Database shows big variance in quality
As Gov. John Kasich tries to salvage his plan to pay Ohio nursing homes based on the quality of care they provide Medicaid patients, the state Thursday released details showing that the level of service varies widely among Ohio’s 929 facilities.
Kasich’s proposal was pulled out of the two-year budget last week by the Ohio House, which pushed
managed-care reforms back to 2021. But the governor hopes to persuade the Senate to reinsert his proposal.
Kasich advocates a managed-care system in which nursing homes would be paid more if they provide higher-quality service, while homes providing lower-quality service would be paid less. The administration says that some nursing homes “underperform on critical quality measures in part because the current reimbursement system does not financially reward high quality or quality improvement.”
Generally, the data show not-for-profit facilities have far more four- and five-star ratings (64 percent) than for-profit facilities (37 percent). The state database ranks nursing homes on a scale of 1 to 5, with 1 the lowest in quality and 5 the highest.
Further, the percentage of homes with 5-star ratings decreases as their size increases (from 31 percent for those with 0-50 beds to 18 percent for 150-200 beds), while facilities with a 1-star rating increase (from 11 percent for 0-50 beds to 26 percent for 150-200 beds).
The database includes
information on nursinghome staffing levels, occupancy, complaints and ownership by county.
Of 52 homes rated in Franklin County, only 6 received the top rating, while 18 received the lowest rating. Just 15 of 52 homes were rated a 4 or 5.
Medicaid, the federalstate system for low-income and disabled people, now pays nursing homes the same rate regardless of the quality of care they provide. About 20 others states have abandoned that payment system in favor of managedcare plans.
The House nixed Kasich’s plan at the urging of nursing homes, assisted-living facilities and home healthcare workers who argued that they already provide care coordination. Many would lose patients and money under the governor’s approach. The House also increased payments to nursing homes $128 million (including $47 million in state share) in 2018 and $179 million ($66 million state share) in 2019.
Ohio’s $25 billion Medicaid program covers more than 3 million poor Ohioans. Most beneficiaries are already in managed care.
A separate report released this week by the Scripps Gerontology Center at Miami University showed that Ohio ranked below the national average on all 10 quality measures used to evaluate nursing homes by the federal Centers for Medicaid and Medicare Services. The Scripps report listed specific criteria, such as urinary tract infections, unexplained weight loss, pain, pressure ulcers and use of antipsychotic medications.
Officials with two outside agencies who reviewed the new state nursing home database said the conclusion is there is no connection now between what the state pays for nursing home care and the quality of service provided.
“The governor’s idea of providing an incentive is a good one, but it’s not like you can do any of these things overnight,” said John Corlett, former state Medicaid director who now heads the nonprofit Center for Community Solutions. “These institutions are working with very fragile individuals, so you have to be careful.”
Amy Rohling McGee, president of the Health Policy Institute of Ohio, said her agency hasn’t taken a position on Kasich’s proposal. However, she said she supports the move to improve nursing home services by providing higher payments for better-quality services.