Nursing Homes Residential Care
/ Assisted Living


Medi-Cal for
Long Term Care
Elder Abuse
/ Financial Abuse
Find an Elder Law Attorney

State nursing home funders announce proposal, then fall silent

California Watch
By Christina Jewett
April 22, 2010

A few weeks ago, Medi-Cal officials released a report with a clear proposal for linking nursing home pay to quality of care. But they've been silent on the issue since.

The state's idea is directly related to a 2004 nursing home funding law (called AB 1629) that California Watch wrote about this weekend. The story ran in the San Jose Mercury News, Orange County Register and Sacramento Bee, to name a few.

The story found that about a quarter of the increase in funds meant to improve nursing home quality - by improving staffing or wages - went to homes where either caregiver pay or staffing rates went in the wrong direction.

So what is the state's new idea on funding nursing homes?

Here's a summary in the words of the state Department of Health Care Services, which released a report on the law in March:

The AB 1629 reimbursement system can be adapted to tie reimbursement to high performance in terms of [nursing home] staffing, resident outcomes, resident and staff experience, community transitions, and other important quality measures.

DHCS believes it can use existing quality measures, collected by the Centers for Medicare and Medicaid Services, to immediately implement [pay for performance] into AB 1629-affected facility rates. However, these quality measures alone are insufficient and will need to be supplemented in years to come with additional measures of care quality and improving patient (and staff) experience.

The goal will be to work with stakeholders to develop an array of quality measures that is more expansive and reliable to ensure that the AB 1629 payment system is identifying all factors that lead to providing high quality care.

"Pay for performance" was an idea that was gaining traction when I spoke in February with Toby Douglas, a Department of Health Care Services deputy director. He said the Schwarzenegger administration was very interested in seeing such a system put in place.

And the report suggests that the state was zooming in on a plan that would link facility pay to quality measures monitored by federal officials, including how many patients are in severe pain, develop bedsores or languish in bed.

However, during a meeting with patient advocates a few days after the report was released, state officials declined to talk about it at all, instead asking patient advocates to weigh in on whether AB 1629's funding mechanism should be renewed or not. The question was an insult to some patient advocates, who spent months in meetings and days crafting proposals to improve the law. (Links to those proposals are at the bottom right-hand side of this page.)

I called a DHCS spokesman this week to see if there had been additional dialog about "pay for performance" and was told Wednesday that there was no further information.

While California is mum on the topic, the federal government is diving into a pilot project connecting nursing home pay to outcomes. Federal Medicare officials are running a demonstration project in Arizona, New York and Wisconsin that will set aside a pool of money for high-performing nursing homes.

The facilities will get a greater share of that money if they meet goals such as minimizing patient transfers to hospitals and passing state inspections with minimal findings of fault.

The California Healthcare Foundation, a nonprofit health policy group, funded the series of stakeholder meetings on the 2004 law in preparation for its renewal, which is currently being discussed behind closed doors.

The Foundation would likely fund a set of meetings to help settle on a "pay-for-performance" structure that would work for California, a program officer said in an interview.

Except no one's asking them to.