Despite being courted by hospital lobbyists, one nursing home group says it is reluctant to join the coalition of providers asking Congress to allow provider-sponsored organizations to serve Medicare beneficiaries.
The American Health Care Association, which represents about 11,000 nursing homes, says it is worried existing PSO legislation could cut its members out of the PSO market. Bills introduced in the House and Senate would allow PSOs, under uniform federal standards, to contract directly with the government to serve Medicare beneficiaries on a capitated basis.
Providers affiliated with PSOs would be required to provide a substantial proportion of the services their enrollees receive. To do so, PSOs would need to include providers ranging from primary-care doctors to hospitals to laboratories.
The AHCA is expressing "strong concerns" about the language in the House and Senate bills. The Senate version of the legislation excludes skilled-nursing care from the list of services that must be provided by each PSO, and the House bill lets HCFA decide what those services would be.
"Most of our folks are suspicious (of the PSO legislation) and supportive of the managed-care industry's effort to express strong concerns about the legislation," said AHCA senior lobbyist Robert Hartwell. "We support the concept of PSOs if they're open for all providers that qualify," he added.
Sen. William Frist (R-Tenn.), a transplant surgeon who is the chief Senate sponsor of PSO legislation, acknowledged "discussions" about what types of providers PSOs would be required to include. Frist said if providers can show they might be excluded, "we'll certainly take a look at it."
The American Association of Homes and Services for the Aging, which represents not-for-profit nursing homes, is more enthusiastic about joining PSOs.
"We see this as a fairly significant piece of legislation that will affect the long-term-care industry," said Michael Rodgers, AAHSA senior vice president. "Long-term-care providers bring an expertise to the table in managing chronic care."
The AHCA's tack is similar to that of the American Medical Association, which supports PSOs but resists the legislation because it wants physicians to have more market control.