Simon Honours

What the future may hold under Tommy Thompson, Part 1 April 5, 2001 Among the mandates from the new Secretary of Health & Human Services: open-door policy, quicker waiver process, and overhauling HCFA By Vladimire Herard Over a month into his job, Health & Human Services Secretary Tommy Thompson still hasn't given particulars about his stance on long-term care issues such as Medicaid reimbursement rates, the Olmstead Act, the nursing shortage, state quality standards rules and inspections, or even the controversial ergonomics rule Congress recently killed. But that doesn't keep some stakeholding lobbyists from predicting he'll be accessible, pragmatic, hard-working, supportive of innovation, progressive, and eager to fight for reforms on Capitol Hill. Some say Thompson is living up to some of these predictions. In February, Thompson told participants of the National Health Care Solutions Summit at the U.S. Chamber of Commerce, "I'm probably going to be the most accessible person that Washington has ever had. If you've got a problem or a criticism, please call me. If you've got a solution, really call me." "He's probably going to act more like a governor than a secretary," said Tom Donohue, Chamber of Commerce president. "This is a hands-on guy who doesn't do much of the b.s. He's pretty much for the solution and how do we do it." And many like Chris Decker, executive director of the Pharmacy Society of Wisconsin, remember Thompson's taste for accessibility and innovation from his days as Wisconsin governor. "It was progress and policymaking," Decker said. "He was always eager to look at new and innovative ways of improving long-term care facilities. With budget priorities and increasing costs, there was always a balancing act. But Tommy was engaging, willing to listen and a champion of innovative programs." He recalls how then-governor Thompson endorsed a plan to allow for Medicare-participating pharmacies to package medicine in unidoses for seniors living in nursing homes. This, Decker said, was significant for facilities to comply with their state's quality of care standards. Decker also points to a home-based health care plan for seniors in Wisconsin called FamilyCare as an example of Thompson's support for nontraditional long-term care services. FamilyCare made healthcare coverage portable for seniors through nursing homes, assisted living and skilled nursing facilities or any other category of senior care. "He's a strong leader," Decker said. "He's passionate. That's how he'll operate. He has a tireless work ethic---works seven days a week." He said he worked with Thompson on a plan for pharmacies and long-term care with positive results. "We had a good relationship with the governor," Decker said. "He listened to his advisers and constituents. No complaints. He was willing to roll up his sleeves." Fostering state relations Thomas Zwicker, owner/operator of Lakewood Health & Rehabilitation Center, a nursing home facility in Milwaukee, Wisc. that is 90 percent Medicare with little private pay, says Thompson may work as closely with the nursing home industry as he had when he was governor, though his agenda would be hard to carry out without seeking to get higher Medicare and Medicaid payments for these groups. Zwicker, who says the last two years have been impossible for him as a nursing home operator when the Balanced Budget Agreement cuts of 1997 struck, says some in Wisconsin may have said that Thompson was too close to the nursing home industry because of his dealings with the payment system. But he says the then-governor was only doing his job. And because nursing home issues tend to be local issues, Zwicker expects Thompson to foster state relations. "Thompson knows there's a need for federal assistance but that the action should be closer to the states," he says. "I don't know what this will involve. He'll try different state remedies. Meanwhile, though, the aging population is increasing and there is no money to do much. The states are more incentivized if they're in control." Catherine Asplen Scott, former senior vice president of public policy with Assisted Living Federation of America, too, fully expects the HHS secretary to build upon the extensive work he began with community-based independent living for seniors and assisted living when he was governor of Wisconsin. "He's interested in assisted living and long-term care," Scott says. "He's shown creativity with the demonstration projects. He's not only into institutionalized care. That's a good thing." While Scott could not go into particulars about Medicaid reimbursement or nursing issues, she says Thompson did pay attention to the high costs of community-based care settings and tried a number of ways to resolve this. His manner was warm with long-term care administrators or funding experts who wanted to offer new ways of resolving the reimbursement or payment issue, Scott says. "He is very open and friendly as soon as he can clear some space in his office for you," Scott says. Smoothing the process Aside from remembering his "excitement" about long-term care and its importance to his governorship of Wisconsin, John Gillan, director of community relations for the American Health Care Association, said he expects Thompson to move forward on making the HHS benefits waiver process easier for states. "We know he supports the waiver," Gillan said. "That is one way to support states and streamline paperwork. He did a waiver pilot for Wisconsin. When we talk about streamlining, we believe it will make the system much less subject to problems and more specific to solutions." In fact, Thompson vowed, after having to work hard to gain a federal waiver for his BadgerCare healthcare program for low-income working families within 185% of the federal poverty level as governor of Wisconsin, he would speed up the process for states by setting a time limit on HHS's review of applications. If a waiver decision isn't done by deadline, Thompson said it will go directly to his office, where he makes the decision. Robert Greenwood, public affairs specialist for the American Association for Homes and Services for the Aging, said Thompson's home state particularly tried several ways to improve care for residents, including, for example, congressional bills by Rep. Patrick Ryan (R-Wisc.) to allow greater flexibility for nurses to perform certain services for residents in long-term-care settings as a cost-cutting measure. He said the state found itself being stalled by state agencies and their rules. "Wisconsin tried to do many innovations and they were thwarted," Greenwood said, citing one restrictive state rule involving eating arrangements for nursing-home residents. AAHSA, Greenwood said, envisions more productive relationships with states. "The nature of the system is that it is more punitive than it is supportive," he said. "We would like to see more cooperative relationships with states." Greenwood also said the group wants to see state and federal agencies deal more with the longterm-care facilities having the most problems with regulatory compliance than the facilities with the highest service marks. "State inspectors should stop treating them all alike," Greenwood said of the long-term care providers, pointing out that they have two weeks before the next state inspection. "The poorlyperforming homes need more attention to be brought up to par with state and federal code. 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