LTC board endorses full-time finance director

Overseeing Moore-Few and Barone Alzheimer Care Centers, Monday afternoon’s meeting of the Long Term Care Board of Directors heard of the financial strength of the LTC unit, the need for additional nurses and approved turning the finance director’s position from part to full-time.

Board members present were George Fox, board president, Jeff Post, Janise Burch, Judy Campbell along with Dr. Warren Lovinger and Steve Branstetter.

The current administrator at Barone, Angela Barrett, also serves as LTC Director of Finance but on a part-time basis.

The new arrangement will see Barrett become full-time finance director, with her office at Moore-Few and a new person hired to serve as administrator at Barone.

“The thing driving all this is the big change in the government’s payment model which begins on Oct. 1, 2019,” said LTC director and administrator of Moore-Few Nursing Care Center, Steve Branstetter.

He explained how the Centers for Medicare and Medicaid took the long-term care profession by surprise on April 27 when it announced the Patient-Driven Payment Model (PDPM) would replace the current system without a phase-in.

The first generation of the current payment system was inaugurated on July 1, 1998. This system identified three primary predictors of cost for skilled nursing facility patients (SNF): clinical diagnosis, amount of assistance patient requires and skilled services received such as therapy or intravenous medication.

The payment system’s current generation requires a facility to assign a patient to one of 66 separate resource utilization or case mix groups. According to a report issued earlier this year by CMS, “for the large majority of SNF patients, payment is determined primarily by the number of therapy minutes they receive.”

Payments in the new system vary based on which of six categories into which a patient is classified. Payments for half of these categories vary according the patient’s length of stay and are computed via a base rate, case mix index and a so-called adjustment factor.

After Branstetter and Barrett reviewed just a bit of the new payment system the LTC director said, “I think you can see everything is getting more complex and if we want to bill accurately and get all we earn for each patient, we’re going to need a full-time finance director.”

Board members endorsed this proposal with Post adding, “As complex as things are already, I’m almost surprised you didn’t do this earlier.”

After the meeting, Barrett was asked for the timeline in completing this transition.

“We hope to get everything in place by the first of the year but we’ll see,” said Barrett.

Branstetter commented on the recent completion of the LTC’s audit for fiscal year 2017-2018 adding, “For several years now, BKD out of Springfield, who does our financial audit, has said there are no other facilities they know of which keep their volumes up and make a profit like we do.”

He said it is care for patients and being careful about each dollar which enabled the LTC unit to build up such a level of reserves that it could loan the hospital the funds ($1.2 million) for the purchase of what is now the Primary Care Clinic, across the street from the hospital on Ash St and in November 2017, give $1 million to the hospital.

Another way in which the financial strength of the LTC unit was described occurred in the monthly financial report which indicated that, for the month of September, the net profit of Moore-Few and Barone was $3,504. The year-to-date loss for the LTC unit stands at $9,697.

It was also revealed that the outgoing billing director had submitted payment requests for Moore-Few but had neglected to do so for Barone which will be reflected in a future loss of payments; most of this money is not recoverable.

This unintentional oversight pointed to the need for having a full-time second set of eyes on the LTC unit’s finances.

Another area of concern was the rise in the amount of account receivables net of contractuals which showed a month-to-month increase of $72,999 in September.

As the written financial report stated, the accounts receivables are “under review and being worked by Medicare Consultant.”

The days cash on hand stands at a very healthy 158.3 while the census at each facility remains strong. While Moore-Few was budgeted at a monthly census of 75, in September the average daily census stood at 77.13. While Barone was budgeted for a census of 37, its average daily numbers came in at 39.37.

“While nationally, census numbers are way down, ours remain strong,” said Branstetter.

He gave credit to the LTC unit’s marketing director, Lorina Byergo, who was at that moment serving in her other capacity which is as secretary for the LTC unit board of directors.

Said the LTC unit administrator, “She does an excellent job of keeping those in charge of hospital discharges in a pretty wide area informed about our five-star rating and the top quality group we have come in to handle therapy.”

In his oral report to the board, Branstetter underlined the contents of an October 9 article in the Kansas City Star whose title sums up its message, “Kansas takes over 21 struggling nursing homes as the industry faces growing obstacles.”

The article identified two primary factors for the closing of 21 nursing care facilities so far in 2018. The first and by far the greater factor was the purchase of many facilities by out-of-state, for-profit corporations.

The article details how some of these groups removed financial resources from the facilities or their corporations found themselves overextended and now each of those facilities had to be taken over and managed by the State of Kansas or closed, as in the case of Fort Scott Manor in nearby Ft. Scott.

While the then Kansas Governor convinced the state legislature that privatization of the state’s Medicaid system would be more efficient and save money, in practice, the article says the opposite is true. There are quite “long delays in getting Medicaid applications approved” onto KanCare (Kansas Medicaid program) and financially devastating delays in “getting timely payments” to nursing care facilities under the privatized system.

The closure of Fort Scott Manor on May 15 “could be traced back several years to the contentious divorce of the owners, a local couple,” noted the article. The article stated it was allowed to close since “Fort Scott had enough beds in other facilities to absorb most of the people displaced by the closure.”

Earlier in the year, on March 29, the Pittsburg Care and Rehabilitation Center was the other nearby Kansas facility to close.

The state has hired a private entity to market, reorganize and sell the other 20 homes the State of Kansas currently manages.

The article noted, “companies are going in receiverships by the dozens in some other states as well, though not in Missouri,” where the number of state operated nursing care facilities is “none.”

Said Branstetter, “We’re working hard to keep both of our facilities strong and around for a long time to come.”