Demidovich said he can realize a one-time $200,000 windfall by “selling” 10 beds — per the recommendations — and another $75,000 to $80,000 annually in increased Medicare reimbursement — a $3 per patient day increase — because his will be considered a small facility and the state wants nursing homes down-sized.
“Everybody goes ‘those beds are worth that much,’ no, no, no,” he said. “It’s the licenses to the beds. If you want to build a nursing home in Ohio today, you have to own the beds to build it. If you want to expand your building, you have to buy somebody else’s license. There has been a freeze on nursing home beds for, I want to say, 15 years.”
The state has been pushing to get people out of nursing homes and back with their families.
Once Demidovich frees up 10 beds, he can use some of the 22 private rooms for specialty services like respiratory or wound care, which would also have a positive impact on his Medicaid rates. He has a meeting with a respiratory specialty group next week.
Demidovich took a $400,000 Medicaid rate hit in July and has seen that revenue source squeezed for years. He has had to borrow $1.1 million from the commissioners since 2013 to fill gaps in its $7.4 million budget, largely because of shifting rules and funding levels of Medicaid reimbursement. There is $500,000 outstanding on the tab with the commissioners.
The county received the consultant's recommendation in mid-September and County Administrator Charlie Young said they just haven't had an opportunity yet to schedule a session with the commissioners to discuss their options. Young said selling the beds and other decisions they need to make cannot be taken lightly.
“So several of these things, we can’t just say ‘okay let’s do that’ and tomorrow it’s done and we’ll start realizing the benefit of them…,” he said. “Going from 109 beds to 99 is pretty much a forever thing, you’re not going to go back up to 109. It looks like it makes a lot sense now, but Medicaid is constantly changing so what you’ve got to weigh is that $3 per patient day advantage enough for us to go ahead and get rid of these beds.”
Demidovich said it takes a least a year for bed selling to be consummated, but Young said shuttering the adult day center — for a savings of $70,000 to $75,000 — could be done fairly quickly. He said they would probably want to give participants and their families 90 days to find other accommodations.
Demidovich has already adopted some of the consultant’s recommendations, like sending billing to an outside vendor, but the commissioners have not yet signed off these two latest ideas.
Commissioner Don Dixon told the Journal-News previously he envisions a hybrid solution of sorts. He said the $500,000 consultant Chris Joos mentioned for facility renovations won’t be nearly enough to make the home competitive in the marketplace. He said they need to hire more consultants to help them figure out a new niche like wound care or the respiratory services Demidovich mentioned, for example.
Right now the home’s niche is that they will take all the poor and difficult patients private nursing homes won’t take.
He said before he’ll agree to either plan he needs to know there are other adult day services for their clients. And he is also still weighing the pros and cons on selling the beds.
“I know adult daycare is a drag on the facility, but it is a service I want to try and make certain it’s provided somewhere else,” he said. “And I want to make certain, if we decide to sell the beds, we don’t have another entity within the county that is an agency that could maybe use those beds in another fashion, ie. some drug addiction rehab.”
About the Author