Cuts in care may be linked to cuts in Medicare, Medicaid reimbursements

Maryann Steerman holds up a note expressing her frustration at the news that Valley Renaissance Healthcare Center is discharging her and 13 others because the respiratory care unit is being closed, a move that is happening more often because of Medicaid and Medicare reimbursement cuts. (Doug Livingston/TheNewsOutlet.org)

Editor’s Note: Reporters at The News Outlet have been looking into the business and life of nursing homes and assisted living facilities in northeast Ohio. While that comprehensive look at the industry will be released in early December, some articles will be available prior because of timeliness issues. This article on how cuts in Medicare and Medicaid are forcing the consolidation of some services, especially respiratory care involving ventilators, highlights an example at a Boardman nursing home.

Maryann Steerman holds up a note expressing her frustration at the news that Valley Renaissance Healthcare Center is discharging her and 13 others because the respiratory care unit is being closed, a move that is happening more often because of Medicaid and Medicare reimbursement cuts. (Doug Livingston/TheNewsOutlet.org)

Published November 9, 2012 in The Vindicator (Link)

By DOUG LIVINGSTON
TheNewsOutlet.org

Fourteen residents have been asked to find a new place to live by Nov. 16 because Valley Renaissance Center, a nursing facility on South Avenue in Boardman, is discontinuing its respiratory care program.

The move is part of a growing trend in which nursing homes eliminate services for high-risk patients who require high-cost treatment, especially in the light of cuts in Medicaid and Medicare reimbursements.

Most of the affected residents rely on a ventilator to breathe. Several cannot talk or must plug the tracheotomy tube protruding from their neck with a finger to speak.

Their treatment can be costly, experts say.

Gene Gantt is a respiratory therapist with 30 years experience and the chairman of the long-term care section of the American Association for Respiratory Care. He said facilities discontinue high-risk services like respiratory care when Medicaid reimbursement rates fail to cover costs.

Ohio’s Medicaid program underwent cuts in 1999 and 2011.

“We had seen a trend of (respiratory care programs) closing down after 1998, when reimbursement changed, and then there was a surge between 2009 and 2011, and now we’re starting to see some of the units closing in states where reimbursement is lower than the cost of care for these patients,” said Gantt.

Mike Fishel, 45, a Valley Renaissance resident who is being displaced, has fallen prey to this trend for the third time. Originally from Summit County, he had to move from Little Forrest Rehabilitation Medical Center (now University Park Nursing and Rehab) in Akron and The Arbors at Canton (now The Laurels at Canton) because those facilities also closed their respiratory programs.

He is one of two residents (the other is Doris Floyd) who have appealed their discharge. Hearings were conducted Monday, Nov. 5, at Valley Renaissance, where an arbitrator appointed by the state Department of Health will weigh arguments from administration and two affected patients.

The hearing officer should have a decision within five business days (or Nov. 12), but Fishel shudders at the possibility of having to move to another facility yet again.

“Most of the people in here, they can’t articulate for themselves. It’s screwed up. But they have no say over anything. They have no power over anything,” Fishel said.

MaryAnn Steerman, the president of the resident council at the facility, has already begun to pack. She has lived at Valley Renaissance for three years. Her respiratory illness renders her incapable of talking. But it isn’t her inability to speak that hinders communication with administration.

“They don’t tell us much,” she writes on a tablet.

Steerman chose not to appeal and to move to Canal Pointe in Akron.

While the unit’s closing isn’t unprecedented, it is noteworthy for the number of people being displaced.

(Richard W. Darbey IV/TheNewsOutlet.org)

“Other ventilator units have closed in the area. But this is the first one where we’ve seen – at least that we’ve been informed – that there are more than a dozen people involved at one time,” said John Saulitis, who as an Ohio Department of Aging ombudsman advocates for long-term care residents in Mahoning, Trumbull, Ashtabula and Columbiana counties.

He had urged Valley Renaissance residents to appeal the “eviction notice” because under state law residents can only be involuntarily discharged if they are a harm to others, have not paid their bills or if they are well enough to return home.

