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Tuesday Lead Letter: Nursing home payment plan will hurt quality care

Medicaid payment reform for nursing homes is necessary and complex.

Done well, it should be the result of clear policy objectives, detailed modeling and vigorous debate.

Unfortunately, the Medicaid Prospective Payment System plan for nursing homes that's included in the Florida Senate's budget has not been subjected to any scrutiny.

It hasn't had a single public hearing, yet its long-term effects would erode the quality of care that Florida seniors receive in nursing homes.

LeadingAge Florida supports the transition to a prospective payment plan for nursing homes. We simply can't support the proposed system because it relies on a risky gamble for Florida's seniors: a guarantee of $57 million in new Medicaid funding each year for the next three years.

Without that funding, the plan will devastate many quality providers.

Although the impact may not be immediate, when the transition funding runs out, 152 nursing homes with the highest four-star or five-star ratings will lose funding, while 97 nursing homes with the lowest one-star and two-star ratings will gain funding.

Some of these high-quality nursing homes would lose as much as 23 percent of their Medicaid funding and a total loss of nearly $40 million.

Lower-quality homes do well under the plan, with $29 million in new funding and no requirements regarding how those new tax dollars are spent.

This system will establish the state's approach to paying for care for our frail elderly for years. It has been more than 30 years since such a major change in Medicaid payment policy.

If this plan is adopted, high-quality homes facing up to 20 percent losses in Medicaid funding will eliminate jobs, cut back on programs and reduce spending on true quality-of-life elements.

It's also easy to gloss over the many substantive problems with the plan because of the sophisticated sales effort that's underway in support of it, including assertions that the plan incentivizes quality.

It isn't clear, though, how shifting $40 million from resident care to property creates an incentive for quality. Proponents also assert the plan enhances accountability; but the plan doesn't contain a single requirement that providers who benefit from additional tax dollars have to spend a dime of those additional dollars on care.

A public hearing and full debate of the plan would have identified all of these issues. The House held a workshop on a similar plan in February and shelved it in favor of further study and development.

We urge the Legislature to step back from this plan and continue working during the interim.

The implications for our seniors are too important not to.

By: Steve Bahmer, president and CEO of LeadingAge Florida.

Source: http://jacksonville.com/