News | March 7, 2012

AQNHC Says Medicare Agreement Ill-Advised; 'Bad Debt' Provision Disproportionately Harms Skilled Nursing Facilities (SNFs) And Their Patients

Multiple Threats to Seniors' Care, Local Jobs, SNF Sector Stability Overlooked; Unique SNF Sector Policy Challenges Ignored; Rationalizing Medicare Post-Acute Payment System Must be Key Objective Moving Forward

Washington, DC /PRNewswire-USNewswire/ - The Alliance for Quality Nursing Home Care (Alliance) today said the skilled nursing facility (SNF) provisions contained in last week's payroll tax agreement disregard the significant multi-front pressures affecting America's SNFs, and discount the obvious threat to patients' care quality resulting from thousands of facility job losses caused by a cascade of cumulative funding cutbacks imposed since 2009. In particular, the Alliance says, the so-called Medicare "bad debt" provision agreed upon last week disproportionately harms the SNF sector and its patients.

"The final agreement ignores the SNF sector's unique challenges in meeting U.S. seniors' growing long term and post-acute care needs," stated Alan G. Rosenbloom, President of the Alliance. "In the midst of economic tumult and sector instability resulting from more than three years of cumulative federal and state funding cutbacks – and compounded by the negative impact of an immediate 11.1 percent Medicare reduction that became effective October 1, 2011 – seniors' care is left in jeopardy, and more facility jobs are sure to be lost. We now fear additional facilities will be driven right to, if not over, the edge of operational viability."

The Alliance leader said the SNF sector is already slated to absorb $127 billion in Medicare reductions between FY 2012-21, that 32 states have cut or frozen SNF Medicaid funding over the past 12 months, and that the agreement ignores the central fact federal law prevents SNFs from collecting as much as 90 percent of SNF bad debt. The federal government prevents SNFs from collecting Medicare co-pays and deductibles from beneficiaries eligible for both Medicare and Medicaid – the so-called "dual eligibles" or "duals," and also authorizes states to avoid making such payments on behalf of those patients.

Stated Rosenbloom: "The federal law prevents SNFs from collecting as much as 90 percent of SNF bad debt. There is no logic to this provision, and the fundamental unfairness of the new policy speaks for itself." He also noted that in addition to cuts already scheduled for implementation and the added burden of the bad debt changes, Medicare providers are facing an additional two percent cut effective January 1, 2013.

Moving forward on the policy front, Rosenbloom pointed out that SNFs currently play a key role in the post-acute care continuum, and are poised to play a still greater role if Congress acts to rationalize the nation's Medicare post-acute payment system. "Simply returning again and again to provider cuts, without seriously revamping post-acute care delivery and payment policies, will have serious, negative consequences for patients, caregivers, local jobs and SNF providers themselves – which are integral to communities across America."

Rosenbloom suggested that a new Politico Pro op-ed authored by prominent researcher Vincent Mor of Brown University and Gail Wilensky, a former Administrator of what is now the Centers for Medicare and Medicaid Services (CMS) under George H.W. Bush, offers wise policy guidance for Congress in both assessing SNF fragility and improving coordination between providers: "Moving forward, it is more important than ever for policymakers to change the current disincentives built into the separate streams that fund nursing homes and hospitals. We need to incentivize hospitals and nursing homes to work together to treat a patient over the course of an entire episode of illness, and to share any savings that could result from joint efforts," they said.

The Alliance for Quality Nursing Home Care (The Alliance) is a coalition of 12 leading post-acute and long term care organizations providing quality skilled nursing care to American seniors and disabled in approximately 1,400 facilities in 44 states nationwide.

SOURCE Alliance for Quality Nursing Home Care

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