In the Spring of this year, I used baseball as a metaphor for the “game of Long Term Care.” At that time I said that providers were “going to have to step up to the plate and respond swiftly and powerfully to the curve balls of regulatory changes, the sliders of reimbursement, the change-ups of market pressures, and the fast balls of competition.” Little did I know at the time that the term, “sliders of reimbursement,” was going to be uncomfortably prophetic. Because of the drastic “adjustments” to Medicare reimbursement and declining Medicaid rates, the slider is real – a potential slide downhill, that is; they’re game changers. I would like to take the baseball metaphor one swing further.