An investigative report that accused New York’s best nursing homes of discriminating against Medicaid beneficiaries draws “incorrect conclusions” based on misleading data and anecdotal comments, a statewide provider organization said Monday.
Top-rated nursing homes in New York accept a lower proportion of Medicaid patients compared to the state’s poorest-performing facilities, “The Buffalo News” reported over the weekend in a lengthy investigate piece.
In 2017, 22,000 Medicaid-only patients in need of skilled nursing care were twice as likely to be admitted to one-star than five-star homes, and health department data from that year showed the contrast was more marked in certain regions. In Western New York, for example, Medicaid beneficiaries were four times more likely to be admitted to one-star homes.
Executives at several top-rated nursing homes said they do not use payer information as admission criteria, and often, they don’t have that information when a hospital asks them to admit someone.
The newspaper’s calculations largely reflected admission of Medicaid-only patients, not those who entered as dual-eligibles, or those who moved from Medicare to Medicaid during their stay. Dan Heim, executive vice president for LeadingAge NY, told McKnight’s Monday that it also overlooked the state’s 94% occupancy rate — a major factor in non-hospital admissions.
“Approximately 90% of admissions to New York’s nursing homes are from acute care hospitals, and nursing homes work closely with hospitals to ensure these individuals receive post-acute care when it is needed,” Heim said. “The vast majority of these patients qualify for Medicare covered post-acute care in the nursing home; and many of them are dually eligible for Medicare and Medicaid. Medicare is the primary payer for a dual eligible during a Medicare-covered stay, not Medicaid. To not include dual eligible beneficiaries in any such analysis is misleading.”
State and federal regulations prohibit nursing homes from discriminating against individuals based on how they will pay their bills.
Some providers told the newspaper Medicaid admission rates are lower because their business models emphasize short-term rehab, which is usually billed to Medicare, even among dual-eligibles.
Becky DelPrince, a vice president at Erie County Medical Center, however, said it is difficult to get her poor patients into the best nursing homes.
“They don’t give us a reason,” she told the newspaper. “They just don’t offer the patient a bed.”
At five-star nursing homes, 7% of new residents in 2017 were Medicaid beneficiaries. At one-star nursing homes, 15% of new residents received Medicaid care, the newspaper found.
New York’s Medicaid program pays much less per patient than the cost of care, creating an average 20% shortfall of about $64 per patient per day, a national accounting firm found last year.
The state’s providers have not received a Medicaid inflation adjustment since 2007, according to Heim.
“To address these shortfalls and keep their doors open, nursing homes must diversify their revenues,” he said. “Despite these efforts, the average 2017 operating margin for New York’s nursing homes was -1.3 percent.”.
In recent years, margins have been pressed lower by a mandatory managed Medicaid program for long-term care residents. The state is seeking a federal waiver to switch them back to a traditional plan if they stay in such for facilities for at least three months.
If approved, the shift could save New York $246 million next fiscal year, partly by limiting duplication of management services.
LeadingAge NY supports the proposal to limit the nursing home benefit to three months for the permanently placed.
“By alleviating the associated administrative burdens on nursing homes and MLTC plans attributable to the current nursing home benefit, this proposal would help these providers and plans to better focus their limited resources on effective care management and quality improvement initiatives for nursing home residents and community enrollees alike,” Heim said.
The shift would affect a majority of the state’s nursing home residents.
Statewide, according to the Buffalo News, Medicaid paid for 62% of resident days in five-star homes versus 71% percent of days in one-star nursing homes, according to Health Department statistics.
New York’s providers say they remain committed to serving residents, regardless of payer.
“There is no barrier to individuals with Medicaid coverage at any of our facilities — including our highest rated,” Chuck Hayes, a spokesman for Elderwood told the newspaper. The company’s five-star Elderwood at Lancaster admitted 1% of new residents as Medicaid beneficiaries in 2017. He added that admissions percentages do not reflect a facility’s true service to Medicaid recipients.
“Rehab patients stay for much shorter periods of time and typically these patients are private pay or Medicare,” he said. “More turnover on these units equate to higher rates of admissions.”
