Simon Honours

What the future may hold under Tommy Thompson, Part 2 April 11, 2001 Among the mandates from the new Secretary of Health & Human Services: open-door policy, quicker waiver process, and overhauling HCFA For Part 1, click here By Vladimire Herard Attending to recruitment Tim Brown, acting director of public relations with the National Association for Homecare, said his group has not gotten to know or dealt directly with Thompson but hopes that the secretary will work on addressing the nursing shortage, documented by AHCA in a report last month among many such studies, Medicaid payments and bringing insurance companies into the fold to cover long-term care. "Recruitment of staff is an issue," Brown said. "Once that's done, the other problems can be dealt with. The changing demographics in our country should mean a change in the Medicaid system. We all need to participate---doctors, administrators, home health care staff and insurance companies. Long-term care as different from acute care will require additional financing from insurance companies." During his four terms as governor, Thompson was credited with developing and supporting Wisconsin's community options program or COP, a state program designed to help seniors live independently. Paid out of $75 million in homestead credits to 175,000 Wisconsin taxpayers, COP has grown from 3,400 slots in 1987 to 20,794 in 2000. Outside of COP, Thompson also created a new assisted living arrangement known as a residential care apartment complex (RCAC) for seniors who want to remain in the community but need social support. As of Sept. 21, 1999, about 76 RCACs contain 2,614 apartments. He also boosted funding by $3 million in 1999 for elderly benefits specialists for seniors in COP or the RCACs, comparable to service coordinators who would have consolidated Medicare, Medicaid and Social Security benefits for seniors living in housing projects if Congress appropriated funds to HUD for fiscal year 2001. As governor, Thompson also did the following: • Committed $1.5 million since 1987 to elder abuse. • • • • • • • Committed more than $68 million on elderly nutrition programs in Wisconsin. Ordered more background checks on nursing home workers, expanded nursing home requirements and beefed up investigations. Required three and one-quarter hours a day of direct nursing care for patients needing intensive care. Increased the care required for skilled care by 10 percent to two-and-one-half hours. Added three ombudsmen to the Board on Aging and Long-Term Care in Wisconsin to bring the total to 14. Allowed for emergency service without authorization for managed-care plan participants and broadened the choice of primary care providers. Tacked five years onto the sentences of persons convicted of violent crimes against anyone aged 62 or older. Meet-and-greet promises One event where Thompson divulged the most about his plans for the agency was at his first gathering of his future advisers and staffers Feb. 2. Weaving such success tales as FamilyCare into his talk, the HHS secretary spared few details during his first meet-and-greet with agency staffers about what policies he would adopt in his department. Thompson often used the words "aggressive" and "innovative" to describe how he would overhaul HCFA and its rules, seeking to resonate with long-term-care providers who've long protested the subagency's costly, complex regulations. Admitting reforming HCFA would be his "biggest problem" as agency chief, Thompson told the standing-room-only crowd of HHS employees and reporters in Washington, D.C. that he would re-examine the purpose, resources and burdens of HCFA and find the right person to head it up, harking back to promises he made during confirmation hearings. At the congressional hearings not long after his swearing-in, Thompson said patients and healthcare providers are "fed up" with excessive paperwork and changing rules. The complexity of the rules, he said, burdens HCFA, criminalizes honest mistakes by healthcare providers and drives many industry members out of its federal program. His pledge to deal with rules coincides with the Bush administration's Jan. 20 memo to all federal agencies to suspend their rules and notices as listed in the Federal Register until the regulations are examined by the White House's Office of Management & Budget. The memo, which was issued a minute after Bush was inaugurated that weekend, signaled a plan by the Bush administration to undo Clinton-era rules to suit the new administration's vastly different political agenda. Reforming Medicare The secretary said he intends to serve seniors by promoting President Bush's state block-grant prescription drug benefit to seniors. Thompson explained that drugs, as opposed to surgery, could save and improve the lives of those in long-term care. He pointed to the findings of the National Bipartisan Commission on the Future of Medicare, a panel of lawmakers and some analysts started in the 1990s to reform the federal program, as a start. The commission's findings of possible bankruptcy and inadequacies in the system fostered a series of bipartisan Medicare reform bills in the 106th Congress that were the focus of much legislative wrangling. So far, some Senate Finance Committee Democrats, many from small, rural states, are worried that Bush's block-grant prescription drug benefit would not enable states to afford the federal matching costs under the president's proposal. For example, during a confirmation hearing before the finance committee, Sen. John Breaux (DLa.) warned Thompson that Bush's proposal would not pass Congress because of its cost to states and appearance as a welfare-style system for seniors. Breaux asked Thompson to forgo a prescription drug benefit and, instead, completely overhaul Medicare to help all seniors, regardless of income. But Thompson is pressing forward with his plan, which mirrors that of President Bush. While the HHS secretary has expressed concerns that Medicare reform could mean that federal law would trample on states' rights and that trial lawyers would reap profits from lawsuits, Thompson agrees with Bush that the best time to pass a reform proposal is early on in the administration while Republicans still control Congress. HCFA and train wrecks To the new HHS secretary's surprise, he's backed by lawmakers, giving him the impetus to carry out his goals for the agency. Thompson said he initially thought governors alone were dissatisfied with HCFA before he heeded the "clarion call" from Democrats and Republicans alike for broad reform. Senate Majority Leader Trent Lott (R-Miss.), too, complained about HCFA's regulations at one of Thompson's confirmation hearings. It was Sen. Pat Roberts (R-Kan.) who suggested that HCFA be re-examined. "People crawl out of train wrecks faster than HCFA responds," Roberts said at one hearing. While calling HCFA a "popular whipping boy" for lawmakers, Sen. Edward Kennedy (D-Mass.) said the agency's problems come from a lack of resources. But Thompson sought to make it clear during his get-together with HHS staff a month ago that HCFA would no longer be a whipping boy nor would it continue to lack resources. "When we have more responsibility, we need to do the job instead of blaming HCFA," he said. "We have to look into innovations. When we have responsibility, we have to be more resourceful." Thompson said during his confirmation hearings he had no "preconceived ideas" on how he will reform the subagency reportedly responsible for the healthcare of 70 million Americans. He said he would learn how it works first before he could deal with its $340 million budget this year. The secretary has yet to learn enough about HHS's 60,000 staff and 2001 budget of $429 billion. But he promised to place seniors and long-term-care high on HHS's priority list, noting that his home state sought more waivers from federal programs than any other state. "Now it's time for me to put up," Thompson said during a confirmation hearing. Click here to subscribe to our free newsletter Most Popular • • • • • • • • products articles downloads Cultural Components Of Care Course Now Available Refinancing Could Help Senior Housing/Healthcare Borrowers Improve Business Outlook, Expert Says Electronic Payments Processing Leader Saves Time, Money For Rehabilitation And Long-Term Care Provider A.G. Rhodes Nursing Homes Select Patient Placement Systems Online Software To Automate Long-Term Care Referral Management The Time To Prepare For The Coming Age Wave Of Older Boomers In Virginia Is Now more... 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