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Chasing millions in Medicaid dollars, hospitals buy up nursing homes

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A wrinkle in Medicaid’s complex funding formula gives nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

Westminster Village North, a nursing home and retirement community in Indianapolis, recently added 25 beds as well as two kitchens to speed food delivery to its residents. It redesigned patient rooms to ease wheelchair use and added WiFi and flat-screen televisions. This fall, it’s opening a new assisted-living unit.

The nursing home can afford these multimillion-dollar improvements partly because it has, for the past five years, been collecting significantly higher reimbursement rates from Medicaid, the state-federal health insurance program for the poor.

The changes began when Hancock Regional, a county-owned hospital 15 miles away, began leasing Westminster Village North. A wrinkle in Medicaid’s complex funding formula gives nursing homes owned or leased by city or county governments a funding boost of 30 percent per Medicaid resident. The money is sent to the hospitals, which negotiate with the nursing homes over how to divvy it up.

About half of Westminster’s residents are on Medicaid, so the new funding was substantial.

“We have seen amazing changes and created a more homelike environment for our residents,” said Shelley Rauch, executive director of the home.

Nearly 90 percent of Indiana’s 554 nursing homes have been leased or sold to county hospitals in the past 14 years, state records show, bringing in hundreds of millions in extra federal payments to the state.

Even though Indiana’s nursing home population has remained steady at about 39,000 people over the past five years, Medicaid spending for the homes has increased by $900 million, to $2.2 billion in 2016, according to state data.

Today, more than two-thirds of Indiana’s Medicaid long-term care dollars go to nursing homes. The U.S. average is 47 percent.

The funding enhancements were pioneered in Indiana, but hospitals in Pennsylvania and Michigan also have used the process. Advocates say it has been a key factor in helping to keep Indiana’s city and county hospitals economically vital at a time when many rural hospitals nationwide are facing serious financial difficulties.

 

Critics contend that the money flow has not significantly improved nursing home quality. Furthermore, they say, it has provided incentives to steer patients to nursing homes rather than lower-cost options, such as home health care or community-based daycare centers.

Joe Moser, who until May was Indiana’s Medicaid director, acknowledged while in office that more people were moving to nursing homes rather than staying in their homes, and said it was due in part to the hospital-nursing home marriages. “It is a factor that has contributed to our imbalance” in care choices, he said.

Daniel Hatcher, a law professor at the University of Baltimore and author of “The Poverty Industry,” a book published last year, said this funding arrangement is a bad deal for the poor because it takes a large portion of Medicaid dollars targeted for services for low-income nursing home residents and sends it instead to hospitals to use as they please.

That undercuts the purpose of the Medicaid program, he said.

“The state is using an illusory practice and taking away money from low-income elderly individuals who are living in poor-performing nursing homes,” he said. He noted Indiana is ranked near the bottom of states for nursing-home quality by several government and private reports. Among them is a scorecard from Families for Better Care and the AARP scorecard.

But proponents of the practice say that even when hospitals get most of the money, it is well spent.

Marion County Hospital and Health Corp., the large safety-net hospital system in Indianapolis, owns or leases 78 nursing homes across the state, more than any other county hospital.

Sheila Guenin, vice president of long-term care there, said the hospital keeps 75 percent of the additional Medicaid dollars and the nursing homes get the rest. Still, the additional money has improved care. The transfer of the license to the hospital has kept several nursing homes from closing and increased staffing rates at many others, she said.

About 40 percent of the county hospital’s nursing homes have five-star ratings from the federal government, up substantially from 10 years ago, Guenin said. Among the improvements at the nursing homes were the addition of electronic health records and of high-capacity emergency generators to provide power in a natural disaster.

Still, some patient advocates said the extra funding is flowing to hospitals and nursing homes with little public accounting. Ron Flickinger, a regional long-term-care ombudsman in Indiana, said, “A lot of extra money is being spent here, but I’m not sure patients have seen it benefit them.”

Medicaid, which typically covers about two-thirds of nursing home residents, is jointly financed by the federal and state governments. States pay no more than half the costs, although the federal match varies based on a state’s wealth. In Indiana, the federal government pays about 65 percent of the costs.

