Numbers matter

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Like $7 billion. That’s the amount of unreimbursed allowable Medicaid costs are projected for nursing centers in 2012, as revealed in a new report by the research group Eljay. That comes out to $22.34 in underfunding per Medicaid patient per day, which is 14 percent higher than the previous year’s shortfall figure.

Here’s another number: 63, the percentage of nursing center residents who rely on Medicaid for their daily care. So, in looking at a typical nursing center which cares for 100 patients, according to Eljay, they would lose $500,000 a year in order to help care for the most vulnerable in our society.

The numbers don’t stop there. In regards to Medicare, skilled nursing centers have seen rounds of reductions over recent years. This includes $14.6 billion from health care reform, $9 billion expected from sequestration, and $3 billion in reductions to bad debt coverage for nursing centers whose patients are unable to cover the cost of their care.

All of these numbers add up to a long term and post-acute care profession on the brink of its own fiscal cliff. The sad truth has been that Medicare has been used by many nursing facilities to help subsidize the increasing underfunding of Medicaid. With continuous cuts to Medicare, even this has become increasingly difficult for providers, leaving them to make difficult choices.

Roughly 70 percent of a facility’s operations are attributed to labor, meaning many nursing centers are being forced to reduce the number of caregivers in their facility, which impacts patient care. Other facilities have had to cut back or halt projects that enhance the quality of care in the facility, such as capital improvement projects or electronic health systems. And unfortunately, other facilities have even had to close their doors.

All the while, 10,000 baby boomers turn 65 with each passing day, and 70 percent of these individuals will need long term care at some point in their lives. Nursing centers are not only continuing to care for those who can no longer stay at home or with a loved one, but are supporting more and more short-stay patients who require rehabilitation following a hospital stay. And each year, these individuals have shown increasing care needs, as short-stay patients require more assistance with daily activities and are often living with multiple chronic conditions.

Limiting providers’ resources isn’t the way to care for the growing needs of our nation’s Greatest Generation or prepare for the tidal wave of baby boomers soon requiring these services. America’s seniors and individuals with disabilities deserve more than being regarded as a number on a budget sheet. They have shared in the sacrifice and coped with the challenges. But it’s time to find other ways to address our budget crisis through comprehensive reform rather than arbitrary cuts.

Skilled nursing providers are already taking steps to show measurable improvement in their quality of care, not just because it’s the right the thing to do, but also because there is potential behind revamping Medicare and Medicaid reimbursement to be tied to quality outcomes for patients. This person-centered focus has the potential to save enormous costs on federal health care programs by incentivizing efficiency and promoting higher quality. If we are to avoid the fiscal cliff responsibly, this is the direction we must head towards. The long term and post-acute care profession is eager to work with Congress and the administration to develop these solutions.

But if it’s limiting states’ ability to determine their own provider assessment rate, or freezing Medicare payments each year, or allowing sequestration to go through, then our patients and our providers lose. None of these “budget items” do anything to increase efficiency or address the growing cost of health care. And while they may help stem the tide of a looming catastrophe, we must ask ourselves, “at what cost?” Numbers matter, and enough is enough.

Parkinson
 is president & CEO of the American Health Care Association.