During the state’s past fiscal year, Ohio’s nursing homes were cited nearly twice as often as in the previous year for putting patients at serious risk of harm.

The jump in “immediate jeopardy” citations in the 2011-12 fiscal year coincides with cuts in the facilities’ Medicaid payments in July 2011 and a Medicare rate cut a few months later. But officials say it’s too soon to say whether the smaller government payments are undermining the quality of nursing-home care.

“It’s quite possible that’s the case, but I don’t think it’s conclusively proven,” said Peter Van Runkle, the executive director of the Ohio Health Care Association, a nursing–home-industry group. “It’s certainly something that bears continued monitoring.”

“Immediate jeopardy” means that what the nursing home is doing has caused, or is likely to cause, serious injury or death. Government officials issued 41 such citations in the fiscal year that ended June 30, the first year that nursing homes received reduced payments. That was up from 22 citations in the previous fiscal year and was the most since 51 immediate-jeopardy citations were issued in the 2007-08 fiscal year.

A state official noted that reimbursement rates were higher in fiscal 2007-08 than in 2011-12, highlighting the uncertainty of any link between reimbursement rates and quality of care.

“We’re watching that closely, but it’s within a range we’re used to,” said Greg Moody, director of the Governor’s Office of Health Transformation. He noted that another significant measure of quality — the number of complaints — dropped 9 percent, to 5,866, from the previous fiscal year.

“I wouldn’t say there’s anything significant that worries us,” said Beverley Laubert, the state’s long-term-care ombudsman.

Other factors, such as differences among inspectors who visit the homes, could have contributed to the past year’s increase in immediate-jeopardy cases, said Bob Applebaum, director of the Ohio Long-Term Care Research Project at Miami University’s Scripps Gerontology Center.

“To me, it’s a little bit early to tell” whether reimbursement rate cuts are affecting patient safety, Applebaum said. He said his program is embarking on a yearlong research project to explore a possible link.

The ombudsman’s office found that complaints about staffing shortages and failures to respond to requests for assistance declined during fiscal 2011-12. The number of complaints about accidents or injuries increased slightly.

Regardless of reimbursement rates, the state has minimum-staffing requirements for nursing homes, Moody said.

Van Runkle said his association is concerned about the number of nursing homes that haven’t paid their bed tax, a number that grew from 15 in December to 33 in February. He said that’s a sign of the financial pressures that nursing homes face.

Moody, however, said nursing homes have had no trouble finding buyers when selling their right to operate beds in the state. “That indicates to me that this is still a viable market,” he said.

Despite signs of financial duress and an estimated 7 percent cut in staffing as a result of reimbursement cuts, the nursing-home industry is persevering, Van Runkle said.

“I’m amazed every day at how our members and all of the facilities have managed to keep pushing on and have managed to provide generally good, quality care,” he said.

From: The Columbus Dispatch