The enhanced nursing home payments began in 2003 when a county-owned Indianapolis hospital decided to take advantage of Medicaid rules to bolster its bottom line. In this case, the hospital purchased a nursing home, then provided the money for the state to increase what it spent on the home to the federally allowed maximum.

That increase, in turn, drew down more federal matching funds. Since the federal remittance was larger than the hospital’s contribution, the hospital got back its initial investment and divided the extra money with the nursing home.

Other county-owned hospitals in Indiana slowly followed suit.

All the Medicaid funding for nursing homes should be going to those homes to care for the poor, not shared with hospitals to use as they choose, he said.

The strategy, promoted by consultants advising hospitals and nursing homes in Indiana, is used heavily there because of the plethora of county-owned hospitals. But the federal government is tightening the rules about such payments.

Texas has secured Medicaid approval for a similar strategy starting this month, but federal officials have made the extra funding dependent on nursing homes meeting quality measures, such as reducing falls. Oklahoma is seeking to get federal approval as well.

And in a rule released last year, the federal Centers for Medicare and Medicaid Services announced that it would gradually force states to shift to payment systems that tie such reimbursements to quality of care. Michael Grubbs, an Indiana health consultant, said that rule does not stop the Indiana hospital funding program, but it’s unclear that it will last.

Nursing-home operators in Indiana say the financing arrangement has helped them keep up with rising costs and improve care for residents.

Zach Cattell, president of the Indiana Health Care Association, a nursing-home trade group, noted the number of nursing homes in the state earning Medicare’s top, five-star rating has increased 9 percentage points since 2011. He said the percentage of high-risk residents with pressure ulcers and those who are physically restrained also dropped significantly.

“The money has meant a great deal to us,” said Gregg Malot, director of business development at Pulaski Memorial Hospital in northern Indiana. “I don’t see this as a loophole but see it as an opportunity for small, rural community hospitals to improve our quality and access to care.”

His hospital is the only one in Pulaski County. The extra Medicaid revenue from having acquired 10 nursing homes statewide — about $2 million a year — has helped finance the purchase of the hospital’s first MRI machine, so doctors don’t have to rely on a mobile unit that used to come twice a week, he said. The hospital also spent some of the money to add a computerized system to monitor patients’ vital signs.

Steve Long, chief executive of Hancock Regional Hospital in Greenfield, said his hospital recently built two fitness centers in the county with help from the extra Medicaid dollars that resulted from its acquisition of Westminster Village.

He rejects the notion that additional Medicaid money reduces the hospital’s incentive to add home- and community-based care in the community. He said new Medicare financing arrangements, such as accountable care organizations, give the hospital motivation to find the most efficient ways to care for patients after they leave the hospital.

But he acknowledged the hospital benefits from seeing more patients go to nursing homes licensed under its name.

“Welcome to health care — it’s a complex and confusing environment where we have all different competing incentives,” Long said.

 

Source: Chasing millions in Medicaid dollars, hospitals buy up nursing homes

Tips for choosing the Medicare plan that’s right for you

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Fall and winter don’t just bring cooler temperatures and the holidays — the final seasons of the year also mean open enrollment for Medicare. For most seniors in the United States, the period between Oct. 15 and Dec. 7 is the only time they can switch or make changes to their Medicare insurance plan.

“As people age, their health care needs evolve,” says Dawn Maroney, chief growth and strategy officer for Alignment Healthcare. “When that happens, they may find the Medicare plan they first chose when they became eligible no longer meets all their needs. This open enrollment period is their yearly opportunity to re-evaluate whether to continue with their plan or switch to another, with changes becoming effective the first of the new year.”

Medicare basics

Most Americans are aware that Medicare is a government program designed to ensure people older than 65 have access to affordable health insurance. The program can also cover people younger than 65 who have certain disabilities.

The Medicare program has four parts, according to Medicare.gov: A, B, C and D.

* Medicare Part A helps pay for in-patient hospital stays, care in a skilled nursing facility and hospice care.

* Medicare Part B helps cover care by doctors or other health care providers, outpatient services, some medical equipment and some preventive services.

* Medicare Part C (also known as Medicare Advantage) covers everything included in parts A and B, and usually includes Medicare prescription drug coverage as part of the plan. Medicare Advantage plans may include extra benefits and services for an extra cost. Medicare-approved private insurance companies, such as Alignment Healthcare’s Alignment Health Plan, run Medicare Advantage plans.

