Nursing home lobbying groups have to make hard sacrifices in the face of the recession. Healthwatch reports that the American Health Care Association (AHCA) and The Alliance for Quality Nursing Home Care (AQNHC) will merge under the banner of the AHCA.  The two groups have been forced by economic realities to form one advocacy group. They hope that the merger will bring about one unified voice to lobby for the nursing home industry.  

They complain that if Medicaid continues to cut prices, residents will suffer, and with the Baby Boom generation getting older, nursing homes will be facing more residents, adding increased pressure to the new AHCA. Advocating as the new AHCA, the two groups will be facing increasing pressures in the future.

See articles here and here.

The nursing home industry is donating large amounts of money to politicians who protect their interests especially their profits.  Several articles have mentioned the $175,000 given to Republican Utah Senator Orrin Hatch. If he wins reelection, Hatch may be chair of the committee that has jurisdiction over the tens of billions of Medicare and Medicaid dollars that flow annually to nursing homes.   Maybe they should use that money to hire staff.

A political action committee representing radiologists has spent about $77,000 supporting his candidacy through print ads and other activities conducted. The contributions show how some interest groups are demonstrating their support for Hatch beyond the $10,000 limit that political action committees must abide by when contributing directly to a candidate’s campaign.

Nursing homes rely heavily on federal reimbursements for profits. The federal government’s Medicare program is projected to spend about $31 billion on nursing home care in 2012. Medicaid, a federal-state partnership, will spend about $45 billion with nursing homes, according to Health and Human Services Department projections.

The nursing home industry’s lobbying group, The Alliance for Quality Nursing Home Care, represents 12 companies owning about 1,400 properties throughout the county. The Alliance for Quality Nursing Home Care provided the largest donation of the year, $100,000, records show. The group then kicked in another $75,000 this year already.

Although the money was given with no strings attached, according to Republican party officials, there is little illusion as to its real purpose: to buy influence.

See articles at McKnight’s, CBS, and Business Week.

 

Kaiser Health News had an interesting article about Maine’s attempt to control health care costs by limiting the amount an insurance company can profit from being a middle man in the health care industry.

A lawsuit brought by a Maine unit of WellPoint – one of the nation’s largest health plans. Anthem Health Plans of Maine argues that regulators violated state law and the U.S. Constitution when they reduced requested premium increases in each of the past three years, depriving the company of "a fair and reasonable return."  How do you determine what is a fair and reasonable profit?  The insurance industy is challenging the authority to determine what is fair and reasonable.

The main issue is whether the rates approved by Maine regulators were "inadequate."   Maine regulators and the attorney general say that state law and the Constitution allow them to ensure consumers are not overcharged by a financially healthy company. Anthem, they said, was strong financially and wouldn’t be harmed by a smaller profit margin.

Many states have laws similar to those in Maine. The District of Columbia and 26 states have the authority to veto rates deemed excessive for some types of insurance, generally policies sold to individuals and small businesses.  

Several states are increasing oversight of premium increases.  In New Mexico, lawmakers approved a law expanding regulators’ review of insurers’ finances to include how much they hold in surplus and reserves. Growing financial reserves were cited by Oregon regulators in July when they reduced a requested 22 percent increase by Regence BlueCross Blue Shield to 12.8 percent, even though that meant the insurer would lose money on policies sold to individuals.

 

Tara Higgins from The Rosen Group sent us an interesting article about the health care industry’s recent lobbying efforts.  "The First Street Research Group has explored some of the lobbying activity behind recent long-term care legislation and profiles one of the major long-term care associations, the Alliance for Quality Nursing Home Care (AQHNC). The First Street report examines the recent lobbying activity of AQHNC, as well as legislation the organization has supported."

"Proprietary research provided by First Street™ Research Group” In addition to the report, the First Street Coalition Builder has created a visual representation of the report data (see below).

For more information about First Street, or to arrange an interview with one of First Street’s lead product managers, please contact Tara at 202-862-4372 or tara@rosengrouppr.com. 