“Usually it’s a dollar and cents kind of issue,” said Daniel Van Dussen, the director of gerontology at Youngstown State University.

Van Dussen said Medicaid reimbursement rates play a major role in outsourcing high cost treatments such as respiratory care.

Over the past year, Medicaid reimbursements for Ohio’s 958 nursing homes have been slashed by 5.8 percent, saving tax payers $360 million over two years. The cuts were made in an attempt to promote quality care by returning some of those funds only if quality measurements were met, according to the governor’s Office of Health Transformation

However, that percentage is an average. Medicare and Medicaid use a formula, which includes levels of patient care, local tax rates and quality measures, to determine how much each facility will be reimbursed per day.

Therefore cuts at Valley Renaissance resulted in a 6.66 percent decrease in per diem Medicaid funding. So, while the facility received $160 per patient per day in 2011, it only got $152 per patient per day in 2012.

In 2012, the average statewide reimbursement rate for nursing homes is $167, a number that Gantt said is too low.

He said when Medicaid reimbursement rates dip below $500 a day, costs begin to exceed revenue and nursing homes are forced to make the tough decision regarding discontinuing costly services such as respiratory care.

Michael Rescineto, the administrator of Valley Renaissance, discussed the difficulty in making such a decision in a faxed statement.

“As the individual who started the Respiratory Program 11 years ago here at Valley Renaissance Healthcare Center, it was an extremely tough decision for me to make to discontinue this service … At no point will a resident be left without a place to go.”

Van Dussen sees the profit driven mentality behind such decisions.

“Why, as a corporation, do we need to own, say, five ventilation units, right? All that overhead, everything else at five different facilities,” Van Dussen said. “Why don’t we merge it into two (facilities).”

What’s happening to the residents of Valley Renaissance happened to the residents of Heather Hill nursing home in Chardon more than a decade ago, when respiratory care was cut.

In that case, Cleveland attorney Janet Lowder represented a 15-year-old resident, who enrolled in Heather Hill’s ventilator program after being struck by a vehicle. Another patient was struck with polio as a child and required ventilator care to breathe.

Lowder, a certified elder law attorney through the National Elder Law Foundation, worked the case pro bono. She filed an injunction to keep the residents in the facility. The case was settled prior to the appeal hearing, but as Lowder built a defense for her argument, her notes suggested that Heather Hill’s rationale for closing the respiratory care program was financially driven.

“The discharge notice … stated that the ‘financial health care climate’ and its loss of ‘over half a million dollars per year on the program … because of changes made to the Ohio Medicaid Reimbursement System in July of 1999’ were the reasons for the ‘‘decision to close the chronic long-term care ventilator program.’ ”

The discharge letter, according to Lowder’s notes, stated that Heather Hill does “not believe it would be responsible to continue to operate this program at this level of loss.”

“Ventilator care is unique in that it requires such specialized care, and it is a costly program to run,” Lowder said. “Long-term care facilities are not required to offer this type of program. It doesn’t hurt their license if they don’t have a ventilator program.”

Rescineto and Provider Services, Inc., which owns Valley Renaissance, did not comment directly about why the Boardman facility had to discontinue the respiratory care unit.

The discharge notice did give residents three possible locations, including Caprice Healthcare in North Lima, Beachwood Pointe near Cleveland and Canal Pointe in Akron. The latter two are part of the Provider Services family, which also owns more than 100 other facilities across Ohio, according to the companies website.

Other facilities that offer respirator care include Andover Village Retirement Community, Andover, in Ashtabula County; Autumn Hills Care Center, Niles, in Trumbull County; and Calcutta Health Care Center, Calcutta, in Columbiana County.

TheNewsOutlet.org is a collaborative effort between the Youngstown State University journalism program, Kent State University, The University of Akron and professional media outlets including, WYSU-FM Radio and The Vindicator (Youngstown), The Beacon Journal and Rubber City Radio (Akron).