- The Washington Times - Tuesday, October 1, 2002

Those entering the Potomac Center elder-care facility in Pentagon City during the past few weeks were greeted with this bold and foreboding notice taped to the front entrance: "Less than 30 days left. On Oct. 1, Congress will slash Medicare funding for skilled nursing care by 10 percent nearly $2 billion in 2003 or $35 per patient per day. Tell Congress to stop the cuts."
Today is the drop dead day for the so-called "Medicare cliff" legislation in which $1.7 billion will be cut in the fiscal 2003 budget that went into effect at midnight.
Opponents say the cuts will force layoffs and nursing home closures and jeopardize care for the elderly, something a majority of voters oppose, according to a poll conducted by Roll Call magazine.
John Schaeffler, vice president of legislative affairs for the American Health Care Association (AHCA), said these cuts are inconsistent with the goal of providing quality care. They couldn't come at a worse time because "Medicaid is getting worse because of a bad economy."
Medicare funding, for temporary care of the elderly, is subsidizing Medicaid payments, for long-term indigent care. The industry says the latter reimbursement funds are nearly $10 per patient per day below the cost of care. Medicaid payments are generally determined by states and many are facing large deficits with the downturn in the economy.
With Medicaid funds facing deeper cuts and Medicare being decreased, it is likely that not only poor patients but also private paying patients will be affected.
Medicaid pays an average of approximately $4.50 per hour for the care of our nation's frail, elderly and disabled, less than most people pay a teenage baby sitter, AHCA notes.
Mr. Schaeffler said that even though the Oct. 1 deadline is here, negotiators from both chambers of Congress could put together a package to maintain current funding and make it apply retroactively before the lawmakers recess Oct. 11 for the fall campaigns.
"It's not ideal but it's better late than never," he said. Multiply the cut of $35 a day per patient by seven days a week by 52 weeks, he said, and nursing facilities will be faced with "tough choices."
The homes and rehabilitation centers are already understaffed at current levels of reimbursement, he said, and "the data shows that if you put more resources you get better quality of care and the deficiencies go down."
Indeed. Debra B. Krahling, the dedicated director of nursing at Potomac Center where my mother is a resident, said, "We still have to provide the highest quality." However, the government wants to set quality standard but doesn't want to give her the tools and money she needs to meet them. For example, she said that for every patient suffering from AIDS in her care, their medicines cost $1,000 a day but her facility is reimbursed only $100.
Mrs. Krahling added that it is becoming increasingly difficult for hospitals to transfer patients with multiple illnesses to long-term-care facilities that are refusing to take them because of the low reimbursement rates. "I know of one patient in Fairfax who has been [in the hospital] for a year because they can't place him."
Diana Pullin, the registered nurse reimbursement coordinator, who spends most of her day buried in paperwork in addition to lobbying Congress, said the cuts "will be a huge blow to skilled nursing." Nearly 3.5 million people live in nursing homes meaning 15 percent of the public has a relative in a home, based a recent article in U.S. News & World Report.
The scathing report challenged line for line by the AHCA states that for the $92 billion spent on nursing homes each year in public and private dollars, comparatively little goes to routine daily care. Their analysis points to poor management rather than inadequate funding as the culprit.
Martha Mohler, a consultant who retired from the Committee to Preserve Social Security and Medicare, says she's been a nurse in a home and had a mother who was a resident in one.
She acknowledges that this is a complex issue as lawmakers try to provide funding for adequate care at the same time they need to protect the overall Medicare program, given that it will be increasingly stretched as baby boomers age.
"It's hard for the lay person to know," she said.
Last week, Mrs. Mohler received an AHCA "Driving for Quality Care" campaign notice in the mail asking her to call Congress to prevent the "Medicare cliff" legislation from going into effect. However, she questions whether government dollars are being spent appropriately for nursing care by the industry and whether they are playing to the public's emotions.
"I'm anxious to see the GAO report and hope Congress looks at it before it acts," she said. "Most of [the Medicare and Medicaid funding] is public money and it needs more accountability and I don't think we've seen it yet." Still, AHCA officials maintain that Medicare cuts will force a return to an era of bankruptcies, job loss, access problems and facility closures.
One study conducted by the Lewin Group earlier this year indicates that if the cuts are enacted, more than half of an estimated 17,000 facilities nationwide profit or nonprofit will be operating in the red. A similar study conducted by the University of North Carolina School of Public Health shows that cuts in funding will lead to cuts in staffing and reduced care.
No matter the disagreement about funding levels, both sides agree that linking funding levels with staffing levels is needed but those pending congressional bills are not getting much attention. "But the [Bush] administration seems to have brushed off that finding," Mrs. Mohler said.
Maybe money alone is no guarantee of the quality of care although you'd expect it would be. All I know from my experience at the Potomac Center is that there never seem to be enough professionals, no matter how dedicated and caring, to provide help for the people who need their intensive care, and I wish for more.

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