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Editorial: Nursing home inequities

Whether it’s the invisible hand of the market or someone is putting his thumb on the scale, the result is the same: There are inequities in nursing home admissions that need to be fixed.

A Buffalo News analysis of state Department of Health data from 2017 found that residents entering nursing homes in New York State whose bills are paid from the start by Medicaid were twice as likely to be admitted to one-star homes than five-star homes – and even worse in Western New York, where they were four times as likely to be admitted to the lowest-ranking facilities.

Nursing homes are prohibited by state and federal regulations from discriminating against individuals because of how their bills get paid. The state Health Department clearly needs to play a bigger role in ensuring that is the case.

Executives from top-rated facilities told The News there is no economic bias in which patients they admit. But the numbers tell a different story.

Lou Michel’s report in The News explained that at five-star nursing homes – the highest rated – 7% of the new residents in 2017 were Medicaid admissions, while at one-star nursing homes, 15% of the new residents were Medicaid admissions.

The data can be viewed different ways, the story pointed out, because about 36,000 individuals eligible for Medicaid who were admitted to nursing homes were also enrolled in Medicare. When that’s the case, Medicare usually pays the nursing home bills for up to 100 days.

When all Medicaid-eligible people are counted – including those whose bills are first paid by Medicare – the gap is reduced. At one-star homes, 32% of admissions were Medicaid-eligible, compared with 27% at top-rated homes.

The U.S. Centers for Medicare and Medicaid Services uses a five-star “quality rating system” to help consumers compare nursing homes, which are rated according to recent health inspections, staffing levels and overall quality measures. The results are published at Medicare.gov.

Nursing home operators say the statistics on admissions disparities paint a distorted picture because many of their clients are admitted for short-term rehabilitation stays, which Medicare funds. Operators contacted by The News refused to provide stats on short-term versus long-term admissions.

It’s easy to see where the incentives lie for nursing home operators. The reimbursement rate for Medicaid patients in Erie and Niagara counties average $216 per day, compared with $475 a day when Medicare pays.

Like admissions policies at many colleges, nursing home admissions are supposed to be needs-blind – not based on how the client’s bill gets paid. But human beings make admissions decisions, making it impossible to eliminate the effects of biases and economic incentives.

The state Department of Health publishes regulations for nursing homes that include telling patients they have the right to “nondiscrimination in admissions,” and mandate that nursing homes must provide the public “with access to quality care by exercising identical policies and practices covering the provision of all required services, regardless of your source of payment.”

The News’ story on admissions disparities relied on data provided by the Department of Health. The News also put together and published a database on admissions statistics for 611 nursing homes, using figures provided by the Health Department.

State regulations require nursing homes to admit a minimum number of Medicaid-eligible individuals. A Health Department spokesman declined to answer repeated questions from The News about how many times the state enforced those regulations in the past five years. That’s suspicious.

Clearly, the Health Department is not doing enough enforcement. Posting the rules without making sure they are followed is not going to get the job done. As part of stepping up its enforcement, the department would be well-served by posting its admissions data online.

When a family or individual is looking for a long-term care facility, they can use the nursing home comparison page on Medicare.gov, a federal site, to check the star ratings. There’s no reason why the Health Department can’t be just as useful in making its data public.

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