Strong support for county home getting into Medicare rehab biz

LACONIA — The Belknap County Convention met last night to consider the Belknap County Commission's request for a supplemental appropriation of $200,000 for the nursing home, but the scheduled public hearing was not held and the anticipated vote was not taken when members learned that the meeting was not noticed in accord with state statute.
Rep. David Huot (D-Laconia) explained that notice of the public hearing failed to include the amount of the supplemental appropriation and the purpose for which it is acquired. Acknowledging the oversight, Rep. Colette Worsman (R-Meredith), who chairs the convention, rescheduled the public hearing for June 3.
However, the convention invited the county commission and administration to present its request for sufficient funding to enable the nursing home to accept a limited number of patients enrolled in Medicare and referred by hospitals for short stays to undergo physical, occupational and speech therapy.
Matt Logue, director of the nursing home, projects that, the program, which would be provided by independent contractors, would generate $400,000 in additional revenue, enough to cover the cost of the services and return a net gain of $200,000. Medicare, he explained, reimburses the nursing home for these services at 14-percent above costs. 
Logue said that the there is currently no waiting list for the nursing home, which has enough capacity for the patients, whose stays average about 30 days, without compromising its mission to provide long-term care for needy county residents.
In anticipation of funding to operate the program throughout the year, Logue drew on budgeted appropriations to introduce it in the first quarter when it returned some $105,000. He explained that without the supplemental appropriation, the services would have to be curtailed, noting that he declined to accept a patient earlier that day.
Mark Lehrman of New Hampshire Catholic Charities, which owns and operates the St. Francis Rehabilitation and Nursing Center in Laconia, said that "there is no unmet need for nursing homes in Belknap County" and by courting Medicare patients, the county nursing home would have "a negative impact on current providers."
Private nursing homes, both for-profit and nonprofit, faced with empty beds, Lehrman said, reduced costs by adjusting staffing levels. "If you have empty beds," he told the convention, "I would suggest you fill them with Medicaid patients as an alternative to pursuing Medicare patients."
Brenda Buttrick, director of the St. Francis Center, said that 30 of its 51 beds were occupied by Medicaid patients. Lehrman noted that a recent study found that the gap between the cost and the reimbursement for Medicaid patients of $57 per day in New Hampshire is the widest in the country. The county, he continued, has the means to narrow the gap by raising taxes, but provide nursing homes must depend on patients with insurance, primarily Medicare, since only one-percent carry long-term care insurance.
Lehrman said "the inherent mission of the county nursing home is to provide long-term care for the poor and indigent. I'm all for competition," he continued, "but what is the mission of the county nursing home? Where is the limit to what county government provides. Where do you draw the line?"
In response, Logue said that people want choices and "the county is offering just another choice." Commissioner Ed Philpot added that "St. Francis has choices, such as the ratio of private paying and Medicaid residents."
Representative Frank Tilton (R-Laconia), noting that a majority of the convention appeared to approving the supplemental appropriation, suggested transferring $50,000 from the contingency account to fund the program until the public hearing could be held and a formal vote taken. Once the appropriation was approved, $50,000, which would fund the program for two months, could be restored to the contingency account and $150,000 applied to operate the program for the balance of the year.
However, Worsman reminded him that the transfer required the approval of the convention's executive meeting, which would require scheduling and posting a meeting, by which time the convention could reschedule the public hearing and take a vote.