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 Top Lobbyist: 'We've Established Credibility for the Sector'

​New congressional standards for skilled nursing centers’ readmissions “are far from ideal,” but still represents “a win” for caregivers, one of the profession’s top lobbyists tells Provider.

“It’s not ideal—not ideal by any stretch of the imagination,” says Clif Porter II, who heads up government affairs for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “But, at the end of the day, I think it’s a win for us.”

Last month, President Obama signed a new law that requires regulators to track skilled nursing readmission rates and to penalize those centers with high levels of preventable hospitalizations. The law was part of yet another short-term fix for Medicare’s physician pay rates, but represents a half-decade-long process that will see the post-acute provider rates cut by 2 percent.

“It’s a cut. That is the reality,” Porter says. “However, what is positive about this is that our providers have some constructive goals before them. If they perform well—and frankly, our members perform better than most—they won’t get cut at all. They also may earn even more.”

The law deducts the 2 percent at the beginning of each fiscal year beginning in 2019 and places it into a rewards fund. Providers that improve their readmission rates or maintain low levels can be rewarded out of that fund, giving some in the sector a shot at 100 percent-plus from Medicare.

The so-called “doc fix” bill that brought the readmissions standards followed a short, tortured road only to wind up where a decade’s worth of such bills have ended up: at the beginning. But Porter says he has been encouraged by how much more open Congress’ and regulators’ doors have been to post-acute care advocates like him.

If some in Washington had their way, the readmissions standards would have imposed a 3 percent cut to provider rates tout court. Porter says he’s keeping his eyes on the larger prize.

“I think our sector and our organization burnished its brand,” he says of the doc fix efforts. “So policy makers know we’re very committed to working on both sides of the aisle.”

Other health care lobbyists bemoan the merest hint of a budget cut and take out menacing advertisements warning Congress and regulators that they are threats to seniors’ health, only to wind up being cut anyway. Porter says that marching under the “We Are the Solution” banner “is a differentiator for us.”

“No one else in this sector is doing that in this town,” he says. “We’ve established credibility for the sector.”

If Porter seems sanguine, it may be because he can appreciate the importance of taking the high road, even through the most treacherous terrain. A fifth-generation Washingtonian who can trace his ancestry back to Lord Fairfax, Porter’s family used to own prized land in northern Virginia until a great-grandfather lost most of it in an ongoing (and certainly not constructive) disagreement with the federal government over Prohibition.

Porter started his career in long term care in the late 1980s, working his way up from administrator-in-training. He has worked his way up through the ranks of the profession.

That’s difficult enough on its own.

But he has done so as an African-American in the South.

“I was fortunate enough to be in the sector at a time when, despite the lack of diversity, I was judged only on my ability,” Porter says. “I’m very grateful for that.”

His coolness under pressure and his view of the long road shouldn’t be mistaken for passivity, though, friends and colleagues warn. Porter is notoriously brisk to the point of bluntness and—strangely for one in his profession—is said to have little patience for double-talk and, especially, meetings.

His office in Washington is sparsely decorated (although his desk faces a framed shot of Jackie Robinson, walking alone outside of Ebbetts Field in New York). Behind Porter sits a dry-erase board upon which he has written three categories—rate, regulation, and volume.

“If it’s not those three,” he says, smiling wryly, “it’s not my problem.”

Congress is in recess now and is mostly focused on the November elections. But Porter can’t sit still. He now finds himself working the circuit, helping to organize fundraisers and meeting politicos in more relaxed settings.

“The most important part of ‘Government Relations’ is the second word,” he says, throwing on his custom-fitted jacket as he heads of to another grip-and-grin.

So how will we know when Porter feels he’s done his job?

“It’s sort of a Holy Grail,” says Porter, leaning back in his chair for the first time in our interview. “I think there’s always some next struggle, but if I can help create an environment predictable for our members and second, get some regulatory relief for our members, then I’ll feel better.”

He says he thinks that the Centers for Medicare and Medicaid Services’ recent decision to pause the controversial therapy audits is proof that AHCA/NCAL’s brand of constructive engagement is paying off.

“We are the best value in the entire sector,” he says. “The government is already beginning to recognize that, and my job is to help expedite the recognition.” (Bill Myers is Provider's senior editor. E-mail him at wmyers@providermagazine. Follow him on Twitter, @ProviderMyers.)

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