Three Napa County nursing homes whose patients keep ending up in the hospital too quickly will have Medicare reimbursements cut, according to a Kaiser Health News story.
The federal government is taking a new step to reduce avoidable hospital readmissions of nursing home patients within 30 days of their discharge by lowering a year’s worth of payments to these nursing homes.
Napa Post Acute (formerly Golden Living Center) will receive a 1.98 percent decrease in payments. The Napa Valley Care Center will receive a 1.90 percent decrease. Piner’s Nursing Home will receive a 1.89 percent decrease.
“To some nursing homes, it could mean a significant amount of money,” said Thomas Martin, director of post-acute care analytics at CarePort Health, which works for both hospitals and nursing homes. “A lot are operating on very small margins.”
“These penalties will reduce federal dollars coming into Napa County that could impact not only senior care services but the economy in general,” said Brian Kallio, the administrator of Piner’s Nursing Home.
At the same time, two Napa County nursing homes will see increases — referred to as bonuses —in Medicare reimbursements for having low readmission rates.
The Meadows of Napa Valley will receive a .31 percent increase and the Veterans Home of California’s Skilled Nursing Facility will receive a 1.08 percent increase.
Nationwide, Medicare reimbursements to nearly 11,000 nursing homes declined. Payments rose to nearly 4,000 others.
These financial incentives, determined by each home’s readmission rates, significantly expand Medicare’s effort to pay medical providers based on the quality of care instead of just the number or condition of their patients, according to Kaiser Health News.
Until now, Medicare limited these kinds of incentives mostly to hospitals, which have gotten used to facing financial repercussions if too many of their patients are readmitted, suffer infections or other injuries or die, the news agency stated.
“The Medicare reimbursement payment system for SNFs (Skilled Nursing Facilities) is very complicated and we spend an inordinate amount of time to satisfy the rights of participation,” said Wayne Panchesson, executive director at the Meadows of Napa Valley.
However, “We are happy that Medicare is rewarding the Meadows SNF with a .31 percent bonus,” said Panchesson.
Panchesson explained that as of Oct. 1, the Centers for Medicare & Medicaid Services (CMS) has been withholding 2 percent of SNF Medicare payments to all facilities.
The CMS has set aside 60 percent of the 2 percent withhold for incentive payments to SNFs.
Roughly speaking, the industry will see between a 2 percent cut or a 1 percent increase in total payments, Panchesson said.
“We are just very grateful we are receiving any increase in Medicare reimbursement, because what we (Nursing homes or SNFs) currently receive is still inadequate to cover our costs or expenses,” said Panchesson.
“However, every bit of extra Medicare revenue we receive will positively impact the care we provide for our seniors at the Meadows, and we ‘never look a gift horse in the mouth.’”
Kallio at Piner’s said, “I certainly see the intent of CMS’s goal to reduce unnecessary and costly re-hospitalizations,” while noting, “We have care processes and re-hospitalization prevention measures in place.”
“However, this recent cut is based on data (from 2015-2017) and does not reflect current practices and was implemented based on data” from a different time period, said Kallio.
Lindsey Sin, a spokeswoman for the California Department of Veterans Affairs, said, “Our homes are committed to providing the same high quality of care for each of our veterans, regardless of their income or eligible reimbursements.”
“The Medicare reimbursement represents a very small portion of total revenue, so it’s not necessarily impactful regarding care,” wrote Sin.
A representative from Napa Post Acute declined to comment.
Derrick Whitacre, administrator of the Napa Valley Care Center, also declined to comment but noted “Napa Valley Care Center always has and always will provide the highest quality and compassionate care to our residents.”
Napa resident Yvonne Baginski, who works with the senior population through local nonprofit Share the Care, observed that frequent hospital readmissions are also a problem with newly released nursing home patients who are sent back to their own homes.
“What we’re seeing out here in the field is that the follow-up care when they return home isn’t there,” she said. “They may get a home health nurse under Medicare to come out twice a week but they need somebody to be in the house taking care of them” full time, “and they don’t have the money for (in home care), so they end up back in the emergency room.”
The new Medicare program is altering a year’s worth of payments to 14,959 skilled nursing facilities nationwide based on how often their residents ended up back in hospitals within 30 days of leaving. Hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been averted with better medical oversight, Kaiser Health News reported.
“Skilled facilities have been working toward this and knew it was coming,” said Nicole Fallon, vice president of health policy and integrated services at LeadingAge, an association of nonprofit providers of aging services.
While most researchers say that readmissions can be reduced, some consumer advocates fear that nursing homes will be reluctant to admit very infirm residents or to re-hospitalize patients even when they need medical care.
“It may end up causing great pain to residents who actually need to be hospitalized,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform in San Francisco.