HARRISBURG ---Stuart H. Shapiro, M.D., CEO of the Pennsylvania Health Care Association and the Center for Assisted Living Management (PHCA/CALM), today commended Gov. Tom Wolf for working to ensure that Pennsylvania’s frail elderly and disabled residents remain a top priority in his first state budget, even as the commonwealth faces mounting fiscal pressures.
“Pennsylvania’s population is aging rapidly and the demand for long-term care services is growing, especially among residents and patients who have higher acuity levels, more complex medical needs and chronic health conditions that require around-the-clock care,” Shapiro said during the taping of a statewide public affairs TV program, which is set to begin airing this weekend.
“The goal now is making sure they continue to get the services they need to live a healthy, safe, high-quality life with the dignity and respect they deserve,” he said.
As part of his 2015-16 budget proposal, Gov. Tom Wolf announced plans to expand home- and community-based services (HCBS) to more than 5,500 residents, and promised to speed up the process to receive home health care, which PHCA/CALM supports.
“When it comes to long-term care, people want to stay at home --- and they should, for as long as it is safe and for as long as it is cost-effective,” Shapiro said. He noted, however, that many times nursing home care is the safe, cost-effective alternative.
According to state data provided to the Pennsylvania Long-Term Care Commission, there are 1,115 elderly people receiving state Medicaid supported services at home in one Medicaid funded program for seniors alone. Their annual cost of care totals $18.2 million MORE than if they were cared for in a nursing home.
“For many, services at home can be safely and cost effectively delivered. For others, a nursing home is the most appropriate setting for safe and cost-effective care,” Shapiro said. “Both services need to be funded adequately, and both deserve our support.”
Shapiro noted that even with Pennsylvania’s tremendous financial restraints, the governor and lawmakers still need to find a way to ensure that limited available state resources serve the greatest number of people in the safest, most appropriate, least restrictive and cost-effective setting possible.
Skilled nursing facilities care for Pennsylvania’s sickest and frailest elderly and disabled who need 24/7 care. Over the years, the acuity (sickness) level of these residents has increased. As the level of care needed by nursing facility residents has risen, so has the cost of care.
Pennsylvania’s Medicaid program doesn’t come close to covering the real cost of care. Two-thirds of the residents are on Medicaid, and for each one of them the cost of care exceeds the Medicaid payments by an average of $23.00 a day.
PHCA/CALM is seeking an increase of 2.4 percent in Medicaid payments to nursing homes to cover the ever increasing cost of care. The 2.4 percent is the three year average increase in the nursing homes market basket used by the Centers for Medicare and Medicaid Services (CMS) to set Medicare rates. This increase equates to $36 million in state funds, which will bring in an additional $40 million in federal funds. The market basket represents how much more it would cost a nursing home each year to purchase the same mix of goods and services.
To help preserve access to care for our most vulnerable populations, PHCA /CALM is also seeking continued funding for the Medicaid Access Program that the legislature created two years ago. This program provides incentive payments to centers that serve high Medicaid populations. We are asking for $16 million in state funds, which will bring in an additional $17 million in federal funds.
Shapiro also stressed the need for relief for Pennsylvania’s skilled nursing facilities from the mounting pressure of frivolous lawsuits filed by mostly out-of-state predatory lawyers. This would allow skilled nursing facilities to shift resources back to patient care where they should be spent.
According to a new national actuarial analysis on liability costs, published by AON, the liability cost per bed per day in Pennsylvania was $4.71 in 2013. Given that Medicaid paid for about 19.2 million days of care in 2013, Pennsylvania taxpayers spent nearly $90.5 million on liability related costs in Pennsylvania nursing homes in 2013, mostly to out-of-state predatory lawyers. That’s $90.5 million dollars that could have been used to improve the quality of care and the quality of life for nursing home residents.
AON reported that nursing homes are projected to pay in 2014 approximately $1,810 in liability costs per bed, which doubled since 2008 ($900). This means that a 100 bed nursing home would pay about $180,000 annually in liability related expenses.
“The high legal costs paid by Pennsylvania health care providers, employers and governments inhibit job growth, increase health care costs and limit access to medical care,” Shapiro said.
“Pennsylvania Newsmakers” is one of the state’s premier politics and public policy television talk shows. The show is available at www.phca.org and will air regionally:
- WGAL Channel 8 (Harrisburg and Lancaster) Sunday, April 5 at 7:30 a.m.
- Pennsylvania Cable Network (PCN) Sunday, April 5 at 4:30 p.m.
- WBPH (Lehigh Valley and Philadelphia) Monday, April 6 at 8:30 p.m.
- WKBS 47 (Altoona) Saturday, April 11 at 9:30 a.m.
- WPCB 40 (Pittsburgh) Saturday, April 11 at 9:30 a.m.
