FAILING GOVERNMENT TAKETH AWAY

OUR TRUE STORY OF HOW THE MONOPSONY GAME IS PLAYED

In 2009 my son, wife and I purchased a 100-bed skilled nursing facility in Muscatine, Iowa with 15 beds available for vets, 2011 in Washington, Iowa we bought a 125-bed facility with 75 available for vets and in 2009 a 139-bed facility in Little Rock, Arkansas with 50 beds available to assist in providing much needed restorative care for the returning veterans. Why wouldn’t collaborating with the private sector to solve the problem of wait times and getting veterans back home work be the solution? It would if the Monopsony Game bureaucrats would get out of the way. We had only 4 vets in Washington and none in the other facilities. At the time, 240 beds were utilizing the Medicaid program rather than VA benefits. There could have been upward to 100 vets being admitted timely upon return to America and put into the appropriate restorative programs for returning them home. (a school of fish versus a VA hospital whale). Without this process upon discharge from the VA all services shift Federal costs inappropriately to the State Medicaid costs.

In Muscatine All-American Care, my company, had restored and returned 260 post hospital patients back into the community. We offered full therapy, skilled nursing, post-acute care, pre acute care together with psychosocial tele-consultation, clubs and classes with the mission of returning 60% of our admissions back out of dependent health care being paid for by Medicaid. We also coordinated the Medicare benefits with VA benefits, as required by health care law, for up to 100 days of Medicare restorative care after the patients exhausted their VA benefit so they can return to their real homes. We could have served up to 100 vets, at a time, utilizing the Medicaid program for the last two- and one-half years after VA benefits. This shifts Federal costs appropriately before utilizing the State’s Medicaid costs. Taking this approach in all 50 states could have resolved the backups for immediate care and better served our 10’s of thousands of injured vets.

Yes, even though our facilities were not yet three stars and had to file for Chapter 11 protection due to the State of Iowa not reimbursing for current costs of care and sanctions imposed on our facilities for minor violations … compared to the what the State had passed on for the previous owners in the past. We appealed the arbitrary treatment by the surveyors and appealed their arbitrary findings. In retaliation the State regulators put us on special focus surveys in all three facilities that prevented us from admitting any patients twenty-six of the 78 months we owned the facilities and fined us $450,000 since we purchased these dumps that were allowed to stay in compliance for years because the owners were politically connected.

Not only have we been subjected to illegal arbitrary and capricious tactics by the States of Iowa and Arkansas Departments of Survey and Appeals run by Directors (who had never set foot in our facilities) and their Gotcha-Gestapo crew, we were prevented from being able to contract with the VA and the VA hospitals in the area to shorten wait times and restore veterans back into the community. Rather we lost over $3 million dollars because of Government run single payer Obama health care.

With this politically motivated treatment our Arkansas facility was returned to the builder and the two Iowa facilities were to be sold under Chapter 11 protection and supervision of the bankruptcy court. And suddenly the State of Iowa issued an update to our rates, two years in arrears, for costs that we had incurred over that time and paid the two facilities $920,000 without interest for back billings.   With the new reimbursement rates we were able to accept an offer to sell them for $8.5 million and liquidate all our debts and walk away with some retirement money … (see postscript for the arbitrary and capricious acts   by the State of Iowa Department of Survey and Appeals that destroyed our businesses).

As a result, the State retaliated against us for our stance on arbitrary and capricious interpretations of the minimum standards of care, and what constitutes substandard care.   We were then black listed by the State as one of the worst facilities in the Iowa due to our political views. The Des Moines Register’s self-anointed watchdog Clark Kaufman is allowed to distort and defame independently owned nursing homes, such as ours, without proof based on what the State’s arbitrary and capricious surveys publish on the internet without due process of law … true or not. We invited him to visit our facilities that he continued to incriminate and distort without investigating the facts but he avoided the truth.

