Michigan’s Nursing and
Rehabilitation Communities
U.P. HEALTH CARE
NETWORK TRUSTEE FORUM
DAVID LALUMIA, PRESIDENT AND CEO
HEALTH CARE ASSOCIATION OF MICHIGAN
APRIL 19, 2013
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
Iron
Luce
Marquette
Alger
Dickinson
Schoolcraft
Chippewa
Mackinac
Delta
Menominee
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
 Proprietary
 Non profit
 County medical care facility
 Hospital 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
 Female
 Median age 85
 Some form of dementia (20%)
 Wheel chair user
 Most experience some level of cognitive
impairment (95%)
 Admitted after hospital stay
 Length 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 care
 Wound care, wound vacs, negative pressure
therapy
 Chest tube care
 Trach care
 IV antibiotics
 Total parenteral nutrition (TPN)
 Bariatric rehab
Specialty Care (2)
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Ventilator care
Dialysis
Chronic disease management
Counseling and social services
Palliative care, pain management, end of life care
Speech, physical, occupational therapy
Full range of rehabilitation 7 days/week
Not all care specialties available in all locations
Transitions from SNF
 5,397 Medicaid beneficiaries discharged from SNF in
2008*
 91% through efforts of SNF
 9% by state transition program
 SNF 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 3/5/12
 Current estimate of Michigan dual eligibles - 211,309
 Nursing 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 facilities
 Home and community-based services
 Home help program
Integrated Care Finances
 $7.89 billion total expenditures
 Long-term care (LTC) includes SNF, home and
community-based waiver and home help services
 LTC = 17% of Medicare expenditures
 LTC = 69% of Medicaid expenditures
 LTC = 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
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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 home
10,000 Americans turn 65 every day
Demand 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,
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resident choice
Focus on quality improvement
Downsizing the number of beds per facility, move to
private rooms
Investing in physical plant improvements
14 new builds in process around the state
Partners in Quality Care
 Experienced post acute care providers
 Aggressively discharging patients from SNF to
home and other settings
 Integrate care with other parts of the continuum of
LTC supports and services
 Partners in integrated care for individuals with
dual (Medicare/Medicaid) eligibility
 Collect 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 Marquette
 Nursing facility owners, administrators, directors of
nursing and staff
 Covering all the hot topics in LTC including managed longterm care
 Keynote address -- Dennis Smith, U.P. Health Plan
 More info -- www.hcam.org. Click on Provider
Information, Education and Conventions, and Events
Calendar.
Thank You
David LaLumia, President and CEO
Health Care Association of Michigan
7413 Westshire Drive, Lansing 48917
517.627.1561/517.420.8319(cell)
davidlalumia@hcam.org
www.hcam.org