Overall Highlights:

AQNHC has spent almost $15 million on its lobbying activity since 2006.

Since 2006 AQNHC has spent over $10 million on 12 different lobbying firms.

AQNHC has lobbied on 29 pieces of legislation since 2006.

S.159: Confidence in Long-Term Care Insurance Act of 2011 was lobbied on by 8 organizations that combined spent nearly $23 million on all of their lobbying activity in 2011.

H.R.63: Long-Term Care Insurance Reform Act of 2011 was lobbied on by 8 organizations that combined had spent over $23 million on all of their lobbying activity in 2011

S.1486: Long-Term Care Hospital Improvement Act of 2011 was lobbied on by just 1 organization that spent spent $800,000 on all of its lobbying activity during 2011 Q1.

 

The Hill reported that the nursing-home industry is spending multimillions to lobby to protect their profits and prevent any Medicare and Medicaid cuts despite record reimbursement rates and profits. The industry says current rates have cut staffing and an inability to provide care.

CoStar Group had an article arguing that cuts will create opportunities for the largest and most diversified publicly traded owners of long-term and post-acute care real estate to buy up financially weakened operators.  For example, Ventas, one of the larger owners of nursing home space, leases most of its skilled nursing and hospital assets to Kindred Healthcare, the largest post-acute provider in the U.S. with over $6 billion in annual revenues and equity market capitalization of over $500 million.

 

USA Today had two related articles recently about the high cost of hospice and how for profit chains have manipulated the Medicare reimbursement rules to generate incredible revenue.  Medicare costs for hospice care have increased more than in any other health care sector as for-profit companies continue to gain a larger share of the end-of-life medical market.  From 2005 through 2009, Medicare spending on hospice care rose 70% to $4.31 billion.

A recent report by the inspector general for Health and Human Services, which oversees Medicare, found for-profit hospices were paid 29% more per beneficiary than non-profit hospices. Medicare pays for 84% of all hospice patients. At the same time, some of the nation’s largest for-profit hospice companies are paying multimillion-dollar settlements for fraud claims and facing multiple investigations from state and federal law enforcement agencies while lobbying Congress to pass tort reform and increase reimbursements.

Critics say costs have also increased because for-profit organizations have cherry-picked patients who live the longest and require the least amount of care — such as those with dementia or Alzheimer’s, rather than those with cancer. From 1998 to 2008, Alzheimer’s and dementia hospice cases grew from 28,000 to 174,000, reports the Medicare Payment Advisory Committee (MedPAC), an independent commission that advises Congress. The inspector general’s report said 90% of those patients lived in nursing facilities when they entered hospice care.

Medicare paid hospices that operated out of nursing facilities in excess of $3,000 more per beneficiary on average than it paid other hospices.   MedPAC found that amont the hospices that exceeded the spending cap, 44% of patients transferred back to traditional care from hospices exceeded the six-month spending cap. That suggests "above-cap hospices may be admitting patients before they meet the hospice eligibility criteria," it said in its 2011 report to Congress.

Meanwhile, the nation’s two largest for-profit hospice companies, Vitas and Gentiva, have together spent $1,188,100 on lobbying this year, records show.  In the first half of 2011, Vitas paid $390,000 to Washington lobbyists, according to lobbying reports. The company receives 90% of its revenue from Medicare and Medicaid, according to its filings with the Securities and Exchange Commission.  Gentiva spent $798,100 in the same time period on lobbying.

Both companies face a series of fraud investigations by state and federal law enforcement agencies, and have paid multiple fines.

Meanwhile, the trade groups representing hospice companies have formed the Hospice Action Network.

A 2005 study in the Journal of Palliative Medicine found that large, publicly traded for-profits had profit margins nine times higher than large non-profits. In 2010, Gentiva collected $326.2million from Medicare for hospice care, compared with $68.8 million in 2009, according to SEC filings. That’s in large part because it has been buying smaller hospices.

Vitas has also been growing: In 2008, its revenues were $808.4 million, and in 2010, $925.8million. It projects an annual increase in admissions of between 5% and 7%.

