Senator Dan Laughlin (R-49) will visit LECOM at Presque Isle on Friday (January 24) to call attention to the alarming rate at which Pennsylvania nursing homes are terminating or curtailing their services to Medicaid patients who depend on mechanical ventilators to breathe.
The local media is invited to cover the tour, which is set for 2 p.m. at LECOM Nursing and Rehabilitation, 4114 Schaper Ave., Erie, PA 16505.
“Unfortunately, we are finding that inadequate Medicaid payments has created an environment where the few nursing homes that provide ventilator care are struggling financially,” Senator Laughlin said. “Many are being forced to discontinue the service or limit the number of patients on ventilators that they can serve.”
In November, Fox Subacute, which operates four ventilator care-only facilities in Pennsylvania, filed for bankruptcy protection. Others including LECOM have announced that they will soon close or reduces services at their ventilation care units if the Medicaid reimbursement issue isn’t addressed.
In response to this crisis, Senator Laughlin is a co-prime sponsor with Senator Camera Bartolotta (R-46) of Senate Bill 959, a measure to increase Medicaid payments to providers that care for meaningful numbers of ventilator and tracheostomy patients.
Contact: Matt Azeles email@example.com
FAQ: Medicaid Services for Ventilator-Dependent Patients
What’s the crisis? In any given month about 700 Medicaid-covered Pennsylvanians need help just to breathe and get that help through a ventilator or tracheostomy care and the supply of providers willing to provide that care to Medicaid patients – who account for nearly 25 percent of the state’s population – is now dwindling to a dangerously low level. Senate Bill 959 is designed to solve this problem and end the crisis.
What is ventilator care and why do some people need it? Ventilator care is a form of treatment provided to people who lose the ability to breathe on their own. Ventilators are computerized machines that provide mechanical ventilation by moving breathable air into and out of the lungs to deliver breaths to a patient who is physically unable to breathe or unable to breathe sufficiently. While some ventilator patients need such care because of degenerative conditions like ALS, others need it because of a specific trauma, such as an auto accident, a fall, or a stroke.
So most ventilator patients are pretty old, right? No, about 10 percent of vent patients are under the age of 40 and nearly half are under the age of 65.
Patients can be weaned of their dependence on a ventilator? In many instances, absolutely, with the ultimate goal of transitioning patients out of the nursing facility and back home.
Don’t they really belong in a hospital? Patients whose dependence on a ventilator comes from a trauma are generally stabilized in an acute-care hospital but once that’s done, they’re better off if they’re transferred to a skilled nursing facility, where specialized health care professionals are available to prevent infections, treat wounds and bed sores, provide needed nutrition, and attempt to free patients from requiring breathing assistance.
What’s a skilled nursing facility? It’s what most people call a nursing home or nursing facility.
You said that the ability to wean patients is one of the biggest advantages of vent patients going to nursing homes for care rather than staying in the hospital. Are there other advantages? Yes: cost. It costs about four times more per day for Medicaid or any insurance to pay a hospital to care for a ventilator-dependent patient than it does to pay a nursing home to care for a ventilator-dependent patient (plus the chances of weaning the patient from the ventilator are greater).
So if nursing homes can provide this care, what’s the problem? Providing this kind of care is hard work and it’s expensive and a lot of nursing homes don’t want to do it. It requires more and better-trained staff, which costs money, it requires more equipment, which costs money, and it requires more medications and other supplies, which also costs money. So most nursing homes just don’t want to provide this level of care at all.
If they’re getting paid to provide the care, why should any of that matter? It matters because Medicaid doesn’t pay providers for all those additional expenses they incur caring for these patients. Instead, Pennsylvania’s Medicaid payments to nursing homes are calibrated for average nursing home patients rather than nursing home patients whose care requires more staff, more equipment, and more supplies. Also, most ventilator patients have other medical problems – usually, the medical problem that led to their need for the ventilator in the first place. It’s a losing proposition financially, so most nursing homes chose either not to accept ventilator-dependent patients at all or to limit the number of such patients they’ll care for so they can minimize their losses.
Most nursing homes don’t care for ventilator-dependent patients at all? As of November 2018, only 25 percent of Pennsylvania’s 619 nursing homes served any ventilator or tracheostomy Medicaid patients at all and even among those that did serve such patients that year, 78 percent of them served just three patients or fewer.
So a relatively few nursing homes are caring for most of the ventilator-dependent patients? In that same time period, just two percent of the 619 nursing homes in the state cared for almost half of the ventilator-dependent patients who were insured by Medicaid.
So the answer to this problem seems obvious: shouldn’t the state just pay nursing homes more for these specific patients? Pennsylvania’s Medicaid program created a supplemental payment that wasn’t targeted enough to provide meaningful financial relief to providers dedicated to this care or give others ample incentive to enter into this space. Ultimately, it proved to be a band-aid but not a solution.
Then what’s the problem? Additional payments haven’t kept pace with the rising cost of providing the care and state budget adjustments over several years actually reduced the daily rates paid to nursing homes by the state.
Says who? When you see the state’s biggest provider of ventilator care file for bankruptcy and some of the other major providers either getting out of the business or limiting how many ventilator patients they’ll serve, that seems to be pretty solid proof that there’s a problem.
So what would it cost to address this problem? Not much, actually. Providers dedicated to caring for significant numbers of these patients – the two percent of total nursing homes noted above – estimate that increasing their daily payments $130 for ventilator- and tracheostomy-dependent patients would enable them to keep serving these Medicaid patients. That would be about $7 million a year for the entire state.
And if the state doesn’t do that? Well, then the state or the managed care plans they contract with to ensure that services are provided can pay hospitals four times as much money to provide suboptimal care for these patients in less appropriate settings, but that doesn’t sound like a very good idea. Or the state could just come up with the $7 million a year, which would be eligible for another $7 million in federal Medicaid matching funds since these are Medicaid payments.
And that’s the only problem it would cause? Spending more money? No, you’d also have the problems of fewer people getting weaned because hospitals don’t specialize in it and certain nursing homes do, and the problem of people in some parts of the state who are going to have a very hard time finding a provider anywhere near where they and their family live to give them the care they need when they need it the most.
So how will SB 959 address this problem? SB 959 will direct the state’s Medicaid program to increase current Medicaid payments for ventilator and tracheostomy services by $130 a day for nursing homes that provide a significant proportion of their care to this medically vulnerable population to maintain their ability to serve this population while also offering an incentive to other nursing homes to do the same. It should help other Pennsylvanians, too, by increasing the likelihood that there will be qualified providers of this kind of care in their own communities.
Recent media coverage of the issue:
- 11/25/18, The Patriot News – https://www.pennlive.com/news/2019/11/central-pa-lawmaker-sounds-alarm-over-care-for-people-who-cant-breath-on-their-own.html
- 11/25/18, ABC27 News – https://www.abc27.com/news/local/bill-looks-to-help-patients-who-need-ventilators/
- 11/26/18, CBS21 – http://local21news.com/news/local/ventilator-crisis-hits-tipping-point-as-patients-worry-about-future
- 12/15/18, front page Sunday edition of the Philadelphia Inquirer – https://www.inquirer.com/business/health/ventilator-nursing-home-patients-medicaid-pennsylvania-20191215.html
- 1/20/20, KDKA – https://pittsburgh.cbslocal.com/2020/01/20/senator-says-bill-can-make-difference-in-ventilator-shortage/