Scully lays it on the line regarding LTC. (NH News Notes).

Not noted for being shy or obtuse, Thomas A. Scully did not disappoint in offering his views on long-term care at the 12th annual conference of the National Investment Center for the Seniors Housing and Care Industries in October. While Scully, administrator of the Centers for Medicare and Medicaid Services, repeated his oft-made assertion that nursing homes are overpaid by Medicare ("cliff' or no cliff), he also sounded a sympathetic note on several points.

Scully acknowledged, for instance, that Medicare is important in cross- subsidizing Medicaid, the profit margins of which "stink," he said. He admitted that Washington legislators need to better understand LTC's need for financial stability; that the quality of nursing home leadership has improved over the past couple of years; that nursing homes are indeed over-regulated because of "unbelievable antagonism" toward them from the public and Congress; and that liability-besieged Florida providers "have a legitimate concern" in worrying that federal nursing-home quality data might attract aggressive trial lawyers.

The remedies he recommended, though, are long-range, with no quick fix in sight.

Scully said that nursing homes have to address negative public perceptions by working together with unions and consumers to genuinely upgrade quality--a 10-year project, in his view. "A [demographic] tidal wave is coming," he said, "and we just have to have better nursing homes and home healthcare to meet it." As for reimbursement, nursing homes should be focusing their attention on state legislatures, he said, since Medicaid, not Medicare, is the basic problem.

"Altogether, nursing homes are 82% dependent on government funding-- more than any government contractor. We need a better mix of funding with private pay, although long-term care insurance is incredibly confusing and hard to figure out and pay for when you start paying for it at age 70. I think a simple, easy, reverse-mortgage program would help."

Scully seemed to have no qualms about having the notorious Medicare "cliff' cuts restored this year, but cautioned attendees that the Bush administration views physicians' concerns about Medicare cutbacks as its "number one" provider priority. He also pointed to a need for more money for the federal State Children's Health Insurance Program (SCHIP) and for Medicare+Choice.

He also cautioned nursing homes that to get federal tort reform to counter the liability crisis, they will need to focus on that issue as intensely as the trial lawyers, who consider it to be their "issue number one." Scully noted, "Ifhealthcare focused on this issue like the trial lawyers do for just one year, they would kill the trial lawyers."