Taxpayers still offset cost for Medicaid patients
By Vicky Wedig
Editor
The county-run nursing home has increased its daily rate and is attracting more private-pay customers, but its operation is still subsidized by $3.6 million in taxpayer collars yearly.
The county’s cost to operate the nursing home vs. the amount of revenue the facility generates was a topic of discussion when the Walworth County Board planned the construction a new home 10 years ago, said County Administrator David Bretl.
The board downsized Lakeland Health Center Center from a 235-bed facility to a 120-bed facility that opened in 2007.
The facility topped out at more than 300 beds in the 1990s, and when the board discussed reducing the number of residents by another 100-plus, residents were concerned the county would lose money, Bretl said.
“People thought we should have more, but that’s not the case,” he said. “The more beds you have, the more you offset with tax dollars.”
Typically, fewer than a quarter of the facility’s residents pay privately. Most – about 66 percent last year – receive Medicaid, which reimburses the county a fraction of the private-pay rate.
“That rate is woefully short of what the cost of care is at the facility,” Bretl said.
The facility increased its rate by 3 percent this year – from $255 to $263 per day. Nursing home administrator Bernie Janiszewski said Lakeland Health Care Center hadn’t increased its rate in a number of years, and the hike brings the home more in line with the amount other facilities in the area charge.
The amount the county is reimbursed for its Medicaid patients changes quarterly, but the current rate is about $155 per day, Janiszewski said.
The taxpayer subsidy of $3.6 million is largely to offset the cost of caring for the Medicaid patients.
Janiszewski said the County Board set a goal of keeping the facility’s portion of Medicaid patients between 68 and 72 percent of its census.
In 2012 and 2013, the center’s average census was 71 percent and 66 percent Medicaid patients; 20 percent and 22 percent private-pay residents and 9 percent and 12 percent Medicare patients.
Medicare covers only short-term care such as rehabilitation as an extension of hospital benefits, Janiszewski said.
As of March, nearly 30 percent of patients this year are private pay and about 50 percent are Medicaid, Janiszewski reported to the Lakeland Health Care Center Board in April.
“I see you’re doing really well on private pay,” said board member Joe Schaeffer.
But, Janiszewski said, the numbers can be deceiving because patients who have applied for and are certain to qualify for Medicaid are counted as private-pay until their benefits come through.
She said the facility uses a referral system to admit the most acute patients as opposed to a first-in-line waiting list.
“It’s not like a deli number,” she said.
Five-star
To continue to attract private-pay patients, retaining the center’s five-star rating is important, Janiszewski said.
The federal government’s Centers for Medicare & Medicaid Services created the Five-Star Quality Rating System in 2008 to help consumers, their families, and caregivers compare nursing homes more easily.
The system rates nursing homes on a scale of one to five stars with five being the highest quality in three areas – health inspections, staffing and quality measures. On the Nursing Home Compare website at medicare.gov, consumers can compare facilities in their area.
A search of facilities within 25 miles of Delavan results in 15 nursing homes that range from an overall rating of five stars – much above average – to two stars – below average.
The only facility within 25 miles of Delavan that has an overall five-star rating plus five stars in each of the three areas of comparison is Golden Years Health Center in Walworth. Golden Years has the highest possible rating with a total of 15 stars.
Lakeland Health Care Center is on par with Mercy Manor Transition Center in Janesville, Holton Manor in Elkhorn and Williams Bay Care Center in Williams Bay, all of which have a five-star overall rating and a total of 12 stars in the three categories.
Lakeland Health Care Center is rated four stars for health inspections, three stars for staffing and five stars for quality measures. Janiszewski said Lakeland has maintained its five-star rating since the system’s inception.
Memory care
The nursing home is in the process of adjusting the security of its 60-bed memory care unit to give patients who don’t need restrictions more freedom.
“If a person does not need to be restrained, they certainly shouldn’t,” Janiszewski said.
All 60 beds are now secured behind a locked door for the safety of some dementia patients who wander.
“We’re going to move that door and secure 30 of them,” she said.
The move is an effort to preserve the dignity of the patients, she said.
Medical care
Janiszewski said the facility is also gearing up for government regulations that aim to prevent nursing home patients from returning to the hospital.
“The idea is to reduce readmissions to the hospital because that’s very costly,” she said.
The center faces sanctions if residents who are admitted to the nursing home from a hospital are readmitted to the hospital within 30 days.
To prevent readmissions, the county is looking to form an accountable care organization whereby the nursing home would partner with doctors, hospitals and other health care providers to essentially become an extension of the hospital, Janiszewski said. The facility has labs and registered nurses and doctors contracted to treat patients at the nursing home. The goal is to treat patients at the nursing home who in the past would have been sent back to the hospital such as someone with pneumonia, for example, she said.
Janiszewski said the biggest impediment has been getting information from the discharging facility to treat a patient seamlessly without beginning the assessment process over. The mandates from Medicare are trying to stop such redundancies, she said.
“We need to be able to look at the hospital’s records for that person who just came here at 3 o’clock on a Friday afternoon,” she said.
