I recently attended a conference for Long Term Health Care Providers. Among the topics presented from an array of health care professionals, was one presented by a ‘Washington DC’ Medicare expert. Her topic was how Medicare and its’ payment process influenced the new national health care reform legislation.
She described how, in essence, the current Medicare payment routing system works. For instance, let’s say a Medicare covered patient was diagnosed with the need to have a hip replacement (The diagnosing doctor receives a Medicare payment for his services). The hip replacement patient receives the necessary surgery (The hospital receives a Medicare payment). The patient needs rehabilitation and required therapies (The rehabilitation center receives a Medicare payment). The patient returns home and requires further support and therapy (The Home Health Agency receives a Medicare payment). Necessary drugs are required post-surgery from a pharmacy (The pharmacy receives a Medicare payment). The patient requires a walker (The home medical equipment provider receives a Medicare payment).
The challenge for the patient and Medicare is that for this one hip replacement, Medicare makes payments to six different providers for six different health care services rendered.. The patient is copied on six (actually many) Medicare billing statements. Not only is this confusing for the patient, but for all intents and purpose, it is even confusing for the Medicare program!
Now, multiply this same scenario repeating itself several million times each year and it’s easy to understand how the Medicare program has grown to be a quagmire of inefficiency and confusion for all involved!
Cue a drumroll . . . “Now stepping in . . . National Health Care Reform!” While the national health care reform legislation is several thousand pages long, touching everything from ‘health exchanges’ to ‘mandatory health insurance coverage for employers of certain sizes,’ a major portion of the reform deals with ACOs (Accountable Care Organizations). The law calls for, in essence, a new bundled payment plan! What’s that? The presenter at the conference summarized it well when she said, “Medicare is so confused with its own billing process, that it has decided it wants the providers to figure it out because they have given up!”
Therefore, under their bundled payment plan a ‘hip replacement’ will receive a pre-defined Medicare payment – one payment to cover all the providers rendering their health care expertise and services. It is then up to those several providers to divvy up the payment to cover their costs. IF, and that’s a big if, any money is left, they get to divide that and keep it as an incentive to continue to reduce future costs! Problem solved? NO! ACOs create new quagmires. How will personal medical files be shared among many providers? How will the files be protected? Who determines how each provider will be paid from the bundled payment? Who is directly accountable for establishing quality care standards? Who is accountable for medical outcomes? Who is the liability shifted to with any further medical complications? With no further Medicare payments coming, where is incentive to provide additional care? What about hospitals striving to keep readmissions under national averages, do they start to refuse readmissions? Etc.? Etc.? National Health Reform . . . be wary!
There comes certain times throughout one’s life where rare opportunities present themselves. These times can be significant, even life changing, or they can be minimized, passed over, ignored, and lost.
Cedar Community, West Bend, Wisconsin is asking for your careful consideration over a rare opportunity!
As many of you know, the fastest growing disease in the Nation and the State of Wiscsonsin is Alzheimer’s disease. Between the years 2000 to 2010, the rate of Alzheimer’s disease has increased by 68%! This is a tragic and deadly disease that affects the inflicted individual, their family members, and our society in general.
In 1976, Cedar Community opened its’ Friendship House, a 128 skilled bed ‘nursing home’ with a design and programming specifically to provide superior and innovative care for those with Alzheimer’s Disease and related forms of Dementia. In 1976 the word Alzheimer’s was virtually unknown by most people. Friendship House was the very first facility of its’ kind in the entire nation!
It is now 37 years after the opening of Friendship House. In the tradition of that original Friendship House, Cedar Community is beginning the process of creating a new, superior, and innovative facility and approach to quality care for those with Alzheimer’s Disease in an assisted living environment. The new facility, now under construction, will be known as “The Cottages at Cedar Run.”
Located on a 160 acre new campus just immediately south of our Cedar Ridge Campus, West Bend, ‘The Cottages at Cedar Run’ will be designed as none other. In our efforts to dramatically advance the environment, programming, and approach to resident-directed care, ‘The Cottages’ will bring resident choice, dignity, sense of ownership, new levels of activity, and most of all a real home feel that will comfort and encourage each resident.
While a lot of effort and planning has already been put in place, more work lies ahead to see ‘The Cottages” come to full fruition. This project will cost $13 million dollars to complete. In terms of financing, plans are to utilize existing Cedar Community assets for about 1/3 of the project costs. Another approximate 1/3 will come for borrowing. The final 1/3, it is hoped, prayed, and being acted upon, will come from the generosity of Cedar Community residents, families, staff, volunteers, foundations, and our greater community of friends.
So the opportunity is this . . . Would you donate to the creation of ‘The Cottages at Cedar Run?”
We have begun a philanthropy fund raising campaign called “Moments to Remember.” The campaign headquarters are located at our Cedar Ridge Campus as a part of our Philanthropy Department. Our Director of Philanthropy is Amy Johnson (262-338-2819).
An elderly man, feeling a little feeble, sitting at his farmhouse window, gazing out at a dozen or more sheep grazing, wondering what the future might bring. No family, few friends, fewer visitors, lonely days and quiet nights. More questions than answers. Were my days spent wisely, he ponders? Does anyone really care? What happens to a farm that no one seems to want? What might the future bring? Eighty years plus brings armfuls of memories. They bring laughs, tears, regrets, joy, and spoken words meant to be unspoken. What might the future bring? Unrelenting waves of emotion, prayerful focus, then resolve. He finally has an answer to, “What might the future bring?” He finally has an answer to, “What happens to a farm no one seems to want?”
His answer? You are now experiencing his answer! That elderly man was William Koehl! That answer came exactly 60 years ago! His answer . . . “Donate my farm to the church in order for it to help elderly people!” Perfect answer, wouldn’t you say!
The story is far from over. Rev. Louis C. Riesch, received the donated farm on behalf of the church, but now the real work begins!
The progression goes a little like this: Farm and farmhouse becomes retreat center; Retreat center becomes a small rest home; A small rest home becomes a nursing home; That nursing home more than doubles in size; That larger nursing home becomes two distinct nursing homes; The second nursing home becomes first Alzheimer’s/Dementia nursing home in the nation; A village of homes is added for independent seniors; Now a second, third, and fourth village is added; A second campus is added with 312 senior apartments; Another campus is added providing a new retreat center; That second nursing home becomes an assisted living facility; Programs and services providing rehabilitation therapy is added with major nursing home rebuilding; Another campus location is added to the map at the new hospital location; More assisted living is added; Another campus is added in Sheboygan County; and another campus is about to be added providing Memory Care Assisted living! WOW!
An annual operating budget of several thousand dollars, now approaches $50 million. A handful of staff, soon will approach 900. The original 22 residents now have nearly 1,100 joining them! All this in a mere 60 years!
So, do you think it’s an appropriate time to celebrate? Do you think it’s an appropriate time to thank God! Do you think it’s an appropriate time to thank William Koehl and Rev. Riesch?
On behalf of the entire Cedar Community Organization, we say Happy Anniversary! Our thanks our founders! Our thanks to our residents, family members, staff, volunteers, donors, and the wider community! Our thanks to God!
Can’t wait to see what the next 60 years will bring! The story is not over!