『Keeping Pace with a Changing Reimbursement Landscape』のカバーアート

Keeping Pace with a Changing Reimbursement Landscape

Keeping Pace with a Changing Reimbursement Landscape

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In this episode, host Debbie Stadtler welcomes John Kane, senior vice president of reimbursement policy at AHCA/NCAL, to discuss how reimbursement policy directly impacts the resources providers have to deliver quality care and the challenge of keeping pace with an ever-changing policy landscape. Kane explores the development of the Patient-Driven Payment Model (PDPM), its shift from volume-based reimbursement to a model centered on patient characteristics, and the challenges states face when adapting PDPM for Medicaid populations. He also examines major Medicaid changes under H.R. 1, ongoing Medicare Advantage challenges related to access and payment, and the growing regulatory demands facing facilities. The conversation highlights why staying informed and engaged is increasingly important as reimbursement continues to evolve toward value-based care. Perspectives in Long Term Care is produced by Association Briefings. Transcript Debbie Stadtler: Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Health Care Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long term Care, a monthly podcast produced by AHCA and NCAL. Each month, we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long term and post-acute care profession. My guest today is John Kane. John is the senior vice president of reimbursement policy at AHCA and NCAL. Prior to this, he spent almost 15 years at the Centers for Medicare and Medicaid Services. Welcome, John. Thanks for being with us. John Kane: Thank you very much, Debbie. It's a pleasure to be here. Debbie Stadtler: We like to start at the beginning. So tell us how you got involved in long term care. How did your career lead you to where you are today? John Kane: A combination of things probably. I think one part of the journey started back years ago when I was studying philosophy of all things... and had every intention of becoming a college professor: teaching, publishing, sipping wine. And but I found that as I was talking with my colleagues, and I would be asking questions that they didn't seem to really care much about. We would be talking about health policy, and I would ask questions like, "Well, how are we gonna pay for that?" Or "How are providers going to implement this?" And they didn't really seem to care, and I realized at that point I wanted to do something that was more applied and less theoretical. And at the same time, as a matter of coincidence, I was actually working at a facility in Blacksburg, Virginia, Five Stars Warm Hearth, shout out. Nothing glamorous but very important role. I worked in the kitchen. And I'll tell you that trying to make a soft liquid diet palatable takes a lot of skill. But my experience there also helped me to see the daily struggle of the people that were working in that industry and the amount of passion that they brought to it and really just dedicating their lives to valuing the lives of seniors. And I loved being a part of it, even a small part. And as I was there, I felt like there was more that I could do, and I wanted to get deeper into it. And so that eventually led me into the deeper areas of health policy and eventually led me to CMS. Debbie Stadtler: I love that story. A little hands-on kitchen experience really leads you to your greater purpose in health policy and helping those in long term care. I love that story. John Kane: I like to think that I've done more not burning people's food than- Debbie Stadtler: Always important. Your background includes years spent working at the Centers for Medicare and Medicaid Services, what we know as CMS. What's that like working on the government side of reimbursement, and how did that time kind of influence your views? John Kane: My time at CMS was some of the most formative and memorable time of my life, especially my career. I can't speak highly enough about the people that I worked with at CMS and that continue to work within CMS. They are dedicated public servants, all of them, and it was also just an incredible feeling to be at the genesis of policy development. It was hard to not feel as though you were doing something that was impactful and you were making a difference every day. At the same time, I also felt a certain disconnection from the industry that I had grown to love. I would go to visit facilities, whether it was because my dad was in a facility or just to get back out in the field and go and visit with residents or visit into the various homes, and it felt different. I was no longer just a person walking through the halls. I was CMS now. And so conversations became more focused on policy than on people, and I missed it. And moreover, I think being at CMS, you develop a level of specialization that is nurtured by the, the siloed nature of the agency. While I was there, ...
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