* Medicare Part D helps cover the cost of prescription medications and is run by Medicare-approved private insurance companies.

Original Medicare versus Medicare Advantage

Most people think of Medicare parts A and B as Original Medicare, in which the government pays directly for the health care services received. People with Original Medicare can see any doctor and hospital that accepts Medicare in the country, without prior approval from Medicare or their primary care physician. Most people do not pay a monthly premium for Part A if they paid taxes while working; everyone pays a monthly premium for Part B, based on income. The standard premium for Part B in 2017 was $134 per month, which is deducted from the individual’s Social Security benefits.

Original Medicare pays for about 80 percent of the total costs of health care. The patient is responsible for the remaining 20 percent, which can mean high out-of-pocket costs in the event of a hospitalization or other events requiring significant medical attention. To offset the financial burden of that 20 percent, some people choose to purchase supplemental insurance, called Medigap.

Private insurance companies offer Medigap to cover things Medicare doesn’t, such as deductibles, co-pays and co-insurance — but, keep in mind, Medigap only supplements Original Medicare benefits. Further, if you do not apply for Medigap in the first six months of becoming eligible, there’s no guarantee that an insurance company will sell you a Medigap policy.

 

With Medicare Advantage, government-approved private companies administer health plans that cover everything Original Medicare does, but can do so with different rules, costs and restrictions that can change every year. For example, a private Medicare plan may require your physician to request permission before performing a procedure in order to be paid by the plan. Medicare Advantage plans, however, usually cover extras that Original Medicare does not, like dental care, vision services, hearing exams and gym memberships.

Most Medicare Advantage plans also include prescription drug coverage (Medicare Part D), which is not included in Original Medicare, at no additional cost. If you elect to enroll in a Medicare Advantage plan, you still have Medicare — this means that you must still pay your monthly premiums for parts A and B, in addition to a monthly premium for Part C, if applicable. Many Medicare Advantage plans are available for no additional monthly premium.

When choosing between Original Medicare and Medicare Advantage, you should consider these questions:

* How likely is it your health needs will change down the road? Since health changes as you age, chances are your treatment needs will, too. If you don’t enroll in the additional insurance and drug coverage when you first sign up for Original Medicare, you may pay a monthly penalty for enrolling later and may not be eligible for additional Medigap coverage.

* Are you still working past age 65? If so, you will probably want to enroll in Part A, because there generally are no monthly premiums, and it may supplement your employer’s insurance plan. You might choose to delay enrolling in Part B, but it depends on your health coverage. Everyone has to pay a monthly premium for Part B.

* Is it more important to you to have lower or no premiums or lower out-of-pocket costs? With Original Medicare, you may pay more out of pocket without supplemental insurance and prescription drug coverage. Medicare Advantage includes supplemental insurance and sometimes prescription drug coverage, too.

* How important is it to keep your doctor? Original Medicare is accepted by any doctor or hospital that accepts Medicare, without referral. Medicare Advantage plans allow you to select a doctor from the plan network, which is usually very large; your current health care providers are likely to be in the network already.

* Do you regularly take prescription medication for chronic conditions? Prescription drug coverage is not included in Original Medicare, and if you fail to sign up for Part D at the time you enroll, you could pay a penalty for adding it later. Most Medicare Advantage plans do cover prescription drugs.

“Medicare Advantage allows patients to receive the care they need to stay well and keeps their budgets in check with set costs and annual maximums,” Maroney says. “It’s an ideal solution for patients who need frequent care or who struggle to meet medical expenses.”

To learn more about Medicare, visit www.Medicare.gov. For information about Alignment Healthcare and its affiliated Medicare Advantage plans, visit www.alignmenthealthcare.com.

 

Source: Tips for choosing the Medicare plan that’s right for you

FREE Seminar

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Join us for a FREE seminar to be conducted at Heritage Hills Nursing Center in Smithfield, Rhode Island where we will be discussing the legal issues that must be planned for with seniors.

Click the below link to lean more. To register, please call Jenny Coutre at 401-231-2700 x39.

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Higher health-insurance rates coming to R.I. for 2018

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A number of Rhode Island health-insurance companies have been granted permission for double-digit rate increases to their premiums for 2018.

