Harmony Healthcare Blog

AHCA Provider Lounge Series: Keeping the Small Provider in the Marketplace

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Apr 06, 2017
Kris Mastrangelo, OTR/L, LNHA, MBA
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Interview with Michael Lehrman, Vice President of Healthcare Services - Catholic Charities of New Hampshire

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Michael Lehrman, Vice President of Healthcare Services - Catholic Charities of New Hampshire, in the AHCA Provider Lounge.  Michael discusses whether or not small providers will have enough resources internally to manage all the regulatory changes that they are facing as compared to the larger chains who have larger staffs to manage such transitions. (Audio transcription below).


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Transcribed Audio:

Kris Mastrangelo:   Good Afternoon.  It’s Kris Mastrangelo at the American Health Care Convention at the Provider Lounge.  Today we have Mike Lehrman, Vice President of Healthcare Services with New Hampshire Catholic Charities.  Welcome Mike.  Thanks for coming.  Tell us a little bit about your organization.

Michael Lehrman:  Catholic Charities New Hampshire basically is a small provider of skilled nursing, assisted living and independent living in New Hampshire.  We have eight facilities, nursing homes, scattered throughout the state of New Hampshire.  Some rural and some in the city. 

Kris:  I’m from Massachusetts so I’m up in New Hampshire quite a bit, but tell me are you are anticipating the changes with healthcare affecting your organization.

Michael:  It’s going to be a challenge – no doubt.  There’s a lot of changes that are coming at us in a fairly short period of time and I think we can take them in stride.  Each one of them is probably manageable. My concern at this point as we’re learning stuff today and yesterday at the conference is the rapidity of the change in a sort of very compressed time frame to get a lot of these things done.

Kris: Yes – it’s about 700 pages strictly in the Requirements of Participation.  We have, you know, the MDS changes, value-based purchasing, bundled payments.  There is a lot coming out.  We’re not sleeping, we’re reading and again I’m thinking that a lot of the changes are a product of the election year.  So, let’s talk about some unintended consequences that might be negative to the consumer.

Michael:  Well in New Hampshire particularly we’re also looking at the prospect of Medicaid Managed Care coming into play in the next couple of years.  So, this is an added burden on providers in terms of being able to adapt to change and that’s a big one.  I think my concern and not just in New Hampshire but I think everywhere, for smaller skilled nursing providers is how they can muster the resources to get all this done in a two-year period and obviously there are some advantages to being small in terms of directing things, but I think the bigger concern on my part at this point is whether or not the small providers will have enough resources internally to manage all the changes and do so successfully in compliance with everything as compared to the larger chains who have corporate staffs of two or three or four people that are focused on any one of these topics and have that expertise in house when they can do it.  So, I think they will be needing more consulting help and I think maybe I guess the concern I have with regards to CMS thinking about this – and I don’t think they do – you may find that smaller groups of providers, small providers being pushed out of the market place.

Kris:  And we don’t want that.  We want diversity within the organizational structures in nursing homes because we know there’s value of large teams but there’s also simultaneously values of independent owners because – and an independent owner is defined by less than ten skilled nursing facilities – so we want that diversity because we want to have new ideas and make sure that the services to the senior population are their best and we don’t want these regulation changes to negatively affect the viability of such small organizations and I think that’s important.

Michael:  And I think that’s important and it also diverts attention from the bigger picture.  So, there’s a lot of things that are embedded in these like the whole concept of person-centered care.  We’ve been trying to march that forward in our organization for the last several years and quite honestly when you have implementation – and these do, I’m acknowledging embed some principles of that – but overall it distracts from your ability to focus on some of those purposeful things you want to do anyway and where you divert your resources to.

Kris: Agreed.  One hundred percent because again one of the things that - reiterating that when their expectations or the system’s changes are so enormous there has to be reform or payment reform in that context.  In other words, you can’t create a Final Rule that talks about increased complexity of this patient population, put all these standards on a skilled nursing facility and then not pay them.  So, the reimbursement needs to follow if the level of acuity, the level of services is being redefined.

Michael:  Well the reimbursement issue by itself is a whole separate thing.  I meant it’s almost like that’s a separate subject.   If you want to talk about how do you cope with the changes and get paid – okay, that’s another subject.  Just the enormity of the changes themselves, minus the reimbursement is a big issue.

Kris:  Agreed.  Agreed.  And it’s a lot to handle for the smaller facilities and we’re seeing it everywhere. One last question.  You know the person-centered care.  We agree it’s the way to go.  We’re all happy with that.  How are you feeling about the quality measures and the five-star?  Any opinions on that?

Michael:  I think they’re fine.  I mean no management system is perfect and we can complain all day long and we do like to complain occasionally about how things come out, but it is something that’s measured and it’s not perfect, but it’s a tool.  So, I think, you know, it’s an okay thing.  I think the problem comes is when people either overinterpret the significance of it and they don’t understand what’s going behind it and take that as the gospel and it’s not necessarily true.

Kris:  Agree. One hundred percent.  If the measure isn’t or in some instances the five-star may not properly reflect, but we’ll dig down and figure that out.  It was great having you today.  Michael Lehrman from New Hampshire Catholic Charities.  He’s the Vice President of Healthcare Services.  We’re grateful for your time.  Thank you for coming today.

Topics: Small Providers, Regulatory Change

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