Edging toward 'the cliff': SNFs may face 17% Medicare cut. (News Fronts).

UNLESS CONGRESS INTERVENES, TEMPORARY Medicare givebacks granted to nursing homes in 1999 and 2000 will expire Sept. 30, 2002, resulting in a 17 percent cut in Medicare payments. Many long term care providers are calling this dramatic drop-off in funding "the Medicare cliff."

"Those seniors who depend on Medicare and need around-the-clock skilled nursing care are clearly put in jeopardy by these cuts, and we strongly urge Congress to ensure the cliff is avoided," stated Charles H. Roadman II, MD, president and CEO of the American Health Care Association (MICA), which represents nearly 12,000 for profit and not-for-profit long term care providers.

According to Roadman, the cuts amount to about $60 per patient per day and "will threaten the quality of patient care, limit beneficiary access to needed services, and perpetuate the nurse staffing crisis by eliminating important health care jobs."

President George W. Bush's proposed FY 2003 budget does not provide for continuation of the Medicare givebacks, which were intended to provide relief for nursing home operators following the Balanced Budget Act of 1997 and the implementation of PPS.

The American Association of Homes and Services for the Aging (AAHSA), representing more than 5,600 not-for-profit providers, states that the president's proposed budget "does not adequately address the health care needs of America's older adults."

According to Susan Polniaszek, senior reimbursement specialist for AAHSA, the average nursing home stands to lose over $200,000 next year if the Medicare cuts go into effect. She adds that for the intensive-service category of the RUG system, the cuts will take away more than $100 per patient, per day.

"It's going to be drastic," says Polniaszek. "Most of our members will use their endowments and will have to do more fundraising. But as CMS has noted in their industry update on nursing homes, it is very difficult for non-profits to rely on endowments and fundraising."

Public awareness

AHCA and the Alliance for Quality Nursing Home Care have introduced a television spot in which a voiceover warns of the proposed 17 percent cut. Jan Ricchio, RN, then appears onscreen telling viewers that "These cuts will abandon those whose needs are the greatest. It's just wrong. Join us to stop Medicare cuts. Please."

Educating the public may be a crucial step in convincing Congress to preserve Medicare funding. William Bruno, director of congressional affairs for AAHSA, says that families of nursing home residents must make very clear to legislators what the impact of the Medicare cuts will be.

"What has to happen," says Bruno, "is a very strong grassroots push in terms of contacting individual lawmakers."

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Late-breaking facts

CONGRESS REPORTS FINDINGS ON ABUSE. An 18-month investigation by the General Accounting Office (GAO) has concluded that "alleged physical and sexual abuse of nursing home residents is frequently not reported in a timely manner" and that few of these allegations are ultimately prosecuted. The Senate Special Committee on Aging presented these findings at a hearing held Mar. 4 and chaired by Sen. John B. Breaux (D-La.), who called for improved law enforcement response and stated that nursing home residents "should not spend their days living in fear." Testimony included a videotaped interview with Helen Love, who described the beating she received from a CNA at a Sacramento, Calif., nursing home, "He started beating me all along the bed," Love said. "He choked me and he went and broke my neck." Love, who then told her interviewer that she was "tired of living this way," died the following day. The CNA, who had a history of abusing residents in other facilities, pleaded guilty to elder abuse and served one year i n prison. The GAO report states that workers who abuse patients in one state are often hired by unsuspecting facilities elsewhere because there is no exchange of information. Medicare officials are studying the feasibility of a national registry of nursing home workers who have abused residents.