A bundle of ill effects from Ohio's change in Medicare reimbursement is hurting specialty nursing home patients -- editorial

By The Plain Dealer Editorial Board

October 28, 2009, 4:49AM

Does it happen every time, or does it just feel that way?

Just as the Ohio General Assembly is about to give the state budget its blessing and send it to the governor for signature, someone tosses in a seemingly minor change that turns out to be major for someone.

One such change that has come to light since July, when legislators approved the current budget, is the "bundling" of certain Medicare services provided by nursing homes.

State officials say the new approach, which is intended to save money in the Medicaid sector of its budget and bring in $55 million more in federal Medicaid funding, seems to be working out well enough for most nursing homes -- as you'd expect, since the nursing home lobby's fingerprints are all over it.

Some nursing homes, however, say they are feeling a pinch so hard and so deep that they won't be able to stay in business unless changes are made.

Here's how it works: Rather than billing the state for Medicaid "support services" that homes provide to patients, like oxygen, transportation, special wheelchairs, over-the-counter medications and occupational and physical therapy, nursing homes now get a flat $3.91 per patient per day to cover such costs.

Run-of-the-mill nursing homes with reasonably healthy residents aren't said to be complaining. But the state is getting an earful from nursing homes that serve patients with serious health problems and severe disabilities. They say they spend a great deal more than $3.91 a day on their patients' support items.

Maureen Corcoran, interim director of Ohio's Medicaid program, says she's looking into effects of the reimbursement change. So is the state Department of Aging.

Several legislators, including Cleveland Democratic Sen. Dale Miller, who warned his colleagues of "serious unintended consequences" way back in July, expect to try to ease the problems when the General Assembly takes up a budget-reconciliation measure.

They should. Behind every business financially afflicted by the change in rules are scores of patients physically afflicted by it. The state must do right by them.