Restructuring long-term care in Ohio has been an ongoing process during the past decade. Policymakers — with the cooperation of nursing home operators, for the most part — have taken incremental steps that require providers of long-term care, nursing facilities in particular, to alter the way they do business to reflect shifting demographics, client demands, higher standards of care and budget constraints.
The Kasich administration is continuing with the transformation process, putting appropriate emphasis on raising the quality of care and services in nursing facilities. To that end, the current budget tied a small amount of nursing home payments to meeting quality measures. So that all facilities would have a fair shot at earning the full incentive payment, the incentive was not particularly burdensome: meeting at least five out of 20 quality measures. The majority of facilities have met the performance bar.
Reasonable, then, in line with the incremental approach, that the governor’s budget plan for the next two years includes several measures to raise the bar. One calls for facilities that must present plans to correct identified systemic problems to receive input and assistance jointly from the departments of aging, health and Medicaid to address the underlying causes. Another requires that at least one of the five measures for earning full incentive payment should be a clinical measure (for example, reducing the incidence of bed sores).
A third seeks to eliminate use of overhead paging systems in facilities. Another sets a time frame for facilities that are on a federal “special focus” list for persistent serious problems to improve or be terminated. Further, administration officials contend the current funding levels are adequate to meet the new performance incentives.
Still, the House and Senate both increase the incentive fund by $60 million in their budget bills, evidence of hard lobbying by the industry. More baffling, the Senate removes the proposals for a clinical measure and for agencies to collaborate with facilities on correction plans. It also extends by six months the time for “special focus” facilities to show compliance. Retain these amendments, and the two-year budget would undercut necessary progress in quality improvement.