 

 Below is a Press Release from DRI-The Voice of the Defense Bar. 

DRI-The Voice of the Defense Bar released a report confirming that large scale contributions to judicial campaigns have reached unprecedented levels in the aftermath of the Supreme Court’s decision in Citizens United v. Federal Elections Commission, posing critical threats to the notion of judicial independence and the integrity of the American civil justice system.

The report, Without Fear or Favor in 2011, examines a vast array of issues affecting judicial independence and accountability, explaining how judicial campaign contributions and attack ads are polarizing the judiciary and compromising the appearance of fairness in our court systems.

The report – with “A New Decade of Challenges” as its underlying theme – proposes a number of solutions. DRI recommends the automatic disqualification of judges who accept campaign contributions above a specific threshold, the establishment of procedures for handling disqualification motions by a judge different than the one who is subject of the recusal motion and expanding the use of non-partisan judicial performance evaluations to help educate voters and promote a less politicized electoral process. DRI also recommends increased diversity in the judicial ranks to better ensure that decisions are perceived to be fair.

Not just concerned with the appearance of fairness of the judicial process, the DRI report also shows with unlimited campaign contributions to judges running for election or retention, how the conduct of judicial elections has significantly degraded. “With increased special interest funding, attack ads have become common, altering both the substance and tone of judicial elections,” said Matt Cairns, president of DRI. “As demonstrated by what occurred in the 2010 Iowa Supreme Court retention election, special interest groups want to treat judicial decisions like they treat the decisions of other branches of government. And, they want treat judicial elections like they are just another partisan political election. However, judicial decision making and judicial elections are different. Our courts act as a check on the excesses of the other branches of government. Judges are supposed to be neutral and fairly evaluate cases based on their interpretation of the facts and the law. Judges shouldn’t be worried about the latest opinion poll on a hot button issue” added Cairns.

 

DRI’s report also chronicles the ongoing impact of the recession on the judiciary. It notes that states have resorted to periodically closing their courts, eliminating programs, imposing unpaid furloughs, reducing court hours and staffs – dubbing these collective cutbacks an improper “rationing of justice.” “Our courts have to be open to all in our society to use to resolve their disputes” added Steve Puiszis, editor of Without Fear or Favor, and chair of DRI’s Judicial Task Force. In some parts of the country, counties do not have sufficient funds to hold jury trials in civil cases. “State courts have been hit especially hard by legislators looking to slash budgets. Systems are stagnating, and public awareness of the problem is unfortunately very low,” said Puiszis.

Finally, DRI’s Without Fear or Favor looks at the overall tone of public discourse surrounding judicial decisions, citing the Internet as a venue increasingly hostile to judges and the judicial system. Indeed, the net effect is to significantly increase the need for tighter courthouse security. “The time to act is now,” Puiszis said. “DRI invites other organizations and concerned observers to join us in a shared effort to defend and preserve our besieged court system.”

DRI created the Judicial Task Force in 2005 to address problems threatening the viability of the American judicial system. DRI’s first Without Fear or Favor report was published in 2007. To read the report, go to www.dri.org.

About DRI – The Voice of the Defense Bar

DRI – The Voice of the Defense Bar is an international organization of defense attorneys and corporate counsel that is recognized as a thought-leader and an advocate for the defense bar at the national and state level as well as in Europe. With more than 22,000 members, DRI provides members and their clients with access to world-class education, legal resources and numerous marketing and networking opportunities that facilitate career and law firm growth. For more information log on to www.dri.org.

 

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Kentucky.com ran an interesting editorial on the legislature’s failure to pass a bill requiring nursing homes to report suspicious deaths to a coroner.  I wonder how much the politicians received from the nursing home industry lobbyists?  See editorial below:

"The legislature’s unwillingness to require that coroners be notified of deaths in nursing homes is chilling.

Opposition from the nursing home industry and the potential costs to the state are the reasons cited by Rep. Tom Burch, chairman of the House Health and Welfare Committee, for not moving his bill that, among other things, would require nursing homes to assign a staff member to notify the local coroner when a patient dies.

