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NH Scorecard

October 1, 2004
by root
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Did the politicians pass? Your colleagues grade Washington, D.C.'s performance in meeting long-term care needs

Nursing Homes/Long Term Care Management asked readers to give Washington's policymakers letter grades on several key issues

Probably no industry in the country receives as much public criticism as long-term care (not even the press!). So what fun it is to put the shoe on the other foot and have the long-term care field judge others-in this case, federal policymakers in Washington, D.C. This magazine took a few days in late summer to run a quick e-mail poll of readers, asking them to grade Washington's leaders-from the President and Congress to professional associations to (yes) the press-on how well they've performed with regard to issues of critical importance to long-term care. The results were-well, let's say they weren't pretty. Our sampling of readers responded with letter grades (from A to F, with F for "failing") and, in many cases, wrote brief commentaries. What follows are the letter grades that predominated numerically for each type of leader under each long-term care topic.

MEDICAID REIMBURSEMENT Our poll was taken at a time when Congress had yet to act to restore Medicaid funding increases that had lapsed this June and the President's budget was calling for cuts. President: D
U.S. Senate: F
Your senator: D
U.S. House: C
Your representative: D
Centers for Medicare and Medicaid Services (CMS): D
The media: F

Selected Comments "More and more requirements, but no dollars to assist in making it a reality. Lawsuits as a result of the most minor of infractions. No more dollars to assist in making quality of care a reality."

"When is the last time the government actually looked at the cost of medical equipment?"

"I have been a nursing home administrator for 30 years, and I have never seen such a lack of concern for our elderly and disabled. We are underfunded by $14 per patient day.... We want to provide quality care, but quality costs $ and everything goes to insurance, licensing, energy-HELP!"

"I believe an owner should be able to make a profit...but only a reasonable profit. The staff need to be paid fairly, and most of the money should go for quality care and services."

TORT REFORM This long-debated issue that cuts across all of healthcare has been described as all but politically dead for long-term care this year. President: F
U.S. Senate: F
Your senator: F
U.S. House: F
Your representative: F
The media: F

Selected Comments "Unrealistic expectations of what it takes to take care of human beings who have reverted back to infancy. Unrealistic expectations that we can control what a noncompliant resident wants. Negative outcomes are all about the facility, not about noncompliant families and/or residents."

"We are such a punitive society. The solution to our problems is not lawsuits but working together to get the problems solved."

"[Politicians are] afraid to address this because of fear of loss of interest group donations. Senators hide behind 'consumer protection,' but it's really the money that talks."

"Family members and residents who have been happy with care still seem to sue after going home. Advertising by attorneys, in print, television, and radio, continues to bombard consumers."

"The rise in liability insurance rates continues for this nursing facility, even though we have had no losses from lawsuits."

MEDICARE PPS REIMBURSEMENT Our poll was taken at a time when CMS had preserved a $1.2 billion add-on and promised a 2.8% increase for next year. President: D
U.S. Senate: D
Your senator: D
U.S. House: D
Your representative: D
The media: F

Selected Comments "Someone needs to look into the discrepancy in reimbursement rates between critical access hospitals and SNF for patients receiving benefits under Medicare Part A. Our local hospital averages about $500 per day reimbursement for a resident on swing-bed (Medicare Part A). As a SNF with the same resident being skilled (Medicare Part A), we are reimbursed about $250 per day. Medicare should require swing-bed patients to be transferred to a SNF for rehabilitation when there is a bed available. This could be a significant cost savings...."

"High-acuity patients are not fully reimbursed. Using the MDS is a big mistake. The 'feds' have turned caregivers into bookkeepers."

"I think that these elderly people who have done nothing wrong except get old don't deserve to be treated like second-class citizens by the government. People in prison get better treatment than the elderly."

"Medicare, with all its faults, is still our best payer. The willingness to maintain enhanced rates is a real positive."