The writer, of Omaha, is a licensed nursing home administrator.
A great deal of attention has been given to Nebraska’s nursing homes recently — and for good reason. Nursing homes provide essential care to our family members and friends. We must figure out how to keep good facilities going in the long term for those who need them.
Nursing homes in Nebraska, as in many states, serve a variety of individuals whose care is paid for in a variety of ways. Some individuals are able to pay for their care out of pocket, while others rely on government programs such as Medicaid.
As the operations director for Gateway Healthcare, I operate six skilled nursing facilities in Nebraska. Providing excellent care is very important to me.
Currently, Medicaid payments to nursing homes are calculated based on a facility’s cost per day, without considering the quality of care provided. This means a facility with a lower quality of care often receives more money than a facility that provides a better quality of service. This makes no sense.
As an example, imagine a town with two nursing facilities. Facility A provides higher-quality care and has an occupancy rate of 96%, with more than 80% of its residents on Medicaid. Facility B provides lower-quality care and has an occupancy rate of 54%, with less than 50% of its residents on Medicaid.
Facility A, the nearly full facility with better quality care, currently gets a base rate of $123.30 per day for each resident on Medicaid. Facility B, on the other hand, receives a base rate of $205.39 — more money, for care that is not as good.
The Nebraska Department of Health and Human Services is developing a new payment system by which all nursing homes will receive a standard base payment and then will be rewarded with additional pay for providing quality care. Encouraging better care makes a lot of sense.
The funding issues that nursing homes currently face are complicated, and it will require more than changes in the Medicaid program to solve them completely. In this year’s legislative session, Nebraska state senators provided a 2% Medicaid provider rate increase, along with an additional, one-time sum of $7.4 million for nursing homes. Unfortunately, the current Medicaid payment structure means that many quality facilities will receive a reduction in rates.
The health of our state’s nursing homes impacts everyone, from residents being served to the taxpayers who pay for a lot of this care. Everyone has a role to play in ensuring these facilities will be available in the years to come. HHS’s plan will be one positive step in that direction.