Dictionary Definition of Monopsony:  the economic condition where the buyer (State and Federal Government) control the market and dictate the minimum standards of care and payment.  In other words, the buyer sets the price without the consideration of costs and defines the services to be delivered or the provides suffer the enforcement consequences (fines, penalties, and incarceration guilty until proven innocent.

Why would the VA Hospitals not contract with skilled nursing facilities that have upwards to 200,000 empty beds nationally? Veterans predominately need long term rehabilitation and restorative services not just Government run acute care.  Why would I bring this up? My wife, son and I owned two skilled nursing homes that have applied for a contract with VA and have been prevented opportunity to help solve the wait time problem because we are not a 5-star provider using the Government’s flawed performance rating and cannot meet their arbitrary financial stability standards; sounds systemic doesn’t it?

We had100 beds in Muscatine, Iowa with 15 available for vets and in Washington we had 125 beds with 75 available for vets to assist in providing much needed restorative care for the returning veterans to their communities.  Why wouldn’t the use of the private sector to solve the problem of wait times and getting veterans back home work? It would if the bureaucrats would get out of the way. We had 4 vets at the present time, utilizing the Medicaid program rather than VA benefits. This shifts Federal costs inappropriately to the State of Iowa Medicaid costs.

In Muscatine All-American Care we restored and returned 260 patients back into the community. We offered full therapy, skilled nursing, post-acute care, pre -cute care together with psychosocial groups, clubs and classes with the mission to restore 57% of the admissions back out of dependent health care paid principally paid by Medicaid.  We always utilized the Medicare benefits, by law, for up to 100 days of restorative and rehabilitative care so the veterans can return to their real homes.

So yes, we are not three stars and have filed for Chapter 11 protection due to the sanctions imposed on our Washington facility for minor violations. We were prevented from admitting patients seven of the twenty –six months we had the facility and fined $100,000 since we purchased this noncompliant dump allowed to stay in compliance for years because the owners were politically connected. Not only have we been subjected to capricious tactics by Rod Roberts and his Gestapo crew but cannot assist the VA hospitals in the area to shorten wait times and restore the veterans back into the community.  Rather we have lost over a million dollars because of Government run health care.

We have been black-listed by the State as one of the worst facilities in the state of Iowa due to our political views. The Des Moines Register’s self-appointed hatchet man Clark Kaufman is allowed to distort and defame independently own nursing homes, such as ours, without proof based on what the State’s arbitrary and capricious surveys published on the internet without due process of law … true or not. We have invited him to visit our facilities that he continues to incriminate and distort without investigating the facts. Our facilities are extraordinarily clean, odor free and have more than the average nursing homes staffing of RNs, LPNs, CNAs, Therapists, social workers, rehab aides and have had $1 million dollars in renovation 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 care of the elderly and disable veterans so they can return to their homes.

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

Postscript:

We were eventually forced out of our nursing facilities due to our view that the regulators make it impossible to manage the nursing homes and impose there might under the theory that making the owners suffer will make it better.  Such a flawed approach to the care of our most vulnerable citizens.  It is just plain wrong to force well-meaning independent operators out of business because of Gestapo tactics.  Why because they are replaced by big real estate companies from the East coast wanting to take over the nursing homes only for profit.  Over the years the entire nursing home industry has been consolidated into a few chains that have lobbyists and attorneys who are connected to the Monopsony.  Following VA example are three definitive examples that require privatization of health care:

 

LITTLE ROCK, Arkansas – VICTIM #1

The Rhoads’ purchased this 139 bed facility in November 2009. It was troubled and was going to be closed. In eighteen months we invested over $500,000 change the culture from a warehouse for nursing home patients to a care house for human being needing health care services.

