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Government & Politics

Conflicting Data Revives the Battle Over How to Fund Ohio's Nursing Homes

Scripps Ohio map
Scripps Gerontology Center at Miami University of Ohio
Scripps Gerontology data shows where Ohio is growing older.

The longstanding battle between the nursing home industry and Gov. John Kasich has made its way to the Ohio Senate. But Statehouse correspondent Karen Kasler reports new data from Kasich’s office is reviving the fight over how to fund the state’s nursing homes.

Scoring below average
The report comes from the Scripps Gerontology Center at Ohio’s Miami University. It shows 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 says.

The year 2013 was three years after John Kasich was elected governor and 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. 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,” Kasich said then.

Different statistics, different stories
Now there are 930 nursing homes in Ohio. And Kasich’s office still has concerns backed up by a release of data showing big problems continue 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 says there’s a way to improve those stats.

“Our objective is always to reward the facilities that are providing the best quality. 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 for those that have lower quality, too,” said Moody.

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. In fact, there are in statutes five specific quality measures that we have to meet.”

Lobbying for managed care
Van Runkle is especially concerned about what the Kasich administration wants to do, namely 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,” says Van Runkle.

But Moody said more than 20 states are trying this approach. He linked it to the state’s five-year pilot called MyCare Ohio, a managed-care program which covers about 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 that, in fact, managed long term services and supports does improve clinical outcomes for patients,” said Moody. “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.