We always assumed that, in most cases, nursing home residents die from the natural effects of aging or illness, and their deaths would be routine matters for coroners to evaluate.

Only when something was out of the ordinary — when there was blood or bruising, for example, or evidence of choking on food or, as at a Calvert City nursing home, a patient was found on the floor with her head wedged between a mattress and bed rail — would an in-depth investigation or autopsy be required.

Such cases, we assumed, were rare. And yet Tracey Corey, the state’s chief medical examiner, estimates that, if even 10 percent of the additional cases generated by the proposed law were turned over to her for further evaluation, her office would need three more doctors and more support staff and equipment.

OK, let’s assume she’s correct. Is the expense a valid reason for not investigating nursing home deaths? Is Kentucky so broke, financially and morally, we can’t follow up on suspicious deaths of helpless patients? That’s a poor excuse, which makes us suspect the real obstacle is the nursing home industry.

Burch said he tried to compromise with industry leaders with no success. "All that I had when they got through compromising was the title (of the bill) and my name on it."

Many nursing homes are owned by for-profit, investor-owned corporations. Why, Kentuckians should ask themselves, are they so resistant to having a set of outside eyes around immediately after a patient dies?

Do we not want to know? Do we not care?

In their investigations of Kentucky nursing homes, Herald-Leader reporters discovered that, in some instances, not even families are fully informed of the circumstances of their loved ones’ deaths. The family of the woman who died in the Calvert City nursing home had to ferret out the details for itself.

When Arkansas enacted a law requiring nursing homes to report deaths to county coroners, criminal prosecutions did not increase, but the number of nursing homes being fined or shut down did, which probably explains why the industry opposes this extra layer of accountability — and why it’s needed.

Another House bill creating a registry of persons charged with adult abuse and barring their employment by nursing homes has been watered down "to begin to prepare to implement" a registry.

Meanwhile, in the Senate, Sen. Tom Buford hasn’t been able to get a hearing for his bill requiring criminal background checks on all nursing home employees.

All in all, a disturbing showing by this legislature that reinforces nursing home reform advocate Bernie Vonderheide’s message that what’s needed is "some real leadership … not just from advocates, but from legislators."

 

McKnight’s had an article about the tragic case of Brian Lee who was fired by the infamous new governor of Florida Rick Scott.  Lee was fired as the director of Florida’s Long-term Care Ombudsman Program (after seven years) for doing his job.  He requested ownership information from nursing homes that are given tax payer funds through Medicare and Medicaid.  The request was authorized under new federal healthcare legislation which will promote transparency and accountability.  Scott fired Lee after operators and industry lobbyists had complained about the request.  Rick Scott is owned by Big Insurance.

Consumer Voice Statement on Florida Ombudsman Resignation:

 

The independence and effectiveness of the Florida long-term care ombudsman program were dealt a severe blow last week by the forced resignation of state ombudsman Brian Lee. The Consumer Voice is shocked that Gov. Rick Scott forced out the ombudsman, who represents some of the state’s most vulnerable residents, on the recommendation of nursing home and assisted living operators who are the subject of the ombudsman program’s oversight.

 

The ombudsman is mandated under the Older Americans Act to be an independent voice for residents and free of conflicts of interest. Ombudsmen investigate resident complaints and serve as advocates to ensure that residents in nursing homes and assisted living facilities are protected under the law.

 

"Brian was recognized by his colleagues in Florida and nationally for his commitment to protecting the rights of long-term care residents and working with residents, families and providers to improve care," said Sarah F. Wells, Consumer Voice executive director. Wells said the office must be independent and free of political interference to perform its statutory functions.

