When a risky strategy is your only ally …. Business, Politics and the spiritual salve that holds it together.

Who will take care of those who can’t take care of themselves?

By Dianne H. Timmering

July 2017

Legislative victory!: Senate Bill 4 – Medical Review Panels! Kentucky gets tort reform! A form of civil practical justice to resolve frivolous unmerited litigation that elicits equity and fairness, and a professional determination of the facts alongside the truth of our intent.

 Excerpt: The truth is, at the core, compassionate imperfect care is the best kind of care and often very difficult care to give. We fought for both policy and legislative victories; not because we want “protection” from the accountability of care, but so that we can give it.

These two victories are about the freedom-filled rights of our U.S. Constitution and Preamble—we the people—as it was meant to exist with the fair distribution of logic, observant of rational considerations and judgement. For Medical Review Panels, our first step in the tort reform odyssey, litigation will now be considered by an expert panel, for both sides, the defendant and the plaintiff, the patient and the provider, with the right to a free trial! Tort reform in the form of panel equality, and urban-rural, in the form of accurate designation, are ultimately both economic issues of mightiness to expand healthcare innovation, retain patient fairness, restore caregiver confidence and keep solvent the industry that gives life and hope to the Least of Us. Dianne H. Timmering

July 2017 – Starting July 1, 2017, after years of a battle, a plan, a struggle and finally a revolutionary win, both Medical Review Panels and Urban-Rural reclassification took effect in the commonwealth of Kentucky.

The financial impact from unfiltered litigious cruelty is not yet known although as the first line of defense against unscrupulous carpetbaggers, its financial relevancy will reveal itself over time. Regardless of this critical point, perhaps it is the emotional breath that will follow our July first momentum, during our own national freedom of independence, which will be a beacon of hopeful relief for our Signature leaders and other “valiants” who take care of the elders of our times.

Policy victory!: Kentucky gets urban/rural re-classification after 14 years of inactivity –a significant change to meet the critical care needs of so many vulnerable aged Kentuckians and compete for wage competitiveness for the care-giver gifts of care.

The Rural to Urban re-classification, unchanged for more than a decade—a “material injustice” by a former governing body, is simply an issue of updating the system to allow providers to be reimbursed under the appropriate demographic area. For years, un-reimbursable care-ratio dollars have been unclaimed even though we have given the care anyway. Now dedicated long-term care providers can not only better care for our precious “consumer,” but find the beloved care-giver at a competitive wage rate that has turned out, the national shortage of care-givers, to be one our greatest nemeses of care delivery. We were an industry on the “brink of failure” not because of lack of supply and demand, or even operationally but because of litigious extortion and payment unfairness!

But neither of these revolutionary wins came without a cost: they took a fight, a strategy, a boldness and intentional risk, even without the assurance of any kind of win. The SignatureNation, and others, have been involved in both this legislative (MRPs) and policy effort (Urban/Rural) for more than a decade – in incipient development, maturation, and advocacy. As healthcare leaders of today must often do, we CHOSE the path of involvement for it was the only way to enact the change we needed for an industry almost on the “brink of failure” (the American Healthcare Association phraseology).

Both were decidedly long-term strategies because nothing short-term was working in the current legislative and executive branch governmental make-up. To get what we needed to battle industry pressures and unnecessary headwinds, we pivoted in 2014 from a strategy of defense to offense, deciding to get to the root of why nothing was happening, why such antiquated regulatory restrictions (urban/rural re-classification) and tort reform efforts were consistently meeting unmerited opposition.

We made the bold move to be out-in-front, to begin the effort to change the make-up of the governmental landscape. Not because of Democrat or Republican leanings, but because as “Health-o-crats”, we needed to change the foothold of inertia and old political ways which were driving our business to the edge of calamity.

We are fighting now for the same thing on the federal level even with an influx of baby boomers and a “sicker” patient population coming in. Where will our people go?

Fighting seemed right not only because of an expanding marketplace in Kentucky, but because of Signature’s more than decade old mission of hope and vision of “compassion-care” rescuing communities and elders who needed us. My precious mother passed away of acute Parkinson’s disease in a Signature center and I am forever grateful that they took loving care of her, because at home, we simply couldn’t anymore; and moreover, didn’t know how.

A revolutionary strategy must be bold and resolute.