Victimized: Within two and one half months of taking over the facility the State surveyors managed to turn a minor injury in the transport van Immediate Jeopardy violation (patient unfastened his seat belt and fell). This ultimately prevented us from

keeping the facility. After their enforcement action, they forced us to reapply for our

Medicare and Medicaid certifi cation, or be shut down. Then put a hold on admissions until the surveyors gave us a clean bill of health.  This cost us over $1 million dollars in revenue that we had to borrow from the bank. This arbitrary and capricious act reduced the sales price of the nursing home from $7,600,000 to $4,650,000 and we were sued by the builder for $2,700,000 the amount it took to emerge from special focus and get a new provider numbers from Medicare and Medicaid.

Fortunately we were able to negotiate a settlement and left Little Rock behind to an operator that put it right back where it was when we took it over. A warehouse for indigent patients. During the eighteen months we owned and operated the facility we remodeled the exterior and interior, removed all odors, turned over all of the staff and implemented restorative care. This enabled us to move from number 13 in quality to number 3 as the choice of the surrounding hospital discharge planners. Our Medicare program was the best in the city and the value to the community was enhanced. The true measure of quality.

“This is the cleanest, nicest looking nursing home I have ever been in and the lunch was scrumptious. You’ve made such difference here.”

Unsolicited remarks from

Mike Mitchell, attorney at law.

 

MUSCATINE – VICTIM#2

The Rhoads’ purchased this 100-bed facility in September 2009. It was troubled and was going to be closed. In eighteen months we invested over $500,000 and borrowed $3 million to renovate and change the culture from warehouse for nursing home patients to a care house for human being needing health care services.

Victimized: Within days of closing the sale of our two Iowa nursing homes, caused by the enforcement actions taken against us, the Surveyors’ managed to turn a minor incident with a troubled Alzheimer’s patient into an Immediate Jeopardy violation that effectively prevented us from closing the sale of the facilities. After the State’s enforcement action, resulting in $8,000 per day in civil money penalties and fines for 41 days or a total of $375,000 of civil money penalties, CMS put a hold on our admissions till the surveyors gave us a clean bill of health.

This arbitrary and capricious act reduced the contracted sales price of the two nursing homes from $8,500,000 to $5,850,000 that in essence bankrupted our small businesses.

We had to put our banks and our vendors on a payment plan until we could go back to the marketplace to solicit another buyer at a reduced price.

Victimized:  As for the problem of getting paid by State and Federal government is an exercise in intimidation by the Monopsony for submitting and getting claims approved and paid.  First of all, it is at the Government’s discretion to approve or deny a bill (claim) for payment for services already rendered.  In the normal course of business, you provide the service and submit the bill you should get paid if it is delivered.  In the health care business where value is a problem not a reason, claims can be and are denied dur to arbitrary and capricious reasons.   For example, for Medicare to be approved the doctor must approve and the documentation must prove medical necessity an intervention and supposedly an outcome.  Most times the denials refuse to pay unless the provider appeals and there five levels of appeal that require an attorney costing $400 per hour with no guarantee of success.   I call this Catch 23 where yes you can appeal but no you can’t afford it because of the denial.   Over the last 54 years billions of dollars have been denied and services already rendered.  That is the number one rule of the Monopsony … deny, deny, deny and threaten to fine then threaten jail time.

Another ploy is for the Medicaid program to only raise rates when they want to.  In Iowa they base current rates on cost reports two to three years in arrears … and only then if the legislature has appropriated enough money to cover all of the providers in each State.  In Iowa when we purchased the facilities our Medicaid daily rate was a measly $102 per day … barely enough to rent a motel room there.   Three years later after investing $5 million in cleaning and staffing up the homes we got raised to $172 per day retroactive to the date designated and received a settlement of $900,000 … no interest for late payment no consideration that we had to borrow more money from the bank and file Chapter 11 bankruptcy until we got paid … just the usual Monopsony tactic.

