A couple of reactions to the latest Albany County attempt to build a new nursing home. Perhaps we’ll get into details later, but the only real change from the last version of the County’s application to the latest revision is an increased revenue estimate because they think the managed long-term care changes the State is forcing as part of Medicaid reform, will generate more Medicaid revenue. More? Did we miss something about the point of Medicaid reform? We though it was to spend less, not more money.
So anyway, here are some reactions to Albany County’s latest.
One of New York’s premier health care finance experts and institutional advisors:
My partner showed me the story in the newspaper. When I saw the projected $24 million loss, I said, that must be a typo.
Nope. That’s what Albany County considers an improvement.
From the administrator of another nursing home in the county (a good one, by the way):
My nursing home is about the same size as the Albany County Nursing Home. My total budget is about the same as what they lose every year.
Translation? They spend twice what I spend to serve the same number of patients.
From the New York State Health Department’s analysis of Albany County’s revised CON application:
Project cost of $70,938,554 exceeds reimbursable project cost by 27%.
Translation? The proposed capital cost of the new building would be $19.1 million more more than we would even consider having Medicaid pay for. And that doesn’t include what we typically require sponsors to contribute as equity.
More from the State Health Deparment’s analysis:
The projected operating loss is almost 50% of operating expenses and the projected incremental loss of $5,561,364, combined with a loss of $6,100,000 in inter-governmental transfers, creates an incremental budget shortfall that would require an almost two percent increase in the total Albany County operating budget, assuming no other changes.
Translation? 50%? That loss is grotesque even before the proposed increased loss. And heads up on inter-governmental transfers. Don’t count on them for the future. And by the way, that amount may by itself be two percent of the County budget, but it alone would generate a 7.7 percent increase in County property taxes. With the additional loss of IGT, which the Health Department appears to expect, the property tax increase would be 11.4 percent.
Still more from the Health Department:
As previously mentioned, the facility incurred a loss of $18,597,505 in 2011. This application proposes a loss of $24,158,769 during the third year after project completion, which is an incremental loss of $5,561,364 when compared with the 2011 operations. As a result, it does not appear that this application will improve the financial performance of the facility.
Translation? Building a new nursing home doesn’t make things better for the County; it makes them worse.
More from the Health Department:
Budgeted revenues are the applicant’s estimates of managed care rates with the implementation of long term care Medicaid mandatory managed care and are based on Albany County Nursing Home’s managed care rate experience to date. The resulting revenues are slightly greater than previously presented budgets. Department staff’s assessment is that the assumed rates are at the high end of what may be considered reasonable.
Translation? The Health Department doesn’t believe the numbers the County submitted. I don’t either. I do love the Department’s euphemism though.
From one of New York’s leading figures on Medicaid managed long-term care:
They think they are gong to make $2 million MORE in revenue under managed care?!
Translation? She doesn’t believe the numbers either.
And still more from the State:
Budgeted expenses have not changed from figures presented in December and April and reflect increased staffing for new proposed programs. While specialty staff may well be needed for the proposed vent bed and behavioral units, projected staffing levels are questionable given the reduced certified bed count from 250 beds to 200 beds.
Translation? The proposed different program mix should require a different staffing mix, but the County did not address that at all. And Albany’s operating costs are too high anyway.
Part of the justification for a new nursing home in its revised Albany County CON application:
ACNH has a significant population of residents who have low PRI scores. Under a system of managed care, it is highly likely these residents would be placed in a less expensive community setting.
Translation? These patients don’t really need to be institutionalized. Though we don’t reflect it in our financial projections, we’re likely to have fewer patients. (The PRI is a patient review instrument, the assessment tool used by all nursing homes in New York.)
Attorney who represents persons with disabilities, referring to the above mentioned “significant population of residents who have low PRI scores:
Under Title II of the Americans with Disabilities Ace, a governmental entity has an obligation to provide services to persons with disabilities in the most integrated setting appropriate to their needs. It does not matter whether it is under a managed care or fee-for-service model, as long as there are community based services available. Not saying it would be an easy case, but combine it with the County’s elimination of EISEP funding and the RSS program, and we may have something DOJ would sink its teeth into.
Translation? While pushing nursing home care as the only alternative and, at the same time, reducing the County budget for home and community based services, Albany County is opening itself to an Olmstead based lawsuit. And I would say deservedly so.
State Health Department summary analysis and recommendation regarding the CON application:
With its previous project deferral actions, the PHHPC gave the applicant the opportunity to develop a more cost efficient and sustainable nursing home project, not just for the citizens of Albany County, but for the regional health care system. The applicant’s resulting, revised operating budget and project budget are not substantially improved from those previously presented to PHHPC. As such, it appears that the applicant has not adequately addressed the PHHPC’s expressed concerns over financial feasibility in a Medicaid managed care environment and disapproval is recommended.
Translation? Pretty much speaks for itself.
Jordan Carleo-Evangelist, reporter for Albany Times-Union, quoting Mike Conners, Albany County Comptroller:
No question that Danny (County Executive Dan McCoy) has lost the enthusiasm for owning and running a nursing home.
Duh. Amazing what having to deal with reality will do to you.
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