Americans will have voted by the time some Provider subscribers read this article. But for many providers, the critical votes may come after this year’s elections. It has become a feature of modern political life that the post-election sessions of Congress, while the old guard waits to give way to the new, are the most frenetic periods in the legislature. Whomever uses the phrase “lame duck,” in other words, hasn’t seen the circling falcons.
Consider: Last year, Congress came the closest it has in years to coming up with a permanent solution to Medicare’s physician pay rate. The annual ritual of self-abuse known as the so-called “doc fix” looked like it might be over after both parties agreed (in principle, at least) to replace the Medicare sustainable growth rate with a bill that would have given doctors a small raise over a number years.

Heading Toward Crisis

The plan couldn’t get traction, a victim of Washington’s continuing slipperiness, but Sen. Ron Wyden (D-Ore.) has promised that he’ll work with Republican counterparts to revive a permanent fix this year.
In fact, the work has already begun, U.S. Rep. Kevin Brady (R-Texas) tells Provider.

“We can’t not do it,” he says. “Nearly half the doctors in my state are already refusing to take Medicare patients, and I’m sure, if you look around the country, you’ll find similar numbers. We’re heading toward crisis.”

Brady adds: “The way we’re doing it isn’t sustainable. And if we’re really going to come up with a permanent solution in the lame duck, we have to start laying the groundwork for it now.”

Can’t Take Sides, But Can’t Ignore, Either

Brady chairs the Health Subcommittee on the House Ways and Means Committee. But, he, too has a critical vote coming in the lame duck session. He has already announced his candidacy to chair Ways and Means. He’ll be taking on U.S. Rep. Paul Ryan (R-Wis.), one of the GOP’s biggest stars (as well as one of the House’s most respected members).

Ways and Means is critical to providers because of its vast jurisdiction over tax and economic policy. Brady, also respected by members on both sides of the aisle, is soft-spoken (especially for a Texan), but he’s no lightweight: He chairs Congress’ Joint Economic Committee, one of four standing committees made up of members from both sides of Congress.

Many experts see Brady as a long-shot against Ryan. But, as so often happens in Washington, watching the debate itself unfold can be profitable. Ryan is thought by many to have national aspirations. And, like Brady, he is taken seriously by his political enemies because he puts a lot of critical thinking behind his proposals. (Ryan, for instance, is one of the first conservative Republican congressional leaders to argue seriously about fighting poverty through social welfare.)

The arguments the two men have as they campaign may well frame the Republican party’s direction on critical questions such as Medicare and Medicaid for the next Congress and beyond, experts say.
It’s a post-election race that many providers won’t take sides in, but certainly can’t ignore.

No Champion, But Heroes Emerging

Like many groups in Washington, long term and post-acute care providers lack a champion—a congressman or -woman who will fight tooth-and-nail for the sector in the same way, say, that some lawmakers can be reliably counted on to defend against gun control.

But provider advocates have been working hard to cultivate “heroes,” says Clifton Porter II, senior vice president of government relations at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

Provider advocates are still fighting against an age-old reputation as places where old folks go to die, badly, Porter says. But advocates hadn’t helped themselves by simply fighting against cuts to their sector, he adds.

Building Credibility

Over the past few years, provider advocates have changed their approach, and now offer themselves—in advertising but also in fact—as “the solution” to health care woes, Porter says. “It’s a differentiator for us in the health care space,” he says. “It builds credibility for us.”

Over the course of the summer and fall, provider advocates have invited dozens, if not hundreds, of congressmen and -women into their centers. And opening congressional eyes to how frail skilled nursing residents are, and how well they’re cared for in those centers, is worth its weight in legislative gold, Porter says.

“I’ve never done a tour where the [lawmaker] was not positively shocked and surprised by how much we do and how well we do it,” Porter says. Meanwhile, short-stay residents and their families are scoring their satisfaction surveys into the 90 percentiles, Porter says.
Add a high-turnover population of happy customers to newly converted lawmakers, and the sector is “creating a multiplier effect.”

Go On Offense

Returns are early, but constructive engagement appears to be paying off. By targeting specific lawmakers for specific legislative issues, not only have provider advocates been able to ward off slash cuts, but they’ve been able to advance some goals of their own—from provider agreements in the Department of Veterans Affairs to bills reforming or scrapping observation stays in hospitals (see congressional profiles).
Indeed, earlier this year, AHCA/NCAL President and Chief Executive Officer Mark Parkinson urged his colleagues to “go on offense.”

Advocates have actually hammered out their own bipartisan coalitions on matters and have found heroes behind them as diverse as Sen. Wyden in Oregon and Rep. Jackie Walorski (R-Ind.).


In fact, providers had one of their biggest victories in years this year, when Congress passed the IMPACT Act. IMPACT requires the federal government to come up with quality measures across the different modes of post-acute care services.

Provider advocates backed IMPACT in and of itself, but also saw it as the camel’s nose under the tent, leading inevitably to a site-neutral system.

Wyden saw the bill as proof that both parties can work together.

“This bipartisan bill is an important and welcomed accomplishment in our quest to provide patients, consumers, and the federal government the best tools for evaluating the quality of care patients receive and the way our health care dollars are spent,” Wyden said at the time.

“It’s also an example of how members of Congress from both parties and both Houses can come together to address an important need. I’m looking forward as we build on this experience to achieve additional reforms.”

Among those invited to the White House in October for the IMPACT Act’s signing was AHCA/NCAL’s Parkinson.

Slow, Deliberate Path

A permanent doc fix will certainly be on the agenda this fall. Experts say that its passage is a long shot, but the point—for advocates—is to show that they’re engaged and not simply putting their hand out every couple of years.

“It’s a very, very slow, deliberate path,” AHCA/NCAL’s Porter says. “But we want to demonstrate that we’re the answer—offering the best care at the best price.”

In fact, provider advocates aren’t just waiting for events to overtake them. Already, AHCA/NCAL has convened a select committee of leaders, hoping to come up with a payment model that saves money without crippling care.

“We want to be ahead of the curve,” AHCA/NCAL Senior Vice President of finance policy and legal affairs Mike Cheek told assembled leaders at the Provider executive roundtable held in conjunction with the AHCA/NCALconvention in National Harbor, Md.,this year.

‘How Can We Change The Program?’

Once there, provider advocates may be surprised how willing politicians will be to greet them.
“I was a governor for about 10 years,” says Sen. John Hoeven (R-N.D.).

“What I tried to do is go to the health care providers and the long term care providers and say, how can we change the program so that we can cut costs and improve care?

“I think that’s true at the state level, and I think you’ve got to do it at the federal [level]. They’re the experts. How can we enable them to do what they do so well?”