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Nursing Home Lobby Fights Move Toward Performance-Based Funding

Nursing home health care
Matthias Zomer

The longstanding battle over funding nursing homes in Ohio is now in the Senate, after the House dramatically changed Gov. John Kasich’s proposal. And a new report has helped reignite the fight.

The report comes from the Scripps Gerontology Center at Miami University – and showed in 2013, the quality of the state’s 962 nursing homes was lower than the national average on 10 key measures. Those include the percentage of patients suffering from falls, pain, weight loss and mental health related issues.

Peter Van Runkle speaks for the Ohio Health Care Association, the lobbying group for Ohio’s nursing homes.  

“They were using 2013 data. And when you look at the 2017 data, the current data, there’s a different story on a number of those measures we are now above the national average. These measures tend to move around some,” Van Runkle said.

Three years after John Kasich was elected governor in 2013, he made a widely reported comment about special interest groups – including the nursing home lobby – that he repeated again in 2011. 

“You get on the bus or we’re going to run you over. Now they think they’re going to stop me, some of them," Kasich said then. "They think they’re going to be able to carve out their little piece of pork. They think they’re going to keep their snouts in that trough. If they do, you lose,” 

Now there are 930 nursing homes in Ohio. And Kasich’s office still has concerns – backed up by a release of data showing there are still big problems with them, especially larger facilities and those that operate for-profit.

The spreadsheet from the Office of Health Transformation shows smaller facilities get higher ratings, and most of those top ratings are in the 64 percent of facilities that are non-profit.

Greg Moody is the director of the Office of Health Transformation, and said there’s a way to improve those stats.

“Our objective is always to reward the facilities that are providing the best quality," Moody said. Unfortunately, the way our current reimbursement system is set up in statute, we pay the same price for the facilities that go the extra distance and provide really good quality, we pay the same price that have lower quality too."

But Van Runkle disputes that.

“The notion that all facilities are paid the same regardless of how they perform on quality metrics is just inaccurate," he said. "In fact, there are in statutes five specific quality measures that we have to meet.”

Van Runkle is especially concerned about what the Kasich administration wants to do – moving to private sector managed care plans for Medicaid patients instead of what it calls a “one-size-fits-all reimbursement.”

“We find it really ironic that the same administration that is pressing this message that we’re not up to snuff is at the same time wanting to cut us and put us in managed care – which of course managed care plans have a financial incentive to pay us less because the less that they pay providers, the more that goes to their bottom line,” Van Runkle said.

However Moody said more than 20 states are trying this approach, and linked it to the state’s five year pilot called MyCare Ohio, a managed care program which covers around 100,000 Medicaid and Medicare recipients.

“We have seen evidence that managed care works through our own MyCare project here in Ohio so the evidence is pretty clear than in fact managed long term services and supports does improve clinical outcomes for patients,” Moody said. “And it saves, ultimately, taxpayers, because we’re talking about the Medicaid program here.”

The Kasich administration’s plan was cut from the budget the House has passed, but the Office of Health Transformation is hoping to lobby the Senate to bring it back. The House also added $100 million to nursing homes, but Van Runkle says there are still $135 million in cuts that weren’t restored.