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Linda Black-Kurek

Championing change in Ohio

By Laura Kuhn

Linda Black-Kurek took a winding road to long-term care, but when she arrived, she became as one of Ohio's most respected LTC community members.

Black-Kurek, who resides in Dayton, is the current president of the Ohio Health Care Association (OHCA). She is also the owner and president of Liberty Health Care Corporation, a nursing facility management and consulting company that owns and operates 15 Liberty Nursing Centers throughout Ohio.

She didn't originally set her sights on long-term care. Black-Kurek began her career as a CPA with a "Big Four" accounting firm, where she became a healthcare industry specialist. "I was assigned to healthcare clients and found that I really liked long-term care," she recalls. "As I work in it now, it's a very rewarding industry. Very challenging, but very rewarding."

Black-Kurek decided to leave her CPA job to become Vice President of Finance for a corporate for-profit chain of nursing homes. After gaining operational experience, she founded a CPA practice specializing in long-term care and eventually became the owner and president of Liberty Health Care Corporation.

"As a CPA and consultant, I specialized in turnaround situations and helping financially troubled facilities," Black-Kurek said. "I decided to do it for myself."

Over the course of her journey, she has accumulated more than 20 years of experience in healthcare accounting, auditing and reimbursement.

OHCA involvement

Black-Kurek was active with OHCA for years and held a number of officer positions before being elected the group's president in 2010. Her term as president will last until 2012.

OHCA was established in 1946 and represents nearly 750 nursing facilities, assisted living facilities and intermediate care facilities for the mentally retarded. The organization serves as an advocate for the more than 100,000 Ohioans who provide care to the state's nearly 74,000 long-term care residents.

Currently, OHCA has three major initiatives in the works. The first is moving the state to the Medicaid pricing system that was implemented five years ago. The system pays based on acuity levels that are determined by RUGs and MDS, and payment varies by facility depending on quality points and the case mix index. "OHCA has a huge push right now to get us to the pricing system so every facility's rates can really be based on acuity," Black-Kurek said.

The second initiative involves enhanced federal matching money. Ohio has also been trying to adjust to a $12 per bed, per day franchise fee, or "bed tax." This figure is up from the $6.25 daily fee that facilities were paying under the previous budget, and facilities aren't permitted to pass the cost on to residents. The increased fee is expected to generate $768 million over two years, which the state plans to use to obtain federal matching Medicaid funds, but Black-Kurek is concerned that the added expense is translating into staffing cuts. "Seventy-five percent of our expenses are our people," she said.

OHCA is asking for relief on the franchise fee. "We'd like to roll that back since the state now has more federal money coming in than we budgeted for," Black-Kurek explained.

The third initiative is a package of non-economic regulatory relief items. "These are things that don't cost anything but could make us more efficient," Black-Kurek said. The items in the package range from a tub/shower amendment that would eliminate the Ohio Department of Health's requirement that all newly built resident rooms contain a tub or shower to a discharge amendment that addresses the difficult issue of discharging residents for non-payment.

The QIS in Ohio

Ohio is one of the first states to implement the new Quality Indicator Survey, or QIS. According to Black-Kurek, many facilities in Ohio have transitioned to the QIS, but some are still seeing the traditional survey. "It's really been a function of how many teams the state has been able to get trained," Black-Kurek said. Since funding has been cut back, Black-Kurek is unsure of when all of the state's teams will be trained.

When the Centers for Medicare & Medicaid Services (CMS) began developing the QIS, the agency's two biggest goals were to make the survey process more objective as well as more resident-focused. Black-Kurek feels that the QIS is accomplishing those goals. "They'll never be able to completely take subjectivity out of the survey process, but the QIS does make the areas they look at more objective," she said. "The resident interviews are making the process more resident-focused as well."

Even though it's fulfilling its goals, Black-Kurek acknowledges that getting used to the QIS is will take some time. She's heard that some facilities are unsettled by the fact that they're not receiving feedback at the end of each day of the survey. "They feel like they don't have as much control of the survey process because they don't have that feedback every day," she said. "It seems like by the time the surveyors talk to you, they've already decided to cite you on something."

Black-Kurek predicts that facilities will become more comfortable with the QIS process after they've gotten through their first one. That said, she has suggestions on how facilities can ensure that they're survey-ready year round.

"Do a mock QIS survey, just like you did mock surveys before," she said. "It's very helpful to ask residents to answer the resident interview questions ahead of time." She recommends having CNAs ask residents the questions because residents might be more likely to open up to an aide than an administrator.

She also recommends that smaller facilities recognize that the QIS is going to affect them differently than the traditional survey did. Since surveyors will be talking to a set number of residents, it is possible that they will speak to every resident at smaller facilities.

Overall, adjusting to the QIS is "just going to take practice," Black-Kurek said.

Advocating for Ohio

As OHCA's president, Black-Kurek is continuously lobbying for changes that will improve care and trim facility costs. That's not an easy task, given that long-term care took a $186 million cut in the last state budget.

"For the last budget, the state was facing a shortfall of between $3 billion and $4 billion," Black-Kurek said. "For the next budget, that figure is going to be around $8 billion. We're looking at how we can deal with that. The legislators are going to have their hands full trying to get a balanced budget."

Throughout her term as OHCA's president, Black-Kurek plans to continue the organization's longstanding dedication to education and advocacy in order to aid Ohio's long-term care facilities and the residents they serve. It's a role she seems born to play.

"I've never been one to sit back and let others take care of things," she said. "I've always been active in lobbying and finding solutions."