U.P. HEALTH CARE NETWORK TRUSTEE FORUM

D AV I D L A LU M I A , P R E S I D E N T A N D C E OH E A LT H C A R E A S S O C I A T I O N O F M I C H I G A N

A P R I L 1 9 , 2 0 1 3

Michigan’s Nursing and Rehabilitation Communities

Licensed and Certified Network of Care

Statewide: 427 licensed facilities, 47,379 beds

29 state licensed and CMS certified skilled nursing and rehab communities in the U.P.

Certified by CMS to be Medicare and Medicaid providers

Authorized to operate a specific number of beds by state certificate of need (CON) process

Assessed provider tax (QAAP) which generates 18% of Medicaid rate and provides $500 million in funding for facility-based LTC

29 U.P. Nursing and Rehab Communities

Keweenaw

Houghton

Ontonagon

Gogebic Baraga

Marquette Iron

Dickinson

Alger Schoolcraft

Luce

Chippewa

Mackinac

Menominee

Delta

29 U.P. Nursing and Rehab Communities (2)

Aspirus Ontonagon Hospital, Ontonagon (46) Bayside Village, L’Anse (59) Bishop Noa Home for Senior Citizens, Escanaba (81) Chippewa County War Memorial Hospital, Sault Ste.

Marie (51)* Christian Park Health Care Center, Escanaba (99) Christian Park Village, Escanaba, (59) Cypress Manor Health & Rehab Center, Hancock (63) Eastwood Nursing Center, Negaunee (100) Freeman Nursing & Rehab Community, Kingsford (45) Gogebic County Medical Care Facility, Wakefield (109) Helen Newberry Joy Hospital, Newberry (48)*

29 U.P Nursing and Rehab Communities (3)

Houghton County Medical Care Facility, Hancock (197) Hyland Convalescent Home, Iron Mountain (51) Iron County Medical Care Facility, Crystal Falls, (200) Iron River Care Center, Iron River (69) Mackinac Straights Hospital & Health Center, St. Ignace (48) Marquette County Medical Care Facility, Marquette (120)* Manor Care Nursing & Rehab Center, Kingsford, (107) Mather HealthCare, Ishpeming (122) Menominee Care Center, Menominee (59) Norlite Nursing Center, Marquette (99) Our Lady of Mercy Health & Rehab, Hubbell (55)

29 U.P. Nursing and Rehab Communities (4)

Pinecrest Medical Care Facility, Powers (160) PortagePointe, Hancock (60) Roubal Care & Rehab Center, Stephenson (39) Schoolcraft County Medical Care Facility, Manistique (95)* Tendercare, Munising (106) Tendercare, Sault Ste. Marie (114) Westgate Nursing, Rehab & Assisted Living Community,

Ironwood (65)

* Prospective HCAM Members

Serving MI Elderly and Disabled Citizens

95,628 served each year*35,378 Medicaid beneficiaries*60,250 Medicare/post-acute care*31,150 Medicare-Medicaid (dual) eligibles

* 2011 Public Sector Consultants study of Issues and Trends in Long-Term Care including review of 2008 MDS data on SNF residents

Provider Profile

ProprietaryNon profitCounty medical care facilityHospital LTC units

Payer Mix

Medicaid 67%Medicare 19%Private pay 14%State sets Medicaid SNF rates using cost-

based reimbursement model

Two Populations Served

Short stay post acute patients discharged from the hospital and requiring intensive rehab and medical care

Longer stay residents with more medically complex conditions that require skilled nursing care and help with activities of daily living

LTC Resident Profile

FemaleMedian age 85Some form of dementia (20%)Wheel chair userMost experience some level of cognitive

impairment (95%)Admitted after hospital stayLength of stay for Medicaid residents has

been reduced by 50% over the past decade.

Post Acute Care Patient Profile

Over age 75 (70%)Broad range of clinical conditions including

pneumonia, congestive heart failure, stroke, joint replacement, kidney and urinary tract infections, septicemia and others

40% discharged within 100 days of admission

SNF effectively managing complex post acute care patient population

Specialty Care

Skilled nursing careWound care, wound vacs, negative pressure

therapyChest tube careTrach careIV antibioticsTotal parenteral nutrition (TPN)Bariatric rehab

Specialty Care (2)

Ventilator careDialysisChronic disease managementCounseling and social servicesPalliative care, pain management, end of

life care Speech, physical, occupational therapyFull range of rehabilitation 7 days/weekNot all care specialties available in all

locations

Transitions from SNF

5,397 Medicaid beneficiaries discharged from SNF in 2008*

91% through efforts of SNF9% by state transition programSNF aggressively prepare residents to return

home or other setting

* PSC Issues and Trends study

Integrated Care for Medicare Medicaid Eligibles

DCH integrated care plan issued 3/5/12Current estimate of Michigan dual eligibles -

211,309Nursing facilities serve 31,150 (14.7%)63% are 85 and older

Duals in U.P. = 8,704 -- 4.1% of state total

Integrated Care Organization (ICO)

State integrated care plan designates ICO to manage physical health

Skilled nursing facilitiesHome and community-based servicesHome help program

Integrated Care Finances

$7.89 billion total expendituresLong-term care (LTC) includes SNF, home

and community-based waiver and home help services

LTC = 17% of Medicare expendituresLTC = 69% of Medicaid expendituresLTC = 39% of both MM expenditures

Approximately $323 million spent for duals in U.P.

HCAM 2011 Study on Issues and Trends in LTC

Michigan is growing older faster than the rest of the country

Caregiver population (age 25-44) has declined by more than 500,000 in MI over past decade

MI is already an efficient user of skilled nursing and rehab care

Nursing facilities are discharging people back home10,000 Americans turn 65 every dayDemand for care in future will challenge both

facility and community-based LTC and responsible integrated care organizations (ICO)

Today’s Nursing Facilities

Culture change – person centered care model, resident choice

Focus on quality improvementDownsizing the number of beds per facility,

move to private roomsInvesting in physical plant improvements14 new builds in process around the state

Partners in Quality Care

Experienced post acute care providersAggressively discharging patients from SNF

to home and other settingsIntegrate care with other parts of the

continuum of LTC supports and servicesPartners in integrated care for individuals

with dual (Medicare/Medicaid) eligibilityCollect and report quality data – nursing

home compare (www.cms.gov)

Prepared for Change

Skilled nursing and rehabilitation communities, like all areas of health care, have advanced in terms of clinical practice, resident rights, quality improvement, and the overall approach to the needs and wishes of residents and patients.

Annual HCAM U.P. Education Conference

May 1-2, 2013, Holiday Inn MarquetteNursing facility owners, administrators, directors

of nursing and staffCovering all the hot topics in LTC including

managed long-term careKeynote address -- Dennis Smith, U.P. Health PlanMore info -- www.hcam.org. Click on Provider

Information, Education and Conventions, and Events Calendar.

Thank You

David LaLumia, President and CEOHealth Care Association of Michigan7413 Westshire Drive, Lansing 48917517.627.1561/517.420.8319(cell)davidlalumia@hcam.orgwww.hcam.org