CLEVELAND, Ohio – Ohio’s top proponent of nursing homes fears that Gov. John Kasich’s proposed cuts to Medicaid will slice into the facilities’ staffing levels.
Peter Van Runkle is the executive director of the Ohio Health Care Association, which represents hundreds of nursing homes in the state. He said most staffing levels in Ohio are predicated on Medicaid.
The tax-supported program pays about $2.7 billion this year to care for about 50,000 of the more than 75,000 residents in Ohio nursing homes. This year, Medicaid will pay nursing homes an average of $193 a day for each resident’s care. In many cases, residents who are financially able pick up some of that.
Van Runkle said he fears that the amount will be cut by 4 percent, to $186 a day, in Kasich’s budget.
“Absolutely, this would hurt us,” Van Runkle said. “We can only hire so many people with the money that we receive from the government.”
Kasich’s administration has pushed to join more than 20 other states that dropped what it calls the “one-size-fits-all reimbursement” and rely instead on managed-care plans, a move that would give nursing homes financial motivation to improve quality and staffing. Managed-care plans deal directly with a patient’s network of providers, including doctors, hospitals and nursing homes.
“The way nursing homes are paid now, there is no incentive to do good work,” said Greg Moody, the director of the Office of Health Transformation.
Van Runkle disagrees with Moody. He said the state already has an incentive-based program for meeting higher standards. He said the Ohio Department of Medicaid deducts $1.79 from the $193 per diem paid to nursing homes for a resident’s care.
That money, which has reached about $30 million, is then pooled, he explained. State Medicaid officials then divide the pool among nursing homes that meet quality standards. The more standards they meet, the greater their share from the pool.
Moody, however, said the standards are so low that most nursing homes receive what they put into the pool. Kasich’s administration is proposing a new structure that provides even greater rewards to care facilities that meet established standards.
The Ohio House passed the budget, but it pulled Kasich’s plan and sought a delay of the managed-care issue until 2021. The budget is pending in the Ohio Senate, where Kasich hopes the managed-care plan would be resurrected.
John Schnelle, a professor of medicine at Vanderbilt University, said government reimbursement is an important factor, but it is not the only factor. He said some homes offer higher staffing than others with the same reimbursement mix.
“If government reimbursement is the key reason behind staffing, then it fails to explain why there are major differences in the staffing levels of nursing homes,” Schnelle said. “Some do quite well. Others do not.”