Joseph DeMattos of the Health Facilities Association of Maryland: Long term and post-acute care advocates from Maryland gather on Capitol Hill

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By Joseph DeMattos, MA
President and CEO Health Facilities Association of Maryland

As the CEO and President of Maryland’s largest and oldest nationally affiliated association representing skilled nursing and rehabilitation centers, I am asked by business and government leaders, friends, and family this question nearly every day: “Five or ten years from now, will there be such a thing as a nursing home?”

The answer is absolutely yes. Today and tomorrow, skilled nursing and rehabilitation centers in Maryland and across the nation will be part of the solution for quality and efficient care for an aging America.

We took that message to Capitol Hill recently to better equip government leaders to make informed decisions that affect the way care is delivered in the future. Leaders for the long-term and post-acute care industry from the Health Facilities Association of Maryland (HFAM) joined more than 400 health care leaders from across the nation at the annual Congressional Briefing hosted by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL).

The 230 skilled nursing and rehabilitation centers located in every community across Maryland provide quality post-acute and long-term care to thousands of Marylanders each year, totaling nine million days of care across all payer sources. Additionally, Maryland’s long-term care provider community directly supports an estimated $3.7 billion in state economic activity and serves as a major job creator and economic engine.

Employing aides, techs, nursing assistants, nurses, rehabilitation professionals, nurse practitioners and physicians, but absent surgery and emergency departments, Maryland’s skilled nursing and rehabilitation centers provide much of the same care provided in hospitals—often at one third to half of the cost.

And importantly, according to Consumer Satisfaction Surveys since 2007, 88 to 90 percent of families have recommended to others the facility in which their loved one received care.

The message we took to members of our congressional delegation was that our centers are part of the quality care solution.  Specifically, we discussed:

-- The increase in “observation stays” in hospitals, in which patients are not officially admitted to the hospital, are likely lengthening hospital stays and creating a hardship for Medicare beneficiaries. Medicare currently will not cover necessary post-acute care in skilled nursing and rehabilitation centers without a qualifying three-day hospital stay.

-- Forty-three states, including Maryland, rely on a Medicaid Provider Assessment to augment underfunded Medicaid rates that provide long-term care to Marylanders most in need.  Cutting the maximum Medicaid rate from 6 percent to 5.5 percent would cut $8 billion from Medicaid nationwide and a little over $12 million here in Maryland.

-- Maryland centers have made great quality improvements that include reducing unnecessary antipsychotic utilization by nearly 30 percent, ranking Maryland 10th best in the nation.

Most importantly, we briefed Members of Congress and their staff on the topline numbers of the unique Maryland Hospital Waiver 2.0, which went into effect two years ago. Maryland operates the nation’s only all-payer hospital rate regulation system. This system is made possible in part by a 36-year-old Medicare Waiver granted by the federal government.

Under the terms of Maryland Hospital Waiver 2.0, Maryland hospitals are committed to achieving quality improvements, including reductions in 30-day hospital readmissions and hospital acquired conditions.

Additionally, the updated Waiver limits all-payer per capita hospital growth, including inpatient and outpatient care, to 3.58 percent, and annual Medicare per capita hospital cost growth to a rate below the national average. Maryland must generate $330 million in Medicare savings over a five-year performance period.

Under the new Waiver, skilled nursing and rehabilitation centers have become an increasingly important part of the quality care solution, and therefore, their patient volumes have increased slightly up. To make the Waiver work financially and to ensure quality care while reducing unnecessary hospital readmissions, hospitals will need to fully partner with our centers to provide stepped-down, transitional post-acute care at lower cost.

While early data from year two of the updated Waiver indicates that savings in hospitals was lower than year one, and spending for care in skilled nursing and rehabilitation centers (SNFs) was slightly up, the length of stay in Maryland skilled nursing and rehabilitation centers still mirrors the national average.

The topline data shows that admissions to nursing centers per thousand beneficiaries has increased by 1 percent and the cost per capita has increased by 2.4 percent.

The Waiver created incentives to move patients in need of stepped-down care out of hospitals more quickly.  It makes sense that referrals to nursing centers from hospitals would increase, and thus the spend incrementally would increase.

Data also indicates that while the average hospital stay for all Medicare beneficiaries in Maryland is  five days,  those who are discharged from the hospital to the nursing home spend an average of 10 days in the hospital. Proving again that skilled nursing and rehabilitation centers provide care for Marylanders with the most complex medical needs.

Maryland healthcare professionals and leaders in skilled nursing and rehabilitation centers have the potential to create a model for transitional and post-acute care that improves quality, bends the cost curve, and gets people home stronger.

So, five or ten years from now, will there be such a thing as a nursing home?  Absolutely yes.


Founded in 1948, HFAM is the oldest and largest nationally affiliated post-acute provider association in Maryland.  It is affiliated with the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), the largest national association of its kind. Combined HFAM has over 168 skilled nursing and rehabilitation center and Assisted Living members.  HFAM skilled nursing and rehabilitation center members provide over 9 million days of care annually across all payer sources (Medicare, Medicaid, private pay), and provide quality care for 72 percent of all Maryland Medicaid long-term care beneficiaries. 

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