$3.3 Billion-LTC's Magic Number. (NH News Notes).

What would you do with $3.3 billion? Well, you could help out the nursing home industry for a year, since accounting firm BDO Seidman reports that providers are being shortchanged by at least this much by Medicaid annually.

While such a large figure probably does not surprise many in the industry, it further points to the need for reimbursement overhaul, according to Charles H. Roadman II, MD, president and CEO of the American Health Care Association (AHCA), who said in a release, "Nationally, Medicaid pays just slightly more than $4 per hour, per patient--less than most people pay a teenage babysitter. That is simply not a viable cost structure to ensure America's most vulnerable seniors receive the quality nursing care they need and deserve. It's essential that Congress evaluate and act upon the underfunding of our seniors' nursing care...."

Joe Lubarsky, national director of BDO Seidman's Long Term Care Services division, pointed out in a statement that Medicaid relies on outdated data and does not use cost inflators to take into account actual nursing home cost increases; states using current cost data often lower payments to meet budget constraints. In fact, in surveying AHCA affiliates in 36 states, BDO Seidman found that New Jersey, Vermont, Massachusetts, Nevada, South Dakota, Oregon, Utah, Florida, Washington and Indiana have the largest difference between cost of care per patient and government reimbursement. New Jersey's per-patient daily shortfall was $21.11, resulting in an annual shortfall of $236,212,160, according to the report. The 1999 average unreimbursed allowable Medicaid cost per patient day was $11.91 in the Northeast, $5.23 in the South, $8.91 in the Midwest and $8.60 in the West.

BDO Seidman surveyed the 36 states in which data were released or were in a form usable for comparison, but it says the collected data represent more than 72% of national Medicaid patient days and are geographically and demographically representative of the nation, permitting broad conclusions about Medicaid funding.

John Gillan, director of community relations at AHCA, points out that state affiliates will use these figures to make the claim to state governments that longterm care needs more reimbursement: "Rather than just focusing on the total cumulative figures, however, the profession continues to focus on the all-important shortfall impact on each patient. That is the basic unit on which to measure quality care. Quality care per patient is what it is all about, not just cold total figures." As the long-term care population continues to grow, Gillan says, the total shortfall will continue to rise, further straining facilities.

Gillan also notes AHCA's beliefs that, despite the politically popular push for more funding for home-based care, increasing funding for one area of longterm care should not come at the expense of another.