Some nursing facilities in Ohio underperform on critical quality measures in part because the current reimbursement system does not financially reward high quality or quality improvement.
Ohio Medicaid pays nursing facilities an amount that is in line with the national average but, according to a Scripps Gerontology Center review of national data, Ohio is below the national average on ten critical measures of nursing facility quality. Ohio Medicaid is required by law (ORC Chapter 5165) to pay low-quality nursing facilities the same amount as high-quality facilities. More than 20 states have already set aside one-size-fits-all reimbursement and instead rely on private sector managed care plans to pay more for quality as an incentive to improve.
To better understand which nursing facilities in Ohio would benefit from linking payment to quality, Ohio Medicaid released data that lets an individual nursing home compare its performance to other nursing facilities statewide. In general, the data shows that smaller facilities tend to have higher quality than larger facilities, and not-for-profit facilities have more four and five star ratings (64 percent) than for-profit facilities (37 percent).
Governor Kasich’s budget proposed to move away from the current payment guarantee for low-quality facilities, increase competition among nursing facilities based on quality, and financially reward high-quality facilities for doing better. The Ohio House of Representatives voted to delay these reforms until 2021 and the issue is now under consideration in the Ohio Senate.
Ohio Medicaid nursing facility payment and quality data
Scripps Gerontology Center review of national quality data
Kaiser Family Foundation review of quality star ratings
Ohio nursing homes among nation's worst