Dateline: July 13, 2006

MCNH future to be topic of July 25 meeting

By Roger Estlack, Clarendon Enterprise

The Medical Center Nursing Home is financially sound and ended the last fiscal year with a projected budget surplus. But officials with the Donley County Hospital District say the good news may not last if plans aren’t made now for the future.

And to get input from the taxpayers for that future, the district has called for a town hall meeting on Tuesday, July 25, at 7:30 p.m. at the Clarendon Lions Hall.

“We’ve been cutting expenses for the last year and a half, but the revenue always stays the same,” said hospital board president Alan Fletcher, summing up the situation.

Much of the problem comes from the fact that Texas ranks near the bottom in its Medicaid reimbursement rate for nursing homes compared to other states.

“We’d be broke now except that the Legislature increased the (reimbursement) rate by $10 per person per day in January,” Fletcher said.

That increase produced an estimated $190,000 in revenue for this year, but it’s set to expire in August 2007, and district officials say the word is that the Legislature does not plan to renew it.

The projected profit for MCNH in fiscal year 2005-2006 is $94,000. Without the higher reimbursement from the state, the nursing home would have had a deficit of nearly $100,000.

Compounding the problem is that Medicaid payments to nursing homes are based on the level of care a resident needs, and MCNH has a high percentage of residents – 26 out of 53 – that are eligible for the lowest reimbursement rate, which is about $80 per day.

“We’re getting people who need an assisted living center (can bathe, feed, and clothe themselves), but we have to keep a staff level for a nursing home,” Fletcher said, noting that factor makes it difficult to compete with other nursing homes.

The average Medicaid reimbursement in Texas is $106 per resident, according to the Texas Health Care Association. The average reimbursement for MCNH is $96.

Figures for 2006 are not available, but in 2004, Texas ranked 48th out of 50 states with an average reimbursement of $92.20. The same year Oklahoma’s rate was $102.96, and New Mexico paid an average of $133.87. In 2005, Texas remained in 48th position with a rate of $95.17 while Oklahoma was paying $102.96, and New Mexico was paying $155.45.

On top of the problems with state funding, MCNH, like many small nursing homes, is faced with increased competition in the job market as wages continue to increase for a small pool of qualified nurses and aides. A beginning LVN in Clarendon earns $13.50 per hour compared to $15.75 per hour in Claude, which is forced to compete with high wage payers in Amarillo.

Employees also want benefits, such as health insurance, that the hospital district does not provide.

The Medical Center also is dealing with rising workers’ compensation costs, which have gone up more than $20,000, and ongoing maintenance issues with a facility that is more than 30 years old, including a lack of electrical outlets for 21st century residents’ belongings (i.e. laptop computers, cordless phones, lift chairs, etc.,), roof problems, and sewer problems.

There are solutions to MCNH’s woes, but each is likely to have its detractors. First, the state could preserve the current reimbursement rate and increase it. Second, the hospital district could add ten beds to the facility at a cost of $600,000 to bring in more income. Third, the taxpayers of Donley County could be asked to pay more to maintain the nursing home. Or fourth, the nursing home could be sold to someone in the private sector.

“The goal has to be to keep Medical Center Nursing Home open,” administrator Vickie Robertson said. “Fifty-three people call it home, and 50 to 55 people are employed here. Losing those jobs would be a huge impact on the local economy.”

Fletcher agrees and says he hopes people will come to the July 25 meeting with creative ideas.

“Regardless of what happens, we don’t want to get stupid and let this thing close up,” he said.