Michael Wylie, vice president of development, Genesis HealthCare, tells Provider that while the long term and post-acute care (LT/PAC) profession harbors more than its fair share of challenges, he sees 2018 as a year full of potential on many fronts, including in how the industry profits from its work to educate federal regulators.
Working with Washington
Speaking as the newly installed chair of the American Health Care Association’s (AHCA’s) Board of Governors, he says the trade group wants to continue to be a powerful voice for skilled nursing owners and operators, one focused on offering solutions to members and the entire industry alike.
One of the key focal points for 2018 is to keep working with the Centers for Medicare & Medicaid Services (CMS) on winning regulatory relief for providers. “We want to have a situation where when CMS looks at incidents and accidents, we want to make sure the ‘punishment fits the crime,’” he says.
In past times, some of the punishments that CMS doled out were designed to cost a provider around $25,000. “Now those same punishments in 2017/2018 could cost you over $1 million,” Wylie says. Another example of how regulators can hamper progress, he says, is the threat of the elimination of the nurse aide training program.
“If you have a survey and you don’t meet certain levels or you have certain repeated deficiencies, you could lose your training program. And, if you are in rural area, for instance, the loss of your training program could be extremely harmful and put you in a deeper hole,” he says.
Over time, however, CMS and AHCA have developed a working relationship wherein the regulators better understand situations like this, and in a more general sense get how the skilled nursing business works and are now listening to the solutions being presented to them.
Helping Members
Beyond Washington, D.C., Wylie says during his chairmanship he wants AHCA to work with the states and “really help any state affiliates that are in a situation where they need some assistance to get rate relief [for Medicaid reimbursement]. AHCA has made it our policy this year to try and help as much as we can.”
Some of his more personal issues that he would like to see addressed include the situation with opioids and how patients who are addicted tend to be much higher-cost cases for a provider. This may leave room for CMS to consider these extra costs in reimbursement policy.
No matter the specific issue, the key is for the provider community to be proactive in all of its dealings with regulators and policymakers, something that has been a priority in recent years, Wylie says.
At Genesis, Wylie runs the company program that manages skilled properties for other owners. “At the end of the day, in my role at Genesis when we run into a problem, we don’t go to the owner and say we have a problem. We instead go to the owner and say, here’s the problem that we have uncovered, and here is a solution that we think will resolve the problem,” he says.
“I think that applies to AHCA as well. You just don’t go to CMS hat in hand and say ‘help us,’ you say here are the issues that we have, here is what we propose. And, they are very receptive to listening.”
As for his role at Genesis, Wylie says his division is hoping to have a solid year for all of the clients it manages, both financially and clinically, with a special eye on quality.
The Genesis Model
With the core of the Genesis operation based on its more than 450 facilities nationwide, there is also room to tweak the business model. Wylie says some of these new ways of offering skilled care include the company’s PowerBack model, which offers high-end, short-term stay units that have anywhere from 80 to 120 beds and can do up to 250 admissions per month.
On top of that, Genesis has as a core business its rehabilitation management company, the largest such offering in the country.
“And, one thing we have done to diversify in a sense is that we are currently in China doing rehab services there. So that is something new and different and fairly successful. We have 10 to 12 full-time employees living and working in China,” Wylie says.
“But, it is more about specializing. We are not changing the business model of what we do. If you take the model from the U.S. over to China, you are diversifying where you provide the service, but you are not changing the service. We already have expertise—we are just taking it to another continent,” he says.