2% reduction) to MA reimbursement for nursing facilities. While we’re never satisfied with a cut in funding when not-for-profit providers only receive approximately 81% of their costs under the MA program, when compared to the 50% cuts received in the higher education and k-12 education line items, we considered ourselves fortunate have been telling our friends in the legislature that we need them to enact the Governor’s budget as proposed for NF care.
On Wednesday, May 11th, the House Republicans introduced their proposed spending plan which added back the $22.9m that Governor Corbett’s budget cut from the MA line item, and broke out spending for the HCBS Waivers and LIFE programs into their own line item. However, it also plans to ‘save’ $70 million in the nursing facility line item by re-aging claims—recouping the extra payment cycle providers saw when the prompt payment provisions of ARRA were implemented so states could receive the enhanced federal Medicaid matching payment.
The proposal stuck to the Governor’s proposed spending level of $27.3 billion in state funds, in spite of the state fiscal YTD surplus of $506 million (for context, the Governor’s budget projected a year end surplus of $78 million, leaving PA with $428 million more in revenue at present than the Governor presumed when formulating his budget), and restored a number of the cuts to basic k-12 education and the State System of Higher Education. The vast majority of the other cuts to DPW’s budget will be achieved by finding and stamping out fraud in the system–$470 million worth if the House Republicans budget holds. When asked whether he thought there was that much money to be had by the Senate Public Health and Welfare Committee yesterday, Acting DPW Secretary Gary Alexander would not speculate, noting “ . . . we’re going after anything that’s there, but I don’t have the info necessary to know exactly how much money that will save”.
It is important to note that this is but the 2nd step in the budget process. The House will presumably pass the Republican budget—their goal now is before or around the Memorial Day Holiday. It will then go to the Senate which went on record yesterday applauding the House Republicans for their leadership, but noting that the $27.3 million is a starting point, “ . . . not a ceiling” for spending. Meaning, if revenues in May come in over estimates AGAIN, and the state has $500-$600 million in surplus heading into the final budget negotiations in June, some of that money will be on the table for spending in their minds.
As soon as we can evaluate exactly what the House Republican budget proposal means for rates, PANPHA will be sending out an Alert via our Capwiz site asking you to contact your legislators. In delivering your message, we will be asking you to outline the impact that the current levels of MA funding are having on the care you provide to your residents. We’ve linked PANPHA’s one page guide on budget advocacy so you can begin to prepare for your advocacy efforts.
