AHCA/NCAL finds a new voice in Washington

Come early January, members of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) should expect to receive a phone call from Washington. On the other end of the line will be Clif Porter, the organization’s new senior vice president and top lobbyist, and he’ll be looking for help.

Porter, who is completing eight years as vice president of government relations for HCR ManorCare and has more than 24 years of healthcare management experience, will be representing AHCA/NCAL and its members on Capitol Hill and before the major federal regulatory agencies.

But he knows from experience that the most effective voice before lawmakers is the operator or administrator who runs a facility in their state or district that provides jobs, contributes to the tax base and serves patients who live there.

“The key is for folks to understand the importance of their role,” said Porter. “There is an element of credibility that comes along with the work that we do, and it differentiates you from a paid lobbyist when you are telling your story to a lawmaker. Operators know the issues and the implications of policy changes far better than any lobbyist can articulate.”

Porter knows what he’s talking about. He was a nursing home operator, managed new facility openings, a turnaround and multifacility firm. Along the way, he worked with state associations, helping to resolve state governmental issues that arose.

Porter is convinced there is a vast resource of knowledge and political relationships among the association’s membership that can be tapped as challenges arise in Washington. “I want to inventory our relationships and find out, in our local communities, who knows what representatives in Congress, whether it’s through the PTA, helping to fund a congressman’s first campaign when running for city council or if they are somebody’s cousin. It’s better to have somebody who knows a member of Congress articulating our message than a stranger.”

So Porter will be making a lot of phone calls to gain this intelligence and develop a team of operators with those connections—and then to launch what he calls the “two-minute drill.”

Porter recognizes that the current financial crisis that is consuming Washington isn’t going away any time soon and that it could pose a real danger to the industry as politicians look for ways to both solve problems and cut spending. And, there is no time to waste. “It is important that in midst of this chaos that we do not allow catastrophe to happen to our sector,” he explained.  “The biggest frustration is the lack of normal order relating to budgets and the like. At this stage, it is completely unpredictable and unprecedented. We have never before faced a scenario like this.”

There are dangers that will arise even before Porter is officially on the job. For example, key congressional committees are working on a “doc fix,” a new procedure for paying Medicare physicians that will avoid the annual threats of mounting reductions in fees for their services. That needs to be finished by year’s end.

Ultimately, contends Porter, this effort puts every sector, including long-term  care at risk. The “doc fix” will cost hundreds of billions over the next decade. Where will the money come from? Lawmakers will need to come up with a “pay for”—cuts to compensate for the additional spending. There is sentiment that health care must provide those funds in some way, shape or form.       

“Our sector has absorbed $57 billion in cuts over last five years, which is far greater than our proportion of spend in Medicare,” said Porter. “So our goal is to offer solutions to rationalize the payment system and move patients into settings that are high quality and low cost and ultimately get them home more quickly without being re-hospitalized, thus saving the system money.”

Porter contends the industry is making headway. “We’ve worked on developing thoughtful solutions that are sustainable and save money over time. We are very confident in our ideas, and decision makers on Capitol Hill are beginning to listen and take notice.”

That is coming on top of the current crisis over the debt limit and all of the efforts to slash spending in the process. “Then with the debt ceiling negotiations, one side of the aisle wants to figure out ways to save money,” said Porter. “So you’re at risk. We want to be in position that the government understands we’re here to offer solutions and ways to save the government significant money apart from mindless across-the-board cuts.”

Porter was asked to list the top three challenges that await him when he actually begins his new job. Here’s what he said:

  1. The impact of demographics as the population ages and the system is swamped with a huge influx of new patients.  “This is going to force creative ideas and innovation to change. But we have to make sure that change makes sense. It needs to happen in a thoughtful, not reactive, way.”
  2. Making sure patients are moving to the most clinically appropriate lowest cost setting for a positive outcome as quickly and appropriately as possible. “We have to make sure patients are not being discharged back to hospitals, but are going home better and able to return to a healthy life.”
  3. Regulation. “We have to assure that we have common sense regulations that do not add significant additional cost to our operations. We need to ensure that any new regulations make sense and are aligned with the system and concept that improves outcomes for patients in an efficient manner. A lot of time, regulations are not in concert with the real world.”

Porter believes the team of consultants and staff at AHCA/NCAL is “best in class.” But, he said, there is a “real opportunity to awaken our operators in the field and get their help locally because that’s where the power is. If a member of Congress hears from three nursing home operators in his or her district that this policy is a problem, that it affects employees, adds cost and harms outcomes, then you will get a groundswell of support that will make our jobs in Washington so much easier. So we need to empower our members. Then Washington becomes an echo chamber that will seek solutions.”

Bob Gatty has covered governmental developments for the trade and business press for more than 30 years. He is founder and president of G-Net Strategic Communications, Sykesville, Md.

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