I respond to the Sunday Dispatch article "Bar is low for nursing homes." The bar is not low. Ohio's skilled-nursing centers are inspected for several days each year against hundreds of federal regulations. Inspections occur more often if there are complaints or if deficiencies are cited.
I respond to the Sunday Dispatch article “Bar is low for nursing homes.” The bar is not low. Ohio's skilled-nursing centers are inspected for several days each year against hundreds of federal regulations. Inspections occur more often if there are complaints or if deficiencies are cited.
Ohio Department of Aging ombudsmen and other regulators frequent the facilities. The government liberally metes out fines and other penalties, including threats of closure. Ask anyone who works in a skilled-care center if the bar is low. The article noted that centers have to meet only five of 20 so-called quality measures to avoid an additional cut to their Medicaid reimbursement. But the context is all-important.
Rates already were cut 5.8 percent in 2011 and, as Bob Applebaum, director of the Ohio Long-term Care Research Project at Miami University, pointed out in the article, they have been flat for years. Do you suppose facilities' costs for delivering care have stayed flat?
Ohio's rates have fallen from seventh in the nation to 21st. We lag comparable states like Pennsylvania and Michigan.
Medicaid rates in Ohio are simply inadequate to support quality care. Medicare pays on average more than $400 per day for skilled care and recognizes that the cost of care rises annually, but Medicaid pays only $175 and stays flat year after year. The quality-incentive system started at the same time that the state cut Medicaid rates.
Gov. John Kasich’s administration and all other parties agreed up front that the standard initially should be set at a baseline level that all or nearly all centers could meet. The idea was to prevent further cuts to already-inadequate rates, but also to set goals for facilities.
As more money was added in future years, the standard would be raised. Unfortunately, since then Kasich has refused to allow for more money, even though most skilled facilities throughout the state went far beyond the baseline. The bar that is too low is reimbursement. The state needs to pay what is necessary to ensure a basic level of quality, then “raise the bar” by rewarding providers who go above that basic level. The suggestion of imposing an additional cut on most skilled centers to give more money to a few is absurd.
How does further reducing already-insufficient resources improve quality?
PETER VAN RUNKLE
Ohio Health Care Association Lewis Center