by James C. Sherlock
Evidence of intentional wrongdoing by specific nursing home chains operating in Virginia is hiding in plain sight. The huge gaps and consistent trends in each exhibit below cannot be attributed to happenstance. It reflects business models rigorously applied.
The numbered exhibits draw entirely on a single Center for Medicare & Medicaid Services (CMS) file, Provider Information.
Medicare Compare rankings, patient acuity and occupancy
Exhibit One:
- Progressively lower-staffed facilities have residents with progressively higher average needs (nursing case-mix-index (CMI) ratio) for medical and activities-of-daily-living support. The national average CMI is 0.99; the two worst chains’ facilities have a CMI of 1.17, 18% higher. CMI ratios are directly proportional to Medicare and Medicaid reimbursements. They are derived from self-reported resident assessment results. That combination in evidence is unquestionably dangerous and amazingly profitable.
- Those facilities with the worst staffing and health inspection results have the highest occupancy. Hospitals can refer to Medicare Compare as easily as anyone else. It should influence hospitals’ selection of skilled nursing facilities with which they contract to transfer discharged patients who still need skilled nursing. A good regulator would review those contracts.
