Rhode Island is a national leader in improving the quality of nursing homes. In fact, the Ocean State’s recent ability to improve conditions in its nursing homes has made Rhode Island’s approach the template for a nationwide push by the federal government to improve nursing home care.
And that’s pretty scary, considering that the nursing home industry in Rhode Island is on life support – crippled by chronic under-funding and a croaking reimbursement system, according to industry experts here.
Rhode Island was a pilot state last spring for a national initiative to improve care in nursing homes by enabling consumers to get information online indicating the level of quality care that a nursing home provides. The initiative was rolled out on Nov.12 by the Centers for Medicaid and Medicare Services.
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Consumers can view the new Nursing Home Compare Web site at www.medicare.gov.
People who log on will see that Rhode Island’s nursing homes provide better care on average than nursing homes nationwide in a couple of key categories. Nursing home residents here are put in physical restraints at half the rate that residents are nationally – 5 percent in Rhode Island versus 10 percent across the nation. The percentage of nursing home residents with pain was 7 percent in Rhode Island, compared to 11 percent nationally.
One nursing home in Coventry that participated in the pilot program, Riverview Healthcare Community, cut pain by 46 percent for short-stay residents and reduced pain for long-term care patients by more than a third.
Rhode Island is ahead of the curve for several reasons, say experts: The legislature has been vigilant in passing laws to improve nursing homes; there are strong trade associations in the state; and nursing home owners and administrators cooperate with each other and state agencies, and take outside help.
And Rhode Island is home to an organization that is a national leader in the quest to improve nursing home care, say industry leaders. Rhode Island Quality Partners, a not-for-profit quality improvement consulting group based in Providence, has been helping to improve care in nursing homes in Rhode Island since its inception in 1996.
Now the federal government has asked RIQP to take its act on the road. As part of its national campaign, Centers for Medicaid and Medicare Services asked RIQP to be the lead quality improvement organization in every state. Currently, RIQP staff is assembling educational and technical resources for every quality improvement organization in the nation that works with nursing homes to improve care.
“We were extremely excited to see the data showing that our work in Rhode Island really fostered quality improvement in our member nursing homes. And based on that work, we’ve been asked to help shape the national aspect of the initiative,” said David R. Gifford, chief medical officer of Rhode Island Quality Partners.
But people in the nursing home industry are hardly celebrating their gains – they’re too afraid that all of their hard work could go up in smoke. Money woes, staffing shortages and a Byzantine reimbursement system threaten to bring quality improvement in Rhode Island’s nursing homes to a grinding halt, even as the nation looks to Rhode Island as a model for improving nursing home care, say experts.
Rhode Island has one of the highest per capita elderly populations of any state in the country. At the same time, the state’s Medicaid program, upon which the state relies more than most states do to pay for nursing home costs, is being under-funded to the tune of approximately $27 million a year, according to Alfred Santos, executive vice president of Rhode Island Health Care Association.
Rhode Island is ranked in the top 15 most under-funded states for Medicaid reimbursements. At the same time, more than 75 percent of all nursing home patients are on Medicaid in Rhode Island, according to industry data.
An independent analysis of Rhode Island’s Medicaid system conducted for the last two years found that the state lost $25 million in 2000 and $27 million last year, according to Santos.
The Rhode Island legislature is expected to restructure the Medicaid reimbursement this year. Santos said increasing Medicaid reimbursements would be crucial to continue improving care in nursing homes.
“We want to continue the program we’re doing, but we can’t continue without funding and staffing,” said Santos. “Unless we receive more funding, we’re going to be in more trouble for years to come.”
And on Oct. 1 the Bush administration slashed Medicare by about 10 percent, just six weeks before the Medicare administration rolled out its new initiative for improving nursing home care.
Medicare, which covers 12 percent of nursing home residents nationally and about 10 percent in Rhode Island, pays an average of slightly more than $300 a day for each Medicare beneficiary in a nursing home. The cuts will shave nearly $2 billion in payments for 2003, and $3.7 billion for 2004.
At Riverview Healthcare Community in Coventry, which showed dramatic care improvement during the federal government’s pilot study last spring, the Medicare rate they receive just went down by $27 per patient per day, according to John E. Gage, administrator of the nursing home.
At The Cedars, a nursing home in Cranston, Medicare payments just dropped $30 per patient per day, according to Joan E. Hupf, director of quality improvement at the Cranston facility.
Nationally, the Medicare rate dropped $30 to $35 on average on Oct. 1.
“For five years, I’ve been developing programs and working to improve our quality of care, and hiring and scheduling staff based on a certain level of funding. My quality improvement programs can’t continue if the money disappears,” said Susan Whipple, owner and administrator of The Cedars. “We all benefit by quality improvement programs, but quality comes at a cost.”
