talking points 2014 ALL - ahcancal.org · TALKING POINTS QUALITY As Congress attempts to address...
1
TALKING POINTS QUALITY As Congress attempts to address fiscal challenges, Members of Congress should recognize the strides skilled nursing providers are making. In 2012, the American Health Care Association (AHCA) launched the Quality Initiative to safely reduce hospital readmissions, increase staff stability, increase customer satisfaction, and safely reduce the off-label use of antipsychotics over the next three-years. Customer satisfaction remains high among long-stay residents (89%) and their families (87%), and short-stay patients’ satisfaction has significantly improved in recent years to 87%. AHCA continues to work with Centers for Medicare and Medicaid Services (CMS) to advance quality goals in conjunction with the five star system. MedPAC confirmed that in 2012, Skilled Nursing operated on razor-thin, 1.8% margins. This number takes into account Medicare, Medicaid, and private pay but does not take into consideration the 2% sequester cut. A series of cuts over the last five years has resulted in little or no margin in the skilled nursing profession—two productivity adjustments, the sequester and sequester extensions, reductions in bad debt reimbursement, and a value-based purchasing cut. Further reductions to the profession threaten access to care for millions of Americans. Private entities are reluctant to invest. Real estate investment trusts are pulling away from skilled nursing. We want to be ready for reforms and new payment models and have actively worked with Congress on payment methods that are agreeable in the place of arbitrary cuts. SETTING RECORD STRAIGHT ON SNF MARGINS AND MEDICARE CUTS THERAPY OBSERVATION STAYS Medicare Part B therapy services enable beneficiaries to maintain their highest level of functional independence following illness or injury. These cost-effective services help avoid costly readmissions, and often facilitate the return to community-based living. However, patient access is restricted by annual per-beneficiary benefit limits (therapy caps). This process also includes mandatory manual medical review (MMR) arbitrarily set at $3,700 that is inefficient and disproportionately impacts patients with the greatest health care needs Beneficiaries and providers need the stability provided by permanent patient-centered improvements. Ask Congress to enact a permanent repeal of the Part B therapy caps, along with necessary improvements to the current medical review and data collection processes. A three-day in-patient hospital stay is required for patients to be admitted to a skilled nursing facility under Medicare Part A. The observation status used by hospitals is technically deemed an outpatient service, while often patients are in the hospital for several days. In many cases patients are not told whether they are classified under observation status or as an inpatient. This is a hardship for seniors who thought their skilled nursing stay would be covered by Medicare and could be facing thousands of dollars in out-of-pocket costs. Ask your Member of Congress to ensure observation stays count toward the required three-day stay by co-sponsoring the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179/S. 569). There are nearly 750,000 residents in assisted living communities, 19% of whom rely on Medicaid funding. Assisted living communities care for the “oldest old” in our society according to the latest federal government research. Nearly 40% of assisted living residents have Alzheimer’s disease or dementia. It is the second most common diagnosis after high blood pressure. The care needs of assisted living residents are rising. A full 38% of assisted living residents receive help with 3 to 5 activities of daily living. Nearly 90% of assisted living communities offer Hospice services through outside Hospice providers. KEY FACTS 1201 L Street NW Washington, DC 20005 www.ahcancal.org In 2013, Medicaid underfunded nursing facility care nationally by $7.7 billion, an average of $24.26 per patient, per day. Skilled nursing centers have been hit with rounds of reductions to Medicare through health care reform, administrative changes, sequestration and as well as other cuts, totaling over $27 billion over the past five years. Approximately 70% of skilled nursing facility costs are labor related. The long term care community provides 3.1 million jobs directly and supports 5.4 million jobs, making it the 10th largest employer in the nation. Long term care generates $529 billion in economic activity and generates $60.9 billion in taxes, thereby contributing to 3.7% of the nation’s GDP 4.1 million Americans received care in a skilled nursing center in 2012. 64% of nursing center residents rely on Medicaid funding for their long term care. 14% of skilled nursing patients rely on Medicare funding for their short-term, post-acute care. Recent data demonstrates that individuals receiving care in skilled nursing centers have increasing care needs, adding to the range and scope of services provided by these facilities. Data suggest that skilled nursing centers represent the lowest-cost institutional setting for post-acute care KEY FACTS
Transcript of talking points 2014 ALL - ahcancal.org · TALKING POINTS QUALITY As Congress attempts to address...
