Another long-term-care group is expressing doubts about legislation that would allow providers to form managed-care networks serving Medicare beneficiaries.
The American Association of Homes and Services for the Aging, which represents 5,000 not-for-profit nursing homes, said it believes the legislation will not allow long-term-care facilities to be the key players in forming provider-sponsored organizations, or PSOs, said Michael Rodgers, the association's senior vice president for government relations and public affairs.
Nine hospital groups, led by the American Hospital Association, are lobbying lawmakers in favor of bills that would allow hospitals and other providers to form, under uniform federal standards, PSOs that can contract with the federal government to serve Medicare beneficiaries on a capitated basis.
The measures are sponsored by Sen. William Frist (R-Tenn.) and Rep. Jim Greenwood (R-Pa.).
The AAHSA last week was preparing written testimony to congressional committees requesting that long-term-care providers, either individual providers or alliances, offering an array of subacute services qualify as PSOs if they're also allied or in contracts with hospitals, Rodgers said.
Long-term-care facilities object to a clause in the legislation that requires the PSOs' affiliates to provide a "substantial proportion" of the Medicare-covered services delivered to their enrollees.
The long-term-care providers said that clause will prevent them from forming their own PSOs because hospitals and doctors provide a large part of Medicare services and control the patients.
"Right now, the legislation seems to be biased. PSOs can be hospitals and doctors, and that's it," Rodgers said. "We want to make sure that's not it. We just want to make sure we don't have a predominantly inpatient and primary-care model."
In its reluctance to join the hospitals' PSO coalition, the AAHSA has joined the American Health Care Association, which represents 11,000 investor-owned and not-for-profit nursing homes.
Robert Hartwell, the AHCA's senior lobbyist, said his group believes the legislation does not allow nursing facilities to "contract up" with hospitals. PSO formation "only flows from the hospital down," Hartwell said.
But Thomas Nickels, the AHA's vice president and deputy director of federal relations, said the clause requiring that PSOs provide a substantial proportion of services is included to ensure that PSOs "not be a string of subcontractors." Nickels said the legislation isn't designed to allow hospitals, nursing homes or any other providers to be able to form PSOs on their own. Rather, he said, it is designed to allow all types of providers to form integrated systems
The American Medical Association has echoed long-term-care groups' concerns. In written testimony to the Senate Finance Committee, AMA board member Donald Theodore Lewers, M.D., said the Senate PSO bill "would favor the hospital-owned or physician-hospital organization model to the exclusion of others."