The new rates released Thursday by the Office of the Health Insurance Commissioner range from increases of 5 percent to 12.1 percent. In six of 12 cases, the rates approved are less than the increases requested by the insurance companies. Collectively, the 2018 premium approvals are $16.7 million lower than what insurance companies requested.

The rate increases approved for the individual market, which covers roughly 47,000 people, are: Blue Cross Blue Shield of Rhode Island, 12.1 percent; Neighborhood Health Plan of Rhode Island, 5 percent.

The rate increases approved for small-group market, which covers roughly 60,000 people, are: Blue Cross Blue Shield of Rhode Island, 7.3 percent; Neighborhood Health Plan of Rhode Island, 6.3 percent; United HealthCare HMO, 8.1 percent; United HealthCare PPO, 8.1 percent; Tufts Health Plan HMO, 6 percent; Tufts Health Plan PPO, 6.5 percent.

The rate increases approved for the large-group market, which covers roughly 123,000 people, are: Blue Cross Blue Shield of Rhode Island, 10 percent; United HealthCare, 8 percent; Tufts Health Plan HMO, 9.8 percent; Tufts Health Plan PPO, 10.4 percent.

Source: Higher health-insurance rates coming to R.I. for 2018

AARP ranks Rhode Island 32nd among states in meeting long-term care needs

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Source: AARP ranks Rhode Island 32nd among states in meeting long-term care needs

PROVIDENCE, R.I. — Rhode Island ranks 32nd in the nation, and the worst in New England, when it comes to meeting the long-term care needs of older residents and people with disabilities, according to a scorecard released this week by the national nonprofit AARP.

The good news: Rhode Island showed improvement in all but one category.

“The vast majority of older Rhode Islanders want to live independently, at home, as they age — most with the help of unpaid family caregivers,” Kathleen Connell, state director of AARP Rhode Island, said in a statement released Wednesday. “Even facing tight budgets, Rhode Island is making progress to help our older residents achieve that goal. However, this scorecard shows we have more to do, and we need to pick up the pace.”

Rhode Island ranks 22nd nationally “support for family caregivers” and 24th in “quality of life and quality of care.” The state ranks 35th in “effective transitions,″ or how effectively the state transitions residents between nursing homes, hospitals and homes — the only category that showed a decline.

The report — “Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers” — is the third in a series that ranks states overall and on 25 separate indicators in five key areas: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and effective transitions between nursing homes, hospitals and homes.

Unpaid family caregivers provide the bulk of care for older Rhode Islanders, in part because the cost of long-term care remains unaffordable for most middle-income families, according to AARP Rhode Island. More than 134,000 Rhode Islanders help care for their aging parents, spouses and other loved ones so they can stay at home. AARP estimates the value of this unpaid care at about $1.78 billion.

“Many [family caregivers] juggle full-time jobs with their caregiving duties,″ Connell said, while “others provide 24/7 care for their loved ones.” Family caregivers “save the state money,″ she said, “by keeping their loved ones out of costly nursing homes – most often paid for Medicaid.″

Rhode Island improved its rank from 50th to 44th in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care at home and in the community.

The report comes at a time when proposals in Washington are being considered to drastically cut federal Medicaid funding, which Connell said “would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on.″

The scorecard was developed AARP with the support of The Commonwealth Fund and SCAN Foundation.

The AARP Rhode Island has more than 138,000 members age 50 and older in the state.

New England Scorecard Rankings (best to worst):

Vermont: 3

Connecticut: 10

Massachusetts: 11

New Hampshire: 16

Rhode Island: 32

Rhode Island’s scorecard:

Overall: 32

Affordability and Access: 34

Choice of Setting and Provider: 30

Quality of Life & Quality of Care: 24

Effective Transitions: 35

-larditi@providencejournal.com

(401)277-7335

On Twitter: @LynnArditi

Don’t Sell The House In A Panic – Plan Ahead!

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Worried about how you are going to pay for your medical bills? Think the only solution is to sell the house to create the cash that you will need? Don’t make uninformed decisions! There are options available that will allow you to receive the care you need without needing to sell the house.

Whether you need to do emergency planning or if you have the benefit of 5 years of expected health – we have options for you.

We meet with you, discuss your specific facts, goals and concerns, and advise you as to your best legal options.

Don’t panic – call us today for a free consultation.

Matt Leonard