TALKING POINTS
QUALITYAs Congress attempts to address fiscal challenges, Members of Congress should recognize the strides skilled nursing providers are making.
In 2012, the American Health Care Association (AHCA) launched the Quality Initiative to safely reduce hospital readmissions, increase sta� stability, increase customer satisfaction, and safely reduce the o�-label use of antipsychotics over the next three-years.
Customer satisfaction remains high among long-stay residents (89%) and their families (87%), and short-stay patients’ satisfaction has significantly improved in recent years to 87%.
AHCA continues to work with Centers for Medicare and Medicaid Services (CMS) to advance quality goals in conjunction with the five star system.
MedPAC confirmed that in 2012, Skilled Nursing operated on razor-thin, 1.8% margins. This number takes into account Medicare, Medicaid, and private pay but does not take into consideration the 2% sequester cut.
A series of cuts over the last five years has resulted in little or no margin in the skilled nursing profession—two productivity adjustments, the sequester and sequester extensions, reductions in bad debt reimbursement, and a value-based purchasing cut.
Further reductions to the profession threaten access to care for millions of Americans.
Private entities are reluctant to invest. Real estate investment trusts are pulling away from skilled nursing.
We want to be ready for reforms and new payment models and have actively worked with Congress on payment methods that are agreeable in the place of arbitrary cuts.
SETTING RECORD STRAIGHT ON SNF MARGINS AND MEDICARE CUTS
THERAPY
OBSERVATION STAYS
Medicare Part B therapy services enable beneficiaries to maintain their highest level of functional independence following illness or injury. These cost-e�ective services help avoid costly readmissions, and often facilitate the return to community-based living.
However, patient access is restricted by annual per-beneficiary benefit limits (therapy caps). This process also includes mandatory manual medical review (MMR) arbitrarily set at $3,700 that is ine�cient and disproportionately impacts patients with the greatest health care needs
Beneficiaries and providers need the stability provided by permanent patient-centered improvements. Ask Congress to enact a permanent repeal of the Part B therapy caps, along with necessary improvements to the current medical review and data collection processes.
A three-day in-patient hospital stay is required for patients to be admitted to a skilled nursing facility under Medicare Part A.
The observation status used by hospitals is technically deemed an outpatient service, while often patients are in the hospital for several days.
In many cases patients are not told whether they are classified under observation status or as an inpatient.
This is a hardship for seniors who thought their skilled nursing stay would be covered by Medicare and could be facing thousands of dollars in out-of-pocket costs.
Ask your Member of Congress to ensure observation stays count toward the required three-day stay by co-sponsoring the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179/S. 569).
There are nearly 750,000 residents in assisted living communities, 19% of whom rely on Medicaid funding.
Assisted living communities care for the “oldest old” in our society according to the latest federal government research.
Nearly 40% of assisted living residents have Alzheimer’s disease or dementia. It is the second most common diagnosis after high blood pressure.
The care needs of assisted living residents are rising. A full 38% of assisted living residents receive help with 3 to 5 activities of daily living.
Nearly 90% of assisted living communities o�er Hospice services through outside Hospice providers.
KEY FACTS
1201 L Street NW Washington, DC 20005www.ahcancal.org
In 2013, Medicaid underfunded nursing facility care nationally by $7.7 billion, an average of $24.26 per patient, per day.
Skilled nursing centers have been hit with rounds of reductions to Medicare through health care reform, administrative changes, sequestration and as well as other cuts, totaling over $27 billion over the past five years.
Approximately 70% of skilled nursing facility costs are labor related.
The long term care community provides 3.1 million jobs directly and supports 5.4 million jobs, making it the 10th largest employer in the nation.
Long term care generates $529 billion in economic activity and generates $60.9 billion in taxes, thereby contributing to 3.7% of the nation’s GDP
4.1 million Americans received care in a skilled nursing center in 2012. 64% of nursing center residents rely on Medicaid funding for their long term care.
14% of skilled nursing patients rely on Medicare funding for their short-term, post-acute care.
Recent data demonstrates that individuals receiving care in skilled nursing centers have increasing care needs, adding to the range and scope of services provided by these facilities.
Data suggest that skilled nursing centers represent the lowest-cost institutional setting for post-acute care
KEY FACTS
