McKnights: ‘Crying wolf’ or dying breed? Incentives often ignore plight of rural skilled nursing operators

For Mark McKenzie, CEO and founder of Focused Post-Acute Care, a lack of physicians and advanced practice clinicians to care for patients at his 26 Texas facilities is the most pressing issue. If the government would pay more for them to drive to and treat patients at his mostly rural facilities, he could work with hospitals to capture more of the locals being sent miles away from home for skilled care.

Nationally, the only physician add-on available, however, is for doctors associated with rural clinics, or those willing to create a clinic of their own.

“No physician’s going to do that for one patient. Delivery of healthcare and being reimbursed for healthcare as a provider should not be that difficult … but we make it difficult in our processes,” said McKenzie, who has for years lobbied lawmakers on the idea of a critical access label or “safety net” designation that sends more financial resources to rural nursing homes at risk of closure.

Those efforts, though, have gained no traction. In the meantime, McKenzie last year gave up five facilities he’d been operating to ensure that his company survives. He said he’s been part of several organizations that viewed their rural facilities as “loss leaders,” operating with little to no margin simply to fulfill a mission in a given community.

But with post-COVID inflation, that strategy has become too costly and threatens organizational livelihood. Good Sam, the nation’s largest nonprofit skilled nursing provider, last year announced it would scale back its operations to core states and has in some cases shrunk its operations even within that core footprint.

“I don’t think lawmakers understand rural healthcare in general, and I think when they hear us [skilled nursing operators] talk about the magnitude of the problem, they assume that we are crying wolf,” McKenzie told McKnight’s.

“We talk about how difficult it is, and then the same guy is there five years later talking about how difficult it is,” he explained. “The lawmakers want to know, if it was so difficult and dire and you were on death’s doorstep five years ago, how have you managed to make it today? I’ve been asked that same question, and at least two times, my answer was, ‘Well, the other three nursing homes in town closed, and I gathered all their employees and all of their remaining residents.’”


Click Here to read the full McKnights Long-Term Care News article written by Kimberly Marselas!