Our facilities were extraordinarily clean, odor free and have more than the average nursing homes RNs, LPNs, CNAs, Therapists, social workers, rehab aides and have had $1 million dollars in renovations and successfully changed the culture of staff from not caring to being committed to the restoration of our patients. Thus, making our facilities into a home like environment; and an effective private enterprise to innovate and improve the care of the disabled veterans and elderly so they can go back their real home.

It is our opinion that Obama Monopsony Care has and will exacerbate these budgetary glitches and service blunders. God save the American Enterprise system from Government control. Let the creators create and the politician’s debate.

POST SCRIPT:

What does this have to do with the VA debacle. If you were able to sell your facilities why are you so disgruntled? Just walkway and count your money. The point is that we ended up losing our investment because nursing homes are the target for every politician and attorney as the reasons for health care being too costly and without needed quality … when in effect the VA circumstances are only the tip of the disaster that takes place with hospitals, pharmaceuticals, physician prescriptions, poly pharmacy and lack of accountable costs and quality controls.

But wait a minute are you saying that the States of Iowa intentionally sent in a surveyor in October prior to closing the sale. Yes, Mr. Rech (appropriately named) who had hurt us in the Washington facility, proceeded to create a finable violation out of a slapping incident by one of our new patients. Mr. Doe was admitted by his son with dementia but without proper admission information and we had not been able to discharge him due to his decline into Alzheimer’s disease, hitting our staff and nonpayment.   He proceeded to enter another patients room and slap her leaving a bruise on her forehead before leaving the room. The family had been complaining about this person entering their mother’s room and reported the slapping to the State of Iowa Department of Survey and Appeals.

This triggered the visit by Mr. Rech who again refused to acknowledge the circumstances and concocted the theory that we should have had 24 surveillance of the man thus triggering a J violation of immediate jeopardy without giving weight to any of our attempts to discharge the man or have his son take him. The fines were assessed on December 20^th 10 days prior to the closing of the sale by CMS the Federal government overseer of Medicare and Medicaid at $8000 per day for 42 days totaling $350,000.   The highest fine ever assessed a skilled nursing facility. Within a week Mr. Rech was again at the Washington facility to follow-up on a self-reported elopement of a patient ready and willing to search and destroy our chances at being sold.

Obviously, this killed the whole deal because of the threats made by the regulators and we had to find another buyer. A year and one half later we were able to sell the facilities for $1.3 million less with just enough to payoff SBA and the bank for fixing the problem of violations that were in the past passed over and used to force us out of the business despite the improvements we made in quality of life for our patients, the environment and culture making a positive contribution to the community.  The new owners in all three of the facilities reverted back to warehousing the elderly and disabled with no real interest in veteran affairs and continuing to make contributions to political campaigns.

The moral of the story is our nation’s nursing homes are a product of overreaching punitive regulations and imminent destruction of the free enterprise system of business. In 35 years in the nursing home business I’ve never seen regulators improve anything and the culture of fear suffocates free enterprise. With that in mind the design of the entire health care delivery system must be for the greater good of those taking responsibility for their own self-health habits and prevent chronic diseases and early confinement in nursing homes. Using the outcome accountability approach for episodes of care from home to doctor, to hospital, to nursing home, to home care, to hospice to grave we integrate and collaborate not debate or destroy the human enterprising spirit.

Yes, as Robert Reich (similar to Rech) former Secretary of Labor under President Clinton, famously stated on CNN round table discussion, that the government must be the payor of last resort for the economy to avoid recessions, inflation and another depression … oh is that what happened in 2007 when the Fed drove up its member bank discount nterest rates up 500% and the sub-prime mortgages collapsed causing a worldwide depression while the Republicans and Democrats blamed Wall Street and Fed Chairman Bernanke saved its member banks and large investment bankers with taxpayer’s equity. A perfect example of how the Monopsony works.

(You can get our complete story on Monopsony in my book “Failing Government Taketh Away” and sequels “America in the Red Zone”, “Remedy Eldercide, Restore Elder Pride”, “The Boomers are Coming”, “The American Enterprise Manifesto”, and self-health books, “Lifestyles for aging”, “Never too Old to Live”)