Sept. 6, 2007

A few years ago, some Catholic hospital systems came under fire for business practices that painted some of this country's most successful and benevolent organizations narrowly and unfairly. During this public relations crisis, Sister Carol Keehan, at that time the new CEO of the Catholic Health Association, met with AAHSA's board. She was asked what happened to create all the furor. She paused and reflected something like this: "While we have some problems to address, the fundamental issue is that we let other people tell our story. We have a great story of charity and service, but we let others tell it very narrowly."

Fast forward to today's national budget debate. Congress is back in session. Many of you made contact with your delegations while they were home on recess. And we have done significant follow-up with their staffs here in Washington to educate them about our predicament.

The overarching issues, of course, are how long-term care should be financed and regulated, how housing policy needs to be strengthened, how to protect our not-for-profit status, and how to help people and families stay at home. The right policy for the right reasons.

The short-term issues are how we support children's health, eliminate Medicare payment freezes, solve the therapy cap issue, support adult day services, advance technology applications and secure more funds for housing preservation and construction.

When Congress recessed for August, the primary legislative vehicle for addressing our health policy objectives was the so-called CHAMP Act of 2007. The centerpiece of the Act would provide health care to 11 million children, five million of whom currently lack health coverage. We joined 11 faith-based organizations and dozens of other nonprofits in support of this bill—the right policy for the right reasons.

A major problem with the CHAMP Act, however, is that it calls for a Medicare freeze for nursing homes and home heath. We reasoned that we could support CHAMP—and through our advocacy activities—get Congress to eliminate this arbitrary freeze provision through sound reasoning and leveraging the not-for-profit experience through member credibility.

You see, some in Congress proposed the freeze because of the financial success of certain specialized post acute care facilities that do quite well on Medicare Part A. We don't fare as well on that score. Judging the financial plight of an entire health sector on the specialized business models of niche players is like saying "Orlando has a booming economy, so why does New Orleans need federal help?" The story that doesn't get told is that most nonprofits that have Medicare programs have a very low margin—less than 4 percent on average. Often, at least part of that margin has to subsidize Medicaid. And, with a proposed freeze on a CMS-determined cost-of-caring increase of 3 percent, many nonprofits, as well as for-profits with Medicaid have NO MARGINS! Yet, we are expected to improve quality on NO MARGINS! Miraculously, somehow, many of you do just that.

Here's where the storytelling comes in. A couple of our colleague associations decided to target what they perceived to be vulnerable members of Congress through negative ads in the districts of those members. In reaction, several congressmen have fired off letters to the editor and op-ed responses. Their replies paint a picture of corporate greed, and implicate all nursing homes. A grossly unjust characterization of everyone in our field.

We must tell the not-for-profit story: limited margins, coping with inadequate Medicaid funding in many states, quality on shrinking resources, doing the right thing for the right reasons. We must tell the press and Congress that the money is needed to improve compensation for staff so they won't have to work two and three jobs to support their families. We must have these funds to meet costs-of-caring increases related to utilities and medical supplies. We must come across as the committed and resourceful people that we are. That's our story.

There's more to gain through credible storytelling than bashing through advertisements. Tell those members of Congress who were targeted that you're not part of it. It's not our style, and I believe it's a waste of your dues money. If we tell our story well, all nursing home residents and staff will benefit.

Then, tell them the whole story. Tell all members of Congress the whole story. Your job: Contact Congress.

Remember that the nonprofit identity is the most valuable identity we have. The credibility of it is immeasurable—because you stand for the right things for the right reasons. That credibility will allow other boats to rise on our tide. Nothing wrong with that! That's part of the not-for-profit story.

 

Larry

William L. Minnix, Jr.
President & CEO

AAHSA · 2519 Connecticut Ave. NW · Washington DC 20008 · www.AAHSA.org