To date we are finally out of this crazy institutionalized business that is now being dominated by the Government Monopsony and its large conglomerates managing real estate investments for incomes not quality patient outcomes. During the five- and one-half years we owned and operated the Muscatine facility we remodeled the exterior and interior, removed all odors, turned over 90% of restorative care. This enabled us to discharge admissions back into the community … unheard circles. The true measure of quality.

“I never make it a point to brag on a facility I tour but I

have to tell you I am amazed by your staff … they are friendly,

smile, and every room is clean, organized with all the beds

made. Everyone I talk to loves this place.”

Unsolicited comments by

Judy a volunteer Ombudsman.

 

 

 

 

 

 

 

 

 

 

 

WASHINGTON – VICTIM #3

 

The Rhoads’ purchased this 125-bed facility in October 2011. It was troubled and was going to be closed. In thirty eight months we invested $500,000 and borrowed another $2million change the culture from a warehouse for nursing home patients to a care house for human being needing health care services.

During the three- and one-half years we owned and operated the Washington facility we remodeled the exterior and interior, removed all odors, turned over 90% of the staff and implemented restorative care. Even though we were targeted by the Monopsony we discharged more and more of our patients back home … the true measure of quality.

 

Victimized: Within two and one half months after acquiring the facility State surveyors managed to turn an incident in the Alzheimer’s unit into a Special Focus violation that cost us $100,000 in fines, $100,000 in legal fees, that eventually forced us to sell our nursing

homes and scuttle our original goals. We were warned that if we fight the Iowa Department of Inspections and Appeals you will be sorry … they will retaliate if you don’t just comply

with their interpretation of minor violations.

 

“I was told this facility is terrible before I came here. Of

course this came from people in the community that have never

been here and believe what they read in the newspaper. And I

was dreading having to come here. But now that I am here I

cannot believe how there is no foul odor, it is extremely clean.

It looks good and in my opinion the detractors should come here

before they judge you by the surveys posted by the State on the

internet.”

 Unsolicited evaluation by

Dave a new volunteer Ombudsman.

Note:  All of this is covered in my books “The Monopsony Game” and “Failing Government Taketh Away” , available on Amazon and bookstores.  Ohers

 

SUMMARY

Our original plan was to acquire troubled skilled nursing facilities, modernize them, computerize them, scour them, change the culture to that of restoring patients for discharge and improve the quality of life of those that have to stay. Admirable and thought to be profi table for all involved. This entailed utilizing the Caregiver Management system of software and operational management tools. Our care planning system is the platform for assigning the workload to the staff, organize the workflow, cost the labor and ancillaries, and restorative programming for clinical and social services. With the two models we were building in Iowa we had plans of acquiring other rural facilities and setting

up a franchise business on site every day promoting accountability quality of care and life would be controlled corporately.  All of these crashing down with the punitive interventions Inspections and Appeals. As the Monopsony game was undermining it.

Is this a scenario of luck, poor management, bad care or punitive enforcement and retaliation? It hurt the three communities, the 300 staff, 225 patients, 225 families and future of those facilities.  After you have read this far make you own conclusion … but consider the fact that every good deed gets punished and this set of circumstances

did not make the dramatic turn around and difference in the care the Rhoads family made the difference … they made the conversions of bad management, bad care and bad luck into modernized and quality of life operations that enabled them to sell the facilities and come out of bankruptcy in spite of the regulators. It is their plan to forget the battles but continue the war on the Monopsony.

If We Lose the Monopsony Game

• Federal spending will escalate as it becomes the purchaser of last resort.

• 40,000 laws passed per year across America.
• Taxes on every commodity and service.
• Small businesses disappear as conglomerates grow.
• Leadership in the world will continue to decline into an oligarch.

If We Win the Monopsony Game

• Privatize half of Government.
• Repeal 10 laws for every
• Rebase taxes on outcome
• Enterprise will thrive.
• Leadership will amend the Constitution guaranteeing

for each law passed at least one terminated.   Monopsony

as is Monopoly will not be allowed by the Federal Justice system.