The nursing home sector may be facing even bigger, more longstanding obstacles than current staffing woes and increased costs due to rising inflation.
According to one industry leader, the crisis facing long-term care is the data itself.
“We have this one-size-fits-all regulation, we have irrational payment systems where reporting is fragmented, redundant and inconsistent and industry metrics that lack context and offer no comparative integrity whatsoever,” Marc Zimmet, president of consulting firm Zimmet Healthcare Services Group, said Wednesday at the company’s annual conference in Connecticut.
Skilled nursing facility markets are “too diverse” to be regulated and paid as a single provider class, according to Zimmet, likening them to hospitals which have many different types classified by the federal government.
Zimmet also used documentation as an example during his wide-ranging discussion, pointing out that the MDS, cost report, UB-04 and quality reports all exist in silos; they speak different languages and are completed by different people at different times in different places.
“The bottom line is everything you think you know about skilled nursing facility data is wrong, is inaccurate — and that’s the greatest danger facing skilled nursing,” he said.
Occupancy vs. census
Nursing home industry census may not be as high as it seems, according to Zimmet.
That’s because, he contends, the data does not take into account how many skilled beds have been decertified when determining how many beds are filled.
“That’s a big problem because you’re telling the world, you’re telling policymakers that SNF recovery is doing much better than it is and that’s crazy,” Zimmet said.
More than 50,000 beds have been taken offline since 2015, he said, leaving 1.6 million active.
There’s also a difference between occupancy and census, Zimmet added. Occupancy is a ratio whereas census is an absolute value.
Relative occupancy in 2022 for skilled nursing facilities falls right around 67%, according to the company’s eCapIntel data.
As it becomes apparent that federal Covid-19 related funds have largely dried up, nursing home providers across the country are turning to the states to lend a hand.
“So the thing about the states right now is that there’s a lot of money … a lot of states are flush,” he said.
Zimmet projected that states were collectively shelling out about $11 billion less in Medicaid payments compared to 2019 — amounting to roughly $743,187 less per facility.
He used Pennsylvania as a recent example of a state that made big headway in obtaining Medicaid rate increases.
Pennsylvania Gov. Tom Wolf recently approved a Medicaid reimbursement increase of 17.5% for the state’s nursing homes for next year, translating to an increase of around $35 per resident per day.
The increase to the state’s budget also includes over $131 million in American Rescue Plan funding that will be used to help bridge the reimbursement funding gap that has formed for a state that hasn’t seen a Medicaid funding increase in nearly a decade.
Nearly 60% of all Pennsylvania nursing facilities had been categorized as “at financial risk,” according to a recent report from the PHCA, which is greater than national numbers – 47% – seen in a report released by CliftonLarsonAllen (CLA) earlier this year.
Zimmet asserted that nursing home advocacy groups and providers need to go to states with ideas, rather than asking for blanket sums of money. Because states have priorities of staffing minimums and private rooms, tying those measures to payment could be the right move forward.
As one example, he provided an optional payment program to compensate nursing homes for reserving Medicaid-only private rooms. The program would incentivize SNFs to reserve a certain number of rooms, while avoiding selling or decertifying beds in case of future bed shortages.
He also shared skepticism that every facility in a state should receive the same Medicaid boost, especially those with smaller Medicaid populations — going so far as to call it “destabilizing for the industry.”