With intention, we supported a dark-horse gubernatorial candidate as well as legislative candidates who supported our issues; we built relationships, educated politicians about our vulnerable patient population, invited them to our facilities, discerned ebbs and flows of underlying opposition, and pivoted at key junctures which significantly increased the odds for a win regardless how risky the strategy had become.

When, for example SB4 (Medical Review Panels) finally hatched out of the House in late February 2017, we, among others, were a part of it until last minutes of the final vote. We co-led the umbrella consortium with the KY Business Chamber, the Kentucky Hospital Assoc., Leading Age and the KAHCF (SNF Assoc.), co-drafting legislation, fighting back against dilution, drawing a line in the sand when we thought the strength of the review panel was dead. Signature leaders and CEOs from across the state battled for a strong bill with courage, fortitude and collaboration, pivoting when needed, holding resolve when demanded.

The Kentucky team was not afraid to get involved in the future of its own destiny!

It was time. We fought for a structure for fair and equitable judgement as the ubiquitous nature of healthcare engagement is based on human ethics, social determinants, expanding sickness of co-morbidities and good human intent. The truth is, at the core, compassionate imperfect care is the best kind of care and often very difficult care to give.

The MRP vote, tenuous when it finally happened – 51 – 46 passing via a simple majority—was a zenith moment, a penetration of time, when business, God and politics all worked together for a common good.

What stood out to me of course was the first amendment right of spiritual freedom, when Jason Nemes, one of the bill’s architects and an ally, who in the end wanted a good bill and one that would withstand a constitutional challenge, but give fairness to both sides with expedited “pay-outs” for someone found to be indeed injured or neglected, it was his invocation of something sacred to me, something I co-founded and built with my co-partner, Joe Steier. Jason said that long term care companies are good, do care for a vulnerable population, and are targets. He then singled out Signature Healthcare for our spiritualty pillar – the caregiver beauty of soul, united with the SHC chaplain corps, unique to our industry, focused on whole patient well-being—in volume and reach, in width and depth for a deeper sense of human wellness. That we were a company, “trying to do right.”

Maybe through our model and vision to change the landscape of long-term care forever, our trials of purpose forge a trail for those who follow behind. We are perfecting the model of equal parts – business, God and politics to make it a whole, for healthcare is not driven by these buckets in single domains. Good policy drives productive business strategy with the ethereal iron impact of spirituality, tying the salve of patient possibility and the infrastructure of sustainable business with real hope in healing.

Mistakes do happen. We know this and own it. Our community is frail. Our framework of care for the elderly resident is through the core of Sacred Six engagement, state of the art clinical training combined with spiritual hope in medicine against growing chronic sickness and the highest levels of frailty. We love our residents, and our intent is to take the best care of them. The MRP does two things – it elicits equity and fairness, and a professional determination of the facts alongside the truth of our intent. It allows the facts to come out, for the unemotional truth to be told and considered. We just want the fairness of what a Medical Review Panel could and will bring to the discussion beyond the automatic lever of accusation, but the relevancy of the good intent of care and the full details around the situation. And it doesn’t preclude the plaintiff to due process and the right to a trial.

As the fourth of July coincides with the enactment of this legislation, these two moments are about the freedom-filled rights of our U.S. Constitution and Preamble—we the people—as it was meant to exist with the fair distribution of logic, observant of rational considerations and ultimate judgement. For Medical Review Panels, our first step in the tort reform odyssey, litigation will now be considered by an expert panel, for both sides, the defendant and the plaintiff, the patient and the provider. Tort reform in the form of panel equality, and urban-rural, in the form of accurate designation, are ultimately both economic issues of mightiness to expand healthcare innovation, retain patient fairness, restore caregiver confidence and keep solvent the industry that gives life and hope to the Least of Us.

These are RevolutionaryTimes.

UPDATE!: But the fight goes on. The MRP bill is a good one—with measured and fair authority for both sides (the plaintiff and the defendant) with no 7^th amendment violation; the right to a free trial is NOT in jeopardy – the designated time periods allow for the facts to be heard—a visceral wall against frivolous litigation. Medical Review Panels not only expedite the evaluation of a patient’s claim and help detect whether it has merit, but can expedite a “pay-out” for someone found to be indeed injured or neglected and does not stop access to a fair trial or the courts. But still the fight goes on…..

Dianne H. Timmering, MBA, MFA, CNA