Harmony Healthcare Blog

AHCA Provider Lounge Series: The Provider's Payment Predicament

Posted by The Harmony Team on Tue, Mar 07, 2017

Interview with David Voepel, Executive Director - Illinois Health Care Association

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews David Voepel, Executive Directore of the Illinois Health Care Association (IHCA), in the AHCA Provider Lounge.  David discusses the predicament providers in his state are finding themselves in when it comes to receiving payment for the care they are providing.   (Audio transcription below).


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Transcribed Audio:

Kris Mastrangelo:   Good Afternoon and welcome back to the Provider Lounge at the American Health Care Association Annual Convention.  Today I have David Vopel from Illinois Health Care.  He is the Executive Director of the association.

David Voepel:  Thanks for having me.  Appreciate it.

Kris:  We are talking to many people this week and we’re really interested to find out what’s happening specifically in Illinois…and what is keeping you and your members up at night.

David:  If I could say in a nutshell, it’s lack of payment from different perspectives.  We have 535 members that cross the gamut of the continuum of care.  So we have SNFs, we have DD providers, we have assisted living providers.  Assisted Living is not paid by Medicaid.  However, the state has decided that we don’t have a budget.  They put together a stopgap budget and it’s for six months.  Fortunately, nursing homes are paid through a court order, but yet we might not get paid for four or five months.  So the problem with that is that okay you don’t know when your cash is going to come in and you still got to make payroll every week or every two weeks so there’s a big issue with that.  Not only that but then when you have a Medicaid applicant come in and you’ll go through all the application process and everything else.  In the state of Illinois, they lose it, they forget it, they drop it.  We call them pendings – Medicaid Pendings.  They could be out for up to two years.

Kris:  You’re telling me that your receivables could run you six months and then your pendings could run up to two years.  You can’t operate in that environment.  Cash is king.  How do you operate?

David:  Exactly.  You have somebody in your facility for two years.  They’re on your dime because the state hasn’t agreed to go with Medicaid on this.  The same issue that Kansas had.  That GoodSam in Kansas brought that whole lawsuit around and we’re looking at doing the same thing in Illinois because it’s just ridiculous.  And CMS has this nice little rule that they conform to and we have a law with the American Disabilities ACT that’s been around for 20 or 30 years now, 1990s.  It says Providers are going to give us the best price, they’re going to house the most frail folks in the nation, our country – we demand that you (states) pay – it’s federal law – within 45 days.  Where’s our state?  ‘Months, maybe two years…what the heck, we don’t care.’

Kris:  That’s difficult.  That’s very difficult and are you seeing shut downs because it?

David:  You would think so, but these guys – I don’t know how they do it.  Well I know one way that they are doing it…they’re transitioning.  Instead of taking Medicaid, they’re saying fine we won’t take Medicaid, we’ll concentrate on Medicare.

Kris: They’re rebranding and then looking at a different patient population.   What’s your assisted living environment like?

David:  Just expanding like there’s no tomorrow.  We call it a Supported Living Program – SLP program.  That’s Medicaid.  There’s only 65 in the state of Illinois.  The rest are assisted living and they’re all private pay and they’re just expanding.  There’s six of them – I’m from Springfield, a town of about a 120,000…there’s six going up right now that I can tell you about…brand new facilities.  Who wouldn’t want to go to them.  So what happens to the SNF that’s right there, who’s occupancy is going down and you have assisted livings that are coming up and that’s expanding.  We’re seeing this whole shift come around and the state is just sitting there sitting on their hands – not doing any payments or anything like that, but yet they want us to take care of the frail and elderly and yet they’re not promoting any of that.

Kris:  In the assisted living – I’ve been researching assisted living for the last 5 years and again, it’s state specific, for example Massachusetts has a social model, other states have a medical model.  Do you find that patient population is primarily private?

David:  Mainly private for the most part.

Kris:  Some states have Medicaid funding for it and some states do not.  But this shifting from the skilled nursing facility into the assisted-living.  There’s pros and cons to it because the cons could be that the staff is not as well versed in the complexity of the senior population.  The pros are that it’s a brand new facility, it’s gorgeous.  Like a five-star hotel…but the journey from the evolution is going to have to come down to cash flow, payment and care.  So it’s very important…

David:  And again we’re seeing a shift and it’s happening throughout our country where assisted livings are now the nursing homes of yesteryear…you know, so the acuity is going up and not only in nursing homes but the acuity is rising in assisted living and whenever you get into programs whether it’s the state or federal government, the government is always five years behind on legislation, whether it’s technology or security or whatever the case might be.  They’re always so slow to react and they’re very reactionary but something has to happen.  So if you have a death in assisted living you’re going to receive an explosion of regulations.  You’re going to see things happen in that area and that’s what we’re here to protect not only the assisted living side but also the SNF side.

Kris:  That’s great.  They need advocates like you.  Every state has an association that are extremely relevant and required in order to represent all the organizations, you know: assisted living, SNFs, independent living in the state.

David:  We always tell people that it’s a democracy.  You can do whatever you want.  You can come to the state house, join us, whatever the case might be, but I promise you you can’t be in every meeting because you have a business to run.  We have to be in every meeting.  We have to be there at the state capital or in Washington DC.  I mean with AHCA, they have to be there so they have to advocate for it and that’s huge and that’s part of the process we use to get new members.

Kris:  David Voepel from Illinois Healthcare.  Thank you so much.  Thank you for coming.  That’s great information.  We’re going to figure this thing out.

Topics: Payment Reform

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