Letter distorts truth concerning nursing home largesse

When you’re making over $250,000 a year, you’re going to try to make it appear that policy that benefits members of the organization paying you looks good, even if you have to distort and falsify the truth as Louisiana Nursing Home Association executive director Joe Donchess did recently in a letter to The Advocate about a column of mine.

Part of the piece pointed out the privileged status of nursing homes in Louisiana and how that would impact Medicaid spending in light of Gov. John Bel Edwards’ declaration to expand Medicaid. It noted:

A constitutional amendment passed in 2014, for which Edwards voted as a legislator, exacerbates the looming crisis. That change essentially locked in the reimbursement rate for privately-operated nursing homes, adjustable upwards by inflation, despite Louisiana’s institutions having among the lowest occupancy rates of the states. Worse, the formula used pushed up the rate artificially by including non-Medicaid patients and also pays operators over $15 million annually for empty beds due to over-capacity ….

And:

Louisiana looks particularly vulnerable [to have a judicial challenge that it makes insufficient effort to place people with disabilities in the least restrictive setting] with waiting lists to receive home- and community-based care nearing 50,000 names and the state projecting spending this year of $80 per capita on these services compared to $209 for nursing homes. By contrast, the South Central region states’ projected averages are $146 for waiver services and $138 for nursing homes.

This prompted Donchess’ letter, with a small bit of truth, a large amount of distortion, and an outright lie for lagniappe. Let’s see what tricks he tried to pull.

He begins by making the obvious statement that the amendment has nothing to do with Medicaid expansion. But this is a red herring: the column pointed out that, along with Medicaid expansion, that the amendment competes with health care dollars by locking them away. The scam behind the provider payments now cordoned off is that they become bait for matching federal dollars that get funneled to nursing homes, which are overfunded already as the column pointed out. Were these dollars freed, or not charged to nursing homes but their lucrative payments cut as a result, extra money would be made available not just for the underfunded home- and community-based options, but also for other health care uses. It’s irrelevant whether the amendment and expansion are directly related; the point he tries to deflect made it the column was that both are inefficient uses of taxpayer dollars and if the amendment did not exist, expansion would have a less deleterious impact on Louisiana health care provision.

Note that he defers defending the sweetheart arrangement nursing homes have that in essence pays them for empty beds. This happened because for decades Louisiana had a funding formula for care of the disabled that essentially drove them into these institutions. This prompted operators to build and build, thinking they could suck off the taxpayer teat in unlimited quantities forever while boosting profits. But when the Olmstead and Barthelemy decisions from the courts came down 15-20 years ago, which forced reversal of the trend to warehouse the disabled, suddenly operators were stuck and would face business losses with all of this excess capacity. In essence, taxpayers now pick up the tab for bad business decisions by a special interest by a policy benefitting these privileged rent-seekers that robs resources from the indigent.

The letter’s sleight of hand gets more misleading when, in trying to defend taxpayer spending by nursing homes, in it Donchess claims that “Nursing facility per capita spending in Louisiana is $68 below the national average while spending in the category that contains home and community-based waivers is $34 higher than the national average.” And that was half true – in 2009 (the newspaper article he mentions relied on the same figures.) The column used 2015 actual budget data from Louisiana and other South Central region states. He also got the second figure wrong, as then it was actually $63 higher.

There are several problems in trying to use these figures. What makes the seven-year old data, besides their datedness, more significantly obfuscating is in beginning in 2009 the state made a successful effort to rein in, through implementation of a resource allocation model, uncoordinated spending in the waiver programs. The next year, the Legislature changed the case mix methodology for nursing homes that has boosted their bed reimbursements nearly 40 percent since.

Worse, the data he uses are not even comparable. These include public and private spending; the data I used are for public dollars only. Further, for nursing homes, the data includes spending on government-owned facilities as well.

Finally, in drawing a comparison between national and state numbers misleads in that it does not account for the cost of living. About a third of states have relatively high costs of living while Louisiana among the other two-third of them group significantly lower, that set containing all states in the South Central region. Thus, the most informed comparison looks at Louisiana’s costs compared to the region, not nationally.

In short, it is laughable that Donchess tries to pass off out-of-date, distorted data as in any way contradicting up-to-date, reliable figures (courtesy of The Advocacy Center), and then has the audacity to write that the relevant, accurate data are “skewed statistics.” However, this transgression appears minor compared to the flat-out lie made in the letter when he wrote that the column was “misinformed” in that “[a]lthough the overall occupancy rates of Louisiana nursing facilities are low, they are not the lowest.”

But the column never stated that Louisiana had the lowest occupancy rates. It read exactly this: “Louisiana’s institutions having among the lowest occupancy rates of the states” [emphasis mine] (and for the record, Louisiana’s ranks 43^rd using the most recent data). I won’t ask Donchess to apologize in the pages of The Advocate for this fib for calling my statement “false”; instead, he is invited to drop me a line with his mea culpa.

When you have an untenable argument as do nursing homes in attempts to refute that they have ridden a gravy train of taxpayer dollars at the expense of other pressing needs, you will lie and mislead as Donchess did in this letter – especially so when necessary to justify a fat salary.