The Un-Level Playing Field
As we move forward into a new world consisting of the Affordable Care Act, Accountable Care Organizations, Managed Long Term Care Plans, as well as the old world concerns of on-going and ever changing regulatory requirements, it may be time to take a look at how our industry always seems to be on the losing side of the equation. In a series of articles, we will highlight how an un-level playing field has developed over many years and how, in this new era, these issues need to be addressed in order to enable nursing facilities to meet the goals of cost containment, patient satisfaction and quality care.
As a first example of this un-level playing field is how nursing facilities are treated by the State regarding payments, overpayments and the interest applied.
As anyone who works in LTC knows, we are dependent upon the local DSS Departments to process medicaid applications. While not required to and at their expense, Facilities often pay staff to help families complete these applications in order to facilitate the processing of the applications to expedite them for cash flow purposes. Once submitted, a Medicaid application can take months, sometimes a year, depending on the case on your County, to ultimately get paid. New York State has a County based, patchwork approach to the application and processing of Medicaid applications, with varying approaches to processing and timeliness.
If a facility is lucky, the family will remit the monthly N.A.M.I thereby giving us some cash flow to the Facility, but often not, choosing to hold onto the check rather than pay the Facility. (It gets even more complicated when an Elder Care Attorney is involved). All the while, a Facility is providing care to the applicant, paying salaries and other expenses while waiting for the medicaid to be approved. Another lag occurs for the case to be “put up” on the system. If they have not secured it from the point of application, Facilities then must go after the family to get the back NAMI, which they have often spent. Multiply this by the number of pending cases a Facility admits, on top on internal conversion cases, and it can amount to quite a hit to cash flow and efficient operations. The impact on a Facility is two fold – first the process adds unneeded costs from labor to manage the application process to the costs of borrowing funds to cover the cash flow deficits. Second, it goes without saying that no interest is applied to these past due amounts.
On the flip side, years worth of appeals lay in Albany without the impetus of interest accruing. Basic appeals, key punch errors and other critical parts of reimbursement can get suspended or denied with little hope of getting addressed. Even more frustrating is when NYSDOH identifies an overpayment (whether real or imagined), they immediately begin a recoupment and apply interest to any outstanding payment not made within the specified time. Regardless of a Facility’s ability to pay the recoupment, NYS takes it off the weekly Medicaid check. Payroll, supplies, oil or electricity payments are not taken in to account during a recoupment.
With cost efficiencies driving our future, these issues need to be addressed or else the added stress of managing care for the lowest dollar becomes that much harder. Stressed providers need a stable reimbursement environment – the playing field needs to be fair and level.
Robert Heppenheimer has been active in Skilled Nursing Facilities for his entire healthcare career and has been an advocate for change in this industry. From 1990 – 2005, Mr. Heppenheimer was Administrator of Record in several facilities on Long Island including; Sunrise Manor Center for Nursing & Rehabilitation, John J. Foley Skilled Nursing Facility, Bellhaven Nursing Center, and Grace Plaza Nursing Center. He has been Executive Director for several facilities since 1999 and took a lead position in New York State appointed Receiverships for Bethany Gardens (Rome, N.Y.) and Affinity Skilled Living & Rehabilitation Center (Oakdale, N.Y). During his tenure he has been responsible for developing proactive programs in the facilities to improve the quality of life and the level of care and compassion provided by facilities.
In 1999 he first became an owner of a skilled nursing facility and has been active in developing these facilities to meet the needs of the “Next Generation”. In March 2006, he became Owner/Operator of Hilaire Farm Nursing Home a 76 bed home in Huntington, New York. In February, 2008 Bob became the Owner/Operator of Nesconset Center for Nursing & Rehabilitation in Smithtown, New York and has brought his innovated philosophy and technology to this Facility as well.
Mr. Heppenheimer has served as President of Intercounty Health Facilities Association, a 55 member Nursing Home trade association on Long Island as well as on the Board of NYSHFA for many years. He currently serves on the Legislative Committee for NYSHFA. He has lectured around the State on Culture Change and other nursing home related topics. He currently serves as Chairman of the Board for a charitable organization for stroke prevention and awareness (Hope for Stroke) and was a founding member of another stroke awareness charity, Judy’s Run.