Add nursing homes to the ever-growing list of opponents of HR 3200, the House version of the health reform package.

 

Joe Donchess, executive director of the Louisiana Nursing Home Association, said the bill would cut $32 billion from Medicare's nursing home program.

 

"That coupled with the $12 billion administrative cut (over 10 years) would mean a 9.5 percent cut to Medicare skilled nursing facilities," Donchess said. "That means some of our frontline staff would likely be laid off."

 

An analysis by the American Health Care Association, which represents nursing homes, found that Louisiana skilled nursing facilities face total cuts of $561 million in funding cuts over the 10-year period.

 

The state's nursing homes would lose more than 757 jobs, according to the association's analysis.

 

"We just can't absorb cuts," Donchess said. "Obviously we have to pay our mortgage bill, our light bill, food bill, things like that."

 

Roughly 70 percent of a nursing home's expenses are labor, Donchess said. The bill's proposed cuts would leave nursing homes with few options other than reducing their staffs – the registered nurses, licensed practical nurses and certified nursing assistants that care for seniors.

 

The quality of care might suffer as a result, Donchess said, and that is why the nursing home association is trying to avoid the cuts.

 

Medicare payments make up close to 25 percent of nursing home revenues, according to the Centers for Medicare & Medicaid Services. According to CMS, spending grew 4.8 percent for freestanding nursing homes in 2007. In 2006, spending grew by 4 percent.

 

The increased nursing home spending occurred while total healthcare spending by public programs slowed, according to CMS. In 2007, public program spending rose by 6.4 percent, compared to 8.2 percent in 2006.

 

Faster increases in nursing home prices were a major factor underlying the trend, according to CMS. The agency has said the administrative reductions are needed to offset earlier adjustments to case-mix indexes.

 

The 2006 changes to Resource Utilization Group classifications increased Medicare spending. CMS found that patients ended up in the newly created, higher-paying groups more than 30 percent of the time. The agency had originally estimated that this would happen only 19 percent of the time.

 

Officials with the American Health Care Association say the administrative cuts, a legacy of the Bush administration, are too deep and would eventually result in the loss of more than 50,000 jobs nationwide.

 

The cuts and resulting job losses fly in the face of what Congress and the Obama administration say they are trying to accomplish, stopping unemployment rates from rising, according to the association,.

 

Meanwhile, supporters of H.R. 3200 have argued that seniors' healthcare benefits will not be reduced.

 

But Donchess said that argument ignores the fact that nursing homes will have to cut staff, which always has a direct, immediate negative impact on patients and patient care.

 

Nursing homes nationwide are lobbying hard to prevent the passage of H.R. 3200, at least in its current form. The message the Louisiana Nursing Home Association is trying to get across is that the elderly shouldn't be robbed of Medicare benefits to prop up a healthcare reform bill whose proposed benefits remain largely unproven, Donchess said.

 

"It's something that I think people hope will work, but I think most people who really understand the legislation believe it won't work," Donchess said.

 

The legislation would take money from other programs to offset its cost, which would be a minimum of $1.8 trillion, Donchess said. And that estimate is probably on the low side, as is typically the case when it comes to healthcare.

 

When reality sets in, people will find that the actual costs will be much, much higher, Donchess said.

 

"So while we support the notion of healthcare reform, we just don't want it to come at the price of elderly programs," Donchess said.

 

In addition to lobbying members of Congress, the American Health Care Association recently released a poll that found nearly half of voters viewed Medicare cuts to nursing homes as the least acceptable option presented to pay for healthcare reform.

 

The poll found that only 3 percent of voters favored cutting Medicare payments to nursing homes. The poll had a 3 percent margin of error.

 

In addition, the poll found that 66 percent of voters would be less likely to re-elect an official who voted in favor of Medicare cuts to nursing homes. The poll also found that 78 percent of senor voters believe that Medicare cuts would result in worse care in nursing homes.