Call your Indiana State rep/senator

[TMFT]

Indiana county hospitals keep nursing home spending secret. This bill would change that.

The bill would shed light for the first time on how much federal money county hospitals divert from their nursing homes.

www.indystar.com

I don't think this article is behind a paywall. Definitely worth reading this & the prior IndyStar investigations (HERE) in the matter.

The gist of it is that nursing homes run by local government get extra Medicaid reimbursements that a private nursing home would get. So county hospitals have been buying up private nursing home all over the state (like 90% of nursing homes are owned by county hospitals now). The loophole is that they're buying them on paper and contracting with private nursing home management companies (a lot of the time previous owners) to manage them. The managing company gets a cut of the money, the hospital gets a cut of the money, and maybe the nursing home actually sees a little more funding, but it's a fairly opaque process there.

End result is that hospitals are taking additional government funding intended to improve care for Medicaid nursing homes and using it for other hospital purposes. It's really disgusting & shameful.

Read up on this proposed legislation & let your representatives know your stance, whichever way you land on it.

As a side note, this is where I point out that although there are stereotypes associated with Medicaid recipients, 21% of all Medicaid spending is on seniors (who presumably qualify already for Medicare). 34% goes to individuals with disabilities, 10% to adults, 17% to children, and 17% to "newly eligible adults," who are adults made eligible for Medicaid by ACA expansion. So even with the expanded eligibility under the ACA, 27% of spending goes to "poor people" generically. The vast majority goes to old folks, children, & the disabled. Link HERE.

 

[anon_6hv78pr714xta]

Indiana county hospitals keep nursing home spending secret. This bill would change that.

The bill would shed light for the first time on how much federal money county hospitals divert from their nursing homes.

www.indystar.com

I don't think this article is behind a paywall. Definitely worth reading this & the prior IndyStar investigations (HERE) in the matter.

The gist of it is that nursing homes run by local government get extra Medicaid reimbursements that a private nursing home would get. So county hospitals have been buying up private nursing home all over the state (like 90% of nursing homes are owned by county hospitals now). The loophole is that they're buying them on paper and contracting with private nursing home management companies (a lot of the time previous owners) to manage them. The managing company gets a cut of the money, the hospital gets a cut of the money, and maybe the nursing home actually sees a little more funding, but it's a fairly opaque process there.

End result is that hospitals are taking additional government funding intended to improve care for Medicaid nursing homes and using it for other hospital purposes. It's really disgusting & shameful.

Read up on this proposed legislation & let your representatives know your stance, whichever way you land on it.

As a side note, this is where I point out that although there are stereotypes associated with Medicaid recipients, 21% of all Medicaid spending is on seniors (who presumably qualify already for Medicare). 34% goes to individuals with disabilities, 10% to adults, 17% to children, and 17% to "newly eligible adults," who are adults made eligible for Medicaid by ACA expansion. So even with the expanded eligibility under the ACA, 27% of spending goes to "poor people" generically. The vast majority goes to old folks, children, & the disabled. Link HERE.

I haven't read the article yet but will. Thanks for posting.

It sounds strange, but could I ask why you find it "really disgusting & shameful?" If a county is redistributing $ from the feds away from nursing home reimbursements to "use it for other hospital purposes" it might be a net neutral or even good thing, might it not? Maybe those other hospital purposes are really needed, important services?

Maybe the county has a better understanding of how those dollars could be used than the feds do, while also supplying quality nursing home care? Or is that at issue, too?

Obviously, transparency is very important so that I get.

 

[JamieDimonsBalls]

The loophole is that they're buying them on paper and contracting with private nursing home management companies (a lot of the time previous owners) to manage them. The managing company gets a cut of the money, the hospital gets a cut of the money, and maybe the nursing home actually sees a little more funding, but it's a fairly opaque process there.

This is quite common FWIW across various states and different provider settings (not just nursing homes). A hospital wants to expand its service offering and diversify its revenue stream, so it sets up a JV with a management company that is better equipped to operate and handle a non-hospital facility. Other examples of these are Urgent Care Clinics and certain sub-specialties (e.g., Orthopedics).

But, I do want to read the article and will try to put it in the queue for the weekend.

 

[TMFT]

I haven't read the article yet but will. Thanks for posting.

It sounds strange, but could I ask why you find it "really disgusting & shameful?" If a county is redistributing $ from the feds away from nursing home reimbursements to "use it for other hospital purposes" it might be a net neutral or even good thing, might it not? Maybe those other hospital purposes are really needed, important services?

Maybe the county has a better understanding of how those dollars could be used than the feds do, while also supplying quality nursing home care? Or is that at issue, too?

Obviously, transparency is very important so that I get.

Definitely read both articles. It's really eye opening on how bad some nursing homes are because of lack of funding. That's also why I've been trying to get my mother in law to move in with us since my father in law passed away. The women in that family live forever and I can pay for it now by saving her money while she's still relatively young, or I can pay for it later by spending an arm & a leg to keep her in a decent home when the time comes.

I think it's shameful because the purpose of the higher reimbursement rates when a county hospital is receiving Medicaid reimbursement rates is to improve the the nursing home. If it's not improving the nursing home at all, I consider it just a step below fraud (I concede it's not illegal, it's just taking advantage of a loophole).

Put another way, the idea behind getting increased reimbursement rates is noble. Medicaid rates are LOW, so a home taking primarily Medicaid patients is almost sure to be woefully underfunded. So, if the clientele would only bring in $25M in revenue each year but it would take $35M to be properly funded, there's clearly a problem. If increased reimbursement rates brought the nursing home $35M but the hospital only uses $25M to fund the nursing home and pockets the rest for other hospital purposes wholly unrelated to the nursing home, then it's using a program designed for patient care as a cash cow for any number of things OTHER than what it's intended for.