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Dunn County Board: Wisconsin worst for nursing home reimbursement

By LeAnn R. Ralph

MENOMONIE  —  There’s a reason why the Neighbors of Dunn County has been experiencing financial difficulty — and part of the reason is completely out of the control of the Dunn County Board.

Wisconsin is the worst state in the nation in terms of nursing home reimbursement rates, said Steve Rasmussen, chair of the Dunn County Board, at the county board’s May 18 meeting.

Rasmussen spoke about reimbursement rates during the committee reports portion of the meeting.

Actually, Rasmussen said Wisconsin was the third-worst state, but James Anderson, county board supervisor from Menomonie and a member of the Neighbors committee, spoke up and said Wisconsin was not third-worst, it is the worst.

Rasmussen agreed that the report that had been given to the committee listed Wisconsin as the worst state for nursing home reimbursement rates.

According to an article published in the Wisconsin State Journal May 18, a new study says because of the low reimbursement rates, nursing home facilities in Wisconsin lose more than $50 per day on Medicaid patients.

The president of Leading Age Wisconsin was quoted in the article as saying that the gap in nursing home costs and reimbursement rates has caused some nursing homes to close and others to downsize.

According to a representative for the Wisconsin Health Care Association quoted in the article, the shortfall in Medicaid payments means that nursing home facilities are unable to pay enough in wages to compete with other employers, resulting in a crisis in the availability of people to take care of nursing home residents.

Financial report

A second Clifton Larson Allen financial report compared the actual financial numbers from the Neighbors in 2015 with the financial forecast from Wipfli before the Neighbors began operating, Rasmussen told the county board.

The comparison showed a variance in revenue, and in 2015, the Neighbors was $1.2 million short, he said.

Out of the $1.2 million, nearly $500,000 is due to the state’s reimbursement rates and the state’s bed tax.

Of the shortfall, $200,000 was because of Wisconsin’s low reimbursement rates, Rasmussen said.

Another $500,000 of the deficit was because the number of residents at the Neighbors was lower than expected. The goal was 93 percent occupancy, but the actual was 89 to 90 percent occupancy, he said.

And part of what contributed to the occupancy deficit was the “mix” of residents: Medicaid, Medicare, private pay and veterans, Rasmussen said.

“There is little we can do about the reimbursement rates,” he said, adding that Dunn County could consider lobbying the state Legislature and asking the Wisconsin Counties Association to become involved in lobbying.

The new goal for the Neighbors is a census of 95 percent as well as continually working on a more advantageous mix of residents and working on better marketing of the facility, Rasmussen said.

Food service

Part of the shortfall also was due to a $200,000 over-run on food service.  Multidisciplinary Assessment (MDA) (medical coding) contributed to some of the shortfall too, he said.

The Neighbors is working on improving MDA and also is working on the food service and combined purchasing with different food vendors, such as Aviands and Aramark, Rasmussen said.

The Neighbors currently is working with private vendors to see about Requests for Proposals, he said.

“The quality of the food and the dining is one of the attractions. We do not want to go cheap and ruin the reputation,” Rasmussen said.

The Dunn County Board may have to consider a debt levy to cover the shortfalls at the Neighbors, Rasmussen said.

The Neighbors of Dunn County has not previously been funded by a tax levy.

Why?

“Why is Wisconsin so low on reimbursement?” asked Gary Bjork, county board supervisor from Colfax.

“I don’t want to be political,” Rasmussen replied.

County Board Supervisor James Anderson noted that the Neighbors committee also had learned that two years ago, Wisconsin was the third worst state in the nation on nursing home reimbursement rates, and that last year, Wisconsin was the second worst.

“Now we are the worst,” Anderson said.

The question is “why are we the worst out of 50 states?” he said.

Wisconsin’s nursing home bed tax also is contributing to the deficit, Rasmussen said.

For the Neighbors, $270,000 goes to Madison, but none of the money comes back, he said.

The state collects $100 million in bed tax. Out of that amount, the state keeps $60 million, and distributes $39 million to other nursing homes, Rasmussen said.

Other business 

In other business, the Dunn County Board:

• Approved a resolution denying the claims of John Stricklin and Mary Stricklin. According to background information with the resolution, John Stricklin and Mary Stricklin filed a claim on January 27, 2016, concerning an alleged incident on October 29, 2015, at the Neighbors of Dunn County. The claim alleges that while in the care of unidentified staff at the Neighbors, Mr. Stricklin received burns to his right foot from scalding water during a bath or shower. John Stricklin and Mary Stricklin are claiming damages of $50,000 each. The county’s insurance carrier, Wisconsin County Mutual, has reviewed the claims and recommended that the claims be denied.

• Approved a resolution recognizing the service of county employee Ronald Bergeson, who has decided to leave his position as a service worker in the Highway Division of the Public Works Department. Bergeson served the citizens of Dunn County for more than 41 years.

• Approved a resolution for 2016 budget adjustments to recognize grants received by the district attorney’s office and the sheriff’s department. The Dunn County district attorneys office received a federal grant of $49,551 to further support victim services provided by the Dunn County Victim/Witness Assistance Program and to provide training for direct service providers within the victim/witness assistance program. The Dunn County sheriff’s department received the amount of $4,000 for the Click It or Ticket Grant, and the money will be used for purchasing a squad camera.