"My next six months is just havoc," John Cornack says.
by Jan Schlain
From the February, 2020 issue
Cornack is CEO of the Eisenhower Center, which cares for people with major neurological problems at facilities in Michigan and Florida. At its namesake residence on Eisenhower Pkwy. and a small geriatric facility nearby, 430 employees look after just 140 patients.
That large staff reflects its clients' severe physical and behavioral problems. Eisenhower Center provides "post-acute" care for badly injured people, most of them with traumatic brain injuries. The "havoc" Cornack describes is having to cut its staff by nearly two-thirds.
Cornack has been caring for severely injured people for thirty years, but in July, his economic model will be destroyed. That's when insurance reimbursement for Michigan residents injured in car crashes will fall 45 percent.
"We can't cut our expenses that much and still get the quality of services for the people we care for," Cornack says. When the rate cut hits, the Ann Arbor center will "have to go down to about 150 employees quickly--within a year. Then we'd have to close most of the centers as the clientele start to be discharged."
The rate cuts were dictated by the new no-fault auto insurance law that governor Gretchen Whitmer signed last June. Seeking to lower Michigan's auto insurance rates, which are some of the highest in the country, the legislature took aim at high medical bills for people hurt in car crashes, and expensive lifelong care for those who suffer the worst injuries.
The new law "reflects the compromises that any productive legislative process requires and the final result is imperfect," emails Mark Bernstein, a U-M regent and member of the state's most prominent personal injury law firm. But he calls it "an important step towards addressing the skyrocketing costs of auto insurance in Michigan. It is worth noting that in 49 other states, there are robust health care systems that thrive in the absence of rich no-fault reimbursement rates. It is hard to defend $5,000 MRIs."
Attorney John Whitman of Garan Lucow Miller represents insurance companies
against firms like Bernstein's. Those cases, he says, often include disputes over how much to pay for care a patient received. "Perhaps an insurance company will say an MRI is worth $1,000, and the other side says, 'No, it's a $10,000 MRI.'"
Whitman says some health-care providers abused the system by billing no-fault care at their highest rates instead of the discounted fees negotiated by insurance companies, or the even lower rates paid by Medicare and Medicaid. "Now there will be a fee schedule that, over time, will come closer and closer to Medicare," he says.
That's the fee schedule that Cornack says will drive him out of business. In their drive to lower insurance premiums, he says, lawmakers knowingly sacrificed the people with the worst injuries. Under the old law, he says, Michigan residents got coverage unmatched anywhere in the country, including lifetime care in specialized facilities like his.
"You and I, up until June of last year, could only buy lifetime medical" coverage for injuries in a car crash, Whitman explains. Under the new law, "you can go out and, in some cases, waive medical entirely--if you have Medicare--or you can purchase very low limits." Some limits will be so low they're likely to be exhausted before an accident victim leaves the ER.
Whitman considers that a "profound negative" of the law. "When tragedy strikes--by the grace of God it usually doesn't strike--but when it does strike, lifetime medical is a good thing to have," he says.
That coverage paid for facilities like Eisenhower, with large staffs skilled in handling people with physical and behavioral problems. Cornack describes one client "who was injured in Marquette when he was three years old." He's now twenty-eight, but functions more like "a nine- or ten-year-old." Sometimes, through no fault of his own, "he's behavioral; he has difficulties."
When the young man "loses it," Cornack says, Eisenhower's staff has the experience and expertise to calm him. But that's not going to be the case, he says, wherever he goes next.
If Eisenhower closes, "some of those folks who are bedridden, wheelchair-based, they're going to have to go to skilled nursing homes with no behavioral health [care], where the average age is eighty-five, not forty-five," Cornack says. "So you're going to have a young person who has a brain injury and behavioral issues in a population of ninety-year-olds. That probably won't work so well."
If his patient from Marquette can't be managed in a nursing home, Cornack predicts, he will end up in the care of family members--but the new law also limits how much families can be paid to look after disabled loved ones. And if "he starts to lose it in the community, there is no one to help him but the police," Cornack says. "What's going to happen when the police intervene? He's going to be incarcerated. He's going to end up in a psych unit. And then he'll be discharged out into the community."
Some legislators admit to problems. "Post traumatic rehab facilities was one of the things I struggled with," Phil Green (R-Millington) told a forum in Bad Axe in January. "Cuts that were made went beyond the intent of the law." As reported in the Huron Daily Tribune, "Green went on to say that meetings over the next couple of weeks will deal with trying to work through current legislation. The push is to loosen price control."
But Cornack, who fought the no-fault changes as president of a provider group, doesn't expect any changes. "Green has hopes that will happen," he emails, "but Green is not powerful enough to bring anything to bear on the floor."
Cornack tells his story by phone from Jacksonville, where he opened an Eisenhower Center in 2016. During the work week, he lives in an RV near his daughter's home there, or in a "tiny house" in the parking lot of the Ann Arbor center. Weekends he goes home to Pittsburgh, where he's lived for thirty-six years and where his wife, Lisa, is being treated for retinitis pigmentosa. Though the commute is difficult, he says, their home is near his wife's specialist at the University of Pittsburgh, and a lot of other people with sight issues live nearby, so it's a good place for her.
The last hope for the state's post-acute care centers may be a lawsuit filed last year. The husband of an Eisenhower resident is a plaintiff in the litigation, which challenges both the rate cuts and limits on family caregiving. But that will take years to play out, and the new fee schedule will take effect within months.
The first cuts, Cornack estimates, will eliminate about 280 jobs. If, as he expects, the Ann Arbor center eventually is forced to close, the remaining 150 staffers will need to find new work.
Two smaller Eisenhower facilities could survive. One, in Manchester, has six patients. Launched in 2014, after Cornack met onetime Detroit Lions quarterback Eric Hipple, it helps former professional football players deal with brain injuries caused by multiple concussions and is supported by the NFL.
The other is the Jacksonville center, which primarily serves former NFL players and military veterans. It currently has ten patients, but "we're trying to get the NFL to be a bigger player, and the Veterans [Administration] to be a bigger player," Cornack says.
Asked about his own plans, he seems unconcerned. In the worst case, he says, he'll "start over again if jobs present themselves--I'll be an aide or something."
What really hurts, he adds, is thinking about the fate of his clients. Inevitably, some of the drivers who choose to save money by opting out of lifetime care will suffer devastating injuries. Their families, he predicts, will "have GoFundMe pages. They'll have lasagna dinners and that kind of stuff to try to help their loved ones.
"They'll go bankrupt a lot."
[Originally published in February, 2020.]
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