The View From Washington. Cynthia K. Morton, MPA Executive Vice President National Association for the Support of Long Term Care eHDS User Group Meeting June 8, 2011. Today’s Session. Where have we been? Where are we now? Where are we headed?. Where have we been?. MAJOR MEDICARE CUTS.
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Cynthia K. Morton, MPA
Executive Vice PresidentNational Association for the Support of Long Term Care
eHDS User Group MeetingJune 8, 2011
Shortfall per Medicaid Resident Day, All States, 1999-2010
Source: Eljay, LLC . A Report on Shortfalls in Medicaid Funding for Nursing Home Care. American Health Care Association. 2010.
*Notes: 2010 data are projected. These data show the shortfall between Medicaid reimbursement and allowable Medicaid costs.
Source: National Governors Association and National Association of State Budget Officers, The Fiscal Survey of the States June, 2011
Performance on Selected Quality Indicators, by Medicaid Payment Rate, 1998
Source: David C. Grabowski, et al. Medicaid Payment and Risk-Adjusted Nursing Home Quality Measures. Health Affairs 23.5 (2004)
Note: Data are adjusted for facility ownership, size, market wage index, and other factors.
Each $10 increase in the daily Medicaid payment level above the national average is strongly associated with 5 to 9 percent lower odds of hospitalization
Source: Gruneir, Andrea, et al. “Hospitalization of Nursing Home Residents with Cognitive Impairments: The Influence of Organizational Features and State Policies.” Gerontologist 47.4 (2007)
Nursing facilities rely on Medicare to fill the Medicaid shortfall, so Medicare reductions will reduce already low overall margins
Source: FY 2008 Cost Reports
*Inpatient operating costs are not adjusted for private beds and facilities in the top and the bottom 10% of the individual margin distribution (outliers) were removed
** Almost two-thirds of non-Medicare days are Medicaid days and the remainder are out-of-pocket, private insurance and other days. Facilities in the top and the bottom 10% of the individual margin distribution (outliers) were removed
*** Facilities in the top and the bottom 10% of the individual margin distribution (outliers) were removed
Where are we now? Are Barely PositivePOST HEALTH CARE REFORM
Accountable Care Organizations
Key Elements of an ACO Are Barely Positive
Where are we headed? Are Barely PositivePOLITICAL CONTEXT
Cynthia Morton, MPA
Executive Vice President
National Association for the Support of Long Term Care (NASL)
The leading national organization representing providers and suppliers of healthcare services and products in the long term and post-acute sector including therapy, medical products, diagnostic testing and information systems.