The outcome of next weeks presidential and congressional elections may not have been the official theme of the Acute Long Term Hospital Associations annual fall conference, but the topic was never far from discussions at the meeting of post-acute providers in Arlington, Va.
Some attendees and panelists joked that post-acute care generally, and long-term-care hospitals specifically, have not been hot topics in the presidential campaigns or recent debates. But one healthcare consultant, now a member of the House of Delegates in Marylands General Assembly, said the nations healthcare system cannot be fixed unless post-acute care is considered a top priority.
Because thats where the savings are, said Heather Mizeur, founding partner of the Mizeur Group, a Tacoma Park, Md.-based lobbying firm whose clients include the Acute Long Term Hospital Association, Kindred Healthcare and Select Medical Corp. Thats where the high-cost, sickest and most vulnerable patients are, she said, adding that more and more people are getting older and sicker and its going to keep trending that way. Mizeur, who served as director of domestic policy for Sen. John Kerry (D-Mass.) from 2003 to 2006, has served in the states House of Delegates since January 2007. After she spoke to attendees about making the case for long-term care on Capitol Hill, Mizeur chatted with me about the two positions in a new presidential administration that are of most interest to healthcare providers: HHS Secretary and CMS administrator.
Assuming that Democrat Barack Obama wins the White House, Gov. Tim Kaine (D-Va.), Gov. Kathleen Sebelius(D-Kan.) and Sen. Hillary Clinton (D-N.Y.) are all possibilities, said Mizeur, who added that no one knows which cabinet department (HHS, Education, or another) they might lead. She also said Clinton is on the short list for everything. Meanwhile, for CMS, there is Liz Fowler, Sen. Max Baucus (D-Mont.) health director at the Senate Finance Committee; Cybele Bjorklund, staff director House Ways and Means health subcommittee; Tim Westmoreland, who works on the House Oversight and Government Reform Committee and is a visiting professor of law at Georgetown University Law Center; and Judy Feder, who is running a close U.S. House race to represent Virginias 10th district. According to Feders campaign Web site, she has three decades of health policy experience, including her work at the Brookings Institution and Urban Institute. From 1999 to 2007, Feder served as dean of Georgetown Universitys Public Policy Institute. Mizeur paused to think of Republican appointee possibilities, but ALTHA CEO Bill Walters jokingly interrupted, Don't bother!
But Alec Vachon, who leads the health policy consulting firm Hamilton PPB in Washington, told me later that the people who are talked about are never the ones who are picked. He did say that Obama has run his campaign brilliantly and it will be interesting to seeif he winsif he applies those same skills in choosing his staff. Vachon spent nearly 10 years on Capitol Hill, working for former Sen. Bob Dole (R-Kan.) and, later, for the Senate Finance committee. What Vachon seemed more certain about was the Democratic Partys actions on health insurance reform.
If Obama becomes president, the Democrats will go into over-drive to get a bill ready, Vachon said.
I only wish the post-acute analysts at the ALTHA meeting had been as unguarded with their predictions as Mizeur and Vachon were. About 15 minutes into a session on LTACs and access to capital, panel moderator Bill Bonello of Wachovia Securities interjected to tell the handful of reporters in the room that he had failed to mention all comments until that point were on background only. What?! I believed Bonello when he told me later it was an honest oversight on his part, but come on: Any one of those other analystsfrom Credit Suisse, from Citigroup Investment Research, from Merrill Lynchknew better and should have reminded him. And in case they dont know (I think they do), then heres how it works: On background is only fair game when its mentioned at the beginning, not in the middle, of a public meeting. There wasnt anything earth-shattering that came from that panel, but I am eager to learn more from one analyst who said healthcare has just started to crack a bit under pressure from the nations struggling economy.
As for the conference, which ran Oct. 22-24, it appeared to be a substantive meeting that highlighted all of the major topics that this segment has explored lately: the Medicare, Medicaid and extension of the State Childrens Health Insurance Program, profit margins, patient and certification criteria,and lobbying in Washington for the value of long-term care hospitals. Attendance was lower than previous years, according to Walters, but those who did attend seemed pleased with the conference agenda. There were about 175 attendees at the fall meeting, compared with 300 participants in May. This includes Judy Ingala, CEO of Vibra Speciality Hospital in Portland, Ore., who said the last days sessions on clinical matterssuch as infectious diseases, new treatment options and wound carehonor the charge that CMS has given us to be acute care for longer lengths of stay.
Meanwhile, Dexanne Clohan, senior vice president and chief medical officer for rehabilitation provider HealthSouth Corp. in Birmingham, Ala., said that while post-acute care has been a smaller piece of the healthcare pie, it is growing.
The message is that for the foreseeable future, providers need to work with policymakers to make the case for the care we provide, Clohan told me at the end of the conferences first official day. In any administration, our work will not be done.
Jessica Zigmondcovers public health, post-acute care, specialty hospitals and rural hospitals.