PHCA/CALM Testifies Before House Aging Committee on Long-Term Care Commission Report

HARRISBURG — The Pennsylvania Health Care Association/Center for Assisted Living

Management (PHCA/CALM) today reaffirmed its support for the final Long-Term Care Commission report and its commitment to continue caring for Pennsylvania’s growing aging and disabled population.

“I am proud to have been one of 24 members of the Long-Term Care Commission that put together this outstanding report,” said Stuart H. Shapiro, M.D., PHCA/CALM CEO. “This report was a compromise document that gives a roadmap for changing our long-term services and supports (LTSS) system and it was unanimously endorsed by every member of the commission.”

During his testimony, Dr. Shapiro noted that this report took into account the fiscal realities that our state faces in determining where long-term care should be provided.

“Both public comments and commission discussions highlighted the many fiscal challenges confronting Pennsylvania’s current LTSS system,” said Shapiro. “The Commissioners considered how the current system could be changed to make it more fiscally sustainable into the future. They discussed how to balance consumer choice, fiscal accountability and consumer safety in light of the growing number of individuals needing LTSS, the US Supreme Court’s Olmstead decision and the commonwealth’s limited fiscal resources.”

The first recommended strategy to make the LTSS system fiscally sustainable was to “Serve the greatest number of individuals in the safest, most appropriate, least restrictive and cost-effective setting possible with the limited available state and federal resources.”

“The Pennsylvania Health Care Association fully endorses and supports individuals remaining in their homes receiving services under the commonwealth’s Medicaid program for as long as it is safe and for as long as it is cost-effective,” Dr. Shapiro stated. “We also believe that the citizens of Pennsylvania want the greatest number of individuals served with limited resources. Thus, we suspect that the citizens of Pennsylvania would be surprised to learn that in many cases the Medicaid program is paying more than $150,000 annually to care for individuals in their homes when the annual cost is only about $50,000 in a nursing home.”

In addition, Dr. Shapiro supported the commission’s recommendation that urges the adoption of a single uniform assessment tool by September 30, 2015 that collects comparable data elements at specified intervals for all LTSS consumers in all commonwealth-funded LTSS settings.

“Without this we will never have comparable data to monitor and understand what the commonwealth is paying for, what the quality of care really is and whether we are getting the type of outcomes that our seniors deserve, and that our taxpayers demand for their investment in long-term care,” said Dr. Shapiro.

Finally, the state needs to streamline, standardize and expedite the eligibility process for individuals seeking access to state-funded LTSS.

“This is very important to correct so that we can assure that individuals receive care in the least restrictive and cost-effective setting possible,” Dr. Shapiro pointed out. “Consumers should be able to return to their homes from a hospital visit, or stay in their homes, when the home is safe and cost-effective for care. The eligibility process should not put barriers in the way.”

The Commissioners also recommended the development and implementation of a LTSS coordinated integrated demonstration project, which is jargon for a Managed Care for the Elderly demonstration project.

“On the subject of managed care for the elderly, I do have very strong feelings,” Shapiro stated. “Thirty states are experimenting with managed care under Medicaid for the elderly. I use the word experimenting purposely for there are no conclusive results that show that managed care improves care or outcomes, gives consumers choice, and saves money. In fact, preliminary data seems to say that it does none of these.

“While I believe Pennsylvania is most prudent to wait for some real and consistent data from other states that the elderly are not hurt by so called managed care and that managed care actually save the state money, I did vote yes on the report’s recommendation for small geographically limited demonstration projects that are voluntary, person centered and developed with real stakeholder involvement.

“I would also like to note that the report also endorsed not proceeding unless the demonstration’s outcomes are positive on a number of parameters. I happen to believe that any demonstration should include both Medicaid and Medicare dollars as the major cost saver is reduced hospitalizations paid by Medicare, but that is a discussion for another day.

“I urge this committee, the Wolf Administration and the entire legislature to look skeptically on the suggestion that managed care will save the state money and improve care. The data is just not there to prove this.”