Report Questions Nursing Home Charges

The Department of Health and Human Services released a report titled “Questionable Billing by Skilled Nursing Facilities.” The title says it all… but we’re still going to comment.

In recent years, government analyses have discovered improprieties in the amount of Medicare dollars billed by–and paid to–to skilled nursing facilities (a general term that includes nursing homes and other long-term care facilities). We’d like to be clear that Medicare dollars are OUR dollars, yours and mine. Medicare dollars are paid from our tax dollars. So as you read the rest of this blog, keep in mind that this story is personal to everyone in the United States, regardless of whether or not you know anyone in a nursing home.

Here’s a summary of this very long, dry government report:

  1. Within two years, from 2006 to 2008, skilled nursing facilities (from here on, I’ll simply refer to this as “facilities”) increased billing for the most expensive therapies by 11%…even though the ages and diagnoses of residents didn’t change. (Translation: Similar resident groups, with higher billing = facilities billed for unused  or unneeded expensive therapies.)
  2. For-profit facilities were far more likely than not-for-profit facilities to bill for expensive therapies. AND, the facilities most likely to bill for higher-cost therapies were owned by large chains. (Question: Is this how “for-profits” make more profits?)
  3. Some facilities were found to have a pattern of routinely billing Medicare for higher-cost therapies, and/or for having residents stay longer. (Translation: Some facilities routinely abuse the billing system…and now the government knows which ones they are.)

The recommendations to remedy the problems are for Medicare to monitor payments more closely…to change the current method for figuring out how much therapy is needed…to keep a closer eye on those facilities (especially the chains) that seem to have a bigger problem with unusual or “questionable” billing.

For more details without having to read the report itself, Paula Span wrote a really nice opinion piece in The New York Times. In it, Ms. Span says:

Families looking into nursing home care for their elders already have reason to be conscious of the distinctions between for-profit and nonprofit homes. For years, studies have found that nonprofits do better on some vital measurements.

“It’s consistent. The for-profits have the worst staffing ratios and poorer quality based on the number of deficiencies — violations of federal requirements — and the most serious deficiencies,” said Charlene Harrington, professor emeritus of social and behavioral sciences at the University of California, San Francisco, who has led a lot of that research.

In a new study, not yet published, Dr. Harrington also has found that of all forms of ownership, homes owned by the 10 largest chains fared worse than other for-profits. “These facilities are reporting the highest acuity levels” — meaning the most serious conditions for patients — “and the worst staffing,” she told me. “Facilities are supposed to increase their staffs when people are sicker.”

In addition, professor of health polity and management at Texas A&M Catherine Hawes notes that while there are some for-profit facilities that provide good care, in general these facilities have to spend more money making stockholders or owners happy (and possibly wealthy).

“If I had to rely on a single piece of information, deciding about a facility for myself or a loved one, I would choose based on ownership status,” [Dr. Hawes] said.

(Translation: The expert would choose the average not-for-profit facility over a for-profit facility.)

If you have any legal questions about long-term care facilities, check out our dedicated nursing home page: HensonFuerst Nursing Home Abuse and Neglect. If you have questions, HensonFuerst has answers.

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