Medicare reimbursement enacted in 2019 creates incentive to "dump" long-term NH residents in favor of newer covid-19 patients (in L.A.)
https://www.foxnews.com/us/los-angeles-coronavirus-nursing-home-dumps-residents-incentive
This story is mainly about a single facility that acted illegally (including moving a resident with dementia to an inappropriate group home without notifying the family at all) and should not be a reflection on any other facilities. BUT to summarize from the article:
"COVID-19 patients recently released from the hospital can bring facilities more than $800 per day, the Los Angeles Times reported. That’s four times more than what nursing homes can collect for long-term residents with mild health issues, such as dementia, which usually earn facilities about $200 a day.
'This creates an incentive for nursing homes to seek out residents with higher rates of reimbursement and ‘churn’ residents by any means possible,' Feuer wrote.
Under Medicare’s most recent guidelines that went into effect last fall, nursing homes can collect substantially more for new patients, especially in the first few weeks of their stay.
That means the federal government’s reimbursement method, combined with a growing number of COVID-19 patients recently released from the hospital and in need of nursing home care, creates an incentive...to make room for new patients, the lawsuit claims."
Just info for those in the L.A. area, and some knowledge to help protect our LOs from unethical facilities.
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Thanks for sharing.
What Fox does not mention is the well established difference between in what MediCARE pays for (like post hospitalization benefit to “rehab” which is typically rehab done in a N.H.) and what Medicaid pays for (which is room&board daily rate with amount paid set by each state’s Medicaid programs) and that it is this that determines what a facility gets paid; & that the medically “at need” requirement for LTC Medicaid is not permanent.
It’s click bait “grannie dumped on the curb”.
Many states Medicaid pay low fixed daily R&B @ $175 / $180 a day.... BUT a post hospitalization Medicare benefit could pay 2X - 3X -4x that rate. AND for Medicare (& other health insurers as well) what’s paid in rehab is based on ICD-10 codes in their hospital discharge paperwork. For COVID, the codes are some of the ones the most costly to be paid for as it’s speciality care unlike PT for hip replacement rehab.
Its - $ difference btw what Medicare & Medicaid pays - nothing new.
But Covid is just making the disparity (in $ paid) way way more obvious as the #s getting hospitalization for COVID are huge with a equally huge % coming from N.H. population.
Add to this that the medically “at need” requirements for LTC Medicaid are not permanent. State Medicaid programs can have N.H. resident reassessment done annually or biannually to see if they still are “medically at need”. Facilities are required to track residents “at need” medical eligibility. That lady that got moved to a group home, I’ll bet a case of Prosecco, had an “assessment” done and she showed that day to be ok for a lower level of care & not skilled nursing care. So she got moved to a group home. Then family complained, she got reassessed, old place got fined. Rinse & repeat.
What’s happening is what gets posted on AC all the time..... elder falls breaks hip; gets hospitalization (MediCARE pays for); then goes to rehab (again MediCARE pays for) which the first 20/21 days is 100% Medicare covered and can pay @ 80% up to 100 days; elder too frail to return home so goes from Medicare $$$ rehab patient to LTC Medicaid $ resident. For a facility $$$ is in MediCARE patients not Medicaid R&B reimbursement resident. 60%-80% of NH are LTC Medicaid beds.
So if a facility can flip 30% Medicare rehab beds / 70% LTC Medicaid to be 70% Medicare then their making serious bank & it off sets the cost to do Covid care in a facility (like 1 to a room vs Medicaid shared room requirements). If they can get a few beds to no longer be “at need” medically that means an opening for MediCARE paid bed. $$$$
Covid is an opportunity to do this.
It’s not so much that it’s Covid but that it’s Medicare post hospitalization benefit that’s way way WAY paying more (than Medicaid) that’s incentivizing taking Covid type of admission. If N.H. population could get measles, it would be same playbook as measles is even more contagious & speciality care for older folks than Covid.
What will happen will be some type of new system to deal with LTC related to Covid. STAT did a podcast on this last week with Drs Morgan Katz & Rachel Werner on protecting NH residents which discussed this. Insurers are not gonna pay for weeks & weeks of ICU or ECMO care with bills of 700k skywards. If I had to guess, it’s likely along what was done for TB & sanitariums decades ago. Or what my state did at Carville for Hansen’s dx. Not going to be elderly in focus but more geared to under 60 set who get the serious Covid that seems to increasingly be looking at months of care.
what so frustrating is that US did not have to have this be our situation.