 

Lee was asked to resign after he asked the state’s nursing homes for names of companies and individuals with an ownership and operational interest in their facilities. State ombudsmen were given authority to request the information from Medicare and Medicaid-funded nursing homes in transparency provisions in the health care reform law. The law was the subject of congressional hearings in which witnesses testified that it is often impossible to hold nursing homes accountable for quality because of complex ownership and operating structures. In a recent report, the Government Accountability Office said, "To determine the effect of ownership on nursing home quality of care, it is necessary to have complete and accurate ownership information that provides a clear understanding of the relationship of each owner to the nursing home and any other owners."

 

Ombudsmen in some states report that nursing homes routinely provide the information when it is requested. In 2012, a summary of the ownership data will be reported on the federal government’s Nursing Home Compare website, which is designed to help families choose a nursing home.

 

"We are very concerned that the governor of Florida has yielded to industry demands to dismiss an effective advocate for residents in a state that so many elderly Americans choose as their retirement home," said Wells. "As a national voice for long-term care residents, we strongly urge the governor to follow the law and allow the ombudsman program to operate without interference."

The National Consumer Voice for Quality Long-Term Care is a 501(c)(3) nonprofit organization founded as the National Citizens’ Coalition for Nursing Home Reform (NCCNHR) in 1975 by Elma Holder. The organization represents the consumer voice at the national level for quality long-term care, services and supports by advocating for public policies that support quality care and quality of life responsive to consumers’ needs in all long-term-care settings; empowering and educating consumers and families with the knowledge and tools they need to advocate for themselves; training and supporting individuals and groups that empower and advocate for consumers of long-term care; and promoting the critical role of direct-care workers and best practices in quality-care delivery.
 

Politico’s Samuel Loewenberg wrote an article about how high priced lobbyists are attempting to get rid of necessary reforms for nursing home care to improve.

The profitable nursing home industry is mobilizing Washington’s most well-connected lobbyists to fight needed reforms,  Recently state and federal investigators and outside experts have agreed to certain reforms as a gaggle of industry lobbyists plotted strategy.

Among the lobbysts was The Carlyle Group, the politically connected and powerful private equity firm that recently bought Manor Care, one of the nation’s largest nursing home chain, for $6.3 billion.  

“In spite of existing oversight mechanisms, we continue to see examples of horrific treatment of nursing home residents,” testified Lewis Morris, general counsel for the Department of Health and Human Services’ Office of the Inspector General.

The lobbyists are carefully watching the Senate, where legislation could increase the oversight and enforcement of the industry.  It is well documented how deficient the oversight and enforcement of the industry is as evidenced by the recent GAO Report.  The senators are expected to try to attach the legislation to the upcoming Medicare payments package.

The industry lobbyists are fighting provisions to fully disclose ownership of nursing homes.  Why? No one knows. Clearly, families of residents should be able to understand who owns and operates the facility where they place loved ones. 

Additionally, penalties would be increased to as much as $100,000 if a patient is harmed or dies due to poor care. The penalties, which have not been changed in two decades, are now capped at $10,000.

To gird for the increased regulation, the industry is using a half-dozen of Washington’s most politically potent lobbying firms on both sides of the aisle.  “It is going to be pretty much battening down the hatches, because we’re not going to have a fair shake with a Democratic majority,” said a nursing home industry lobbyist who spoke on the condition of anonymity.

Since Carlyle took over Manor Care, some homes have reported significant patient care problems, said SEIU spokeswoman Julie Eisenhardt.   Meanwhile lobbyists for The Carlyle Group are stating that there is no evidence that private equity ownership negatively impacts care.   Both the Government Accountability Office and the Senate Finance Committee are still investigating the negative effect of private equity ownership on nursing home quality.

The issue is at the heart of one of the most controversial parts of the Grassley-Kohl legislation: a requirement that the sometimes-twisted ownership structures of nursing homes be made more transparent.   Congressional staff, experts, and advocates for the elderly say that private equity firms often establish layers in ownership structure as a way to dodge responsibility and legal liability.

And GAO reported how federal government regulators often miss signs of abuse and care deficiencies, ranging from failure to ensure “proper nutrition and hydration and [prevent] pressure sores” to serious deficiencies that could lead to “actual harm and immediate jeopardy.”