Heddington Oaks is seeing fewer Medicare patients these days. That translates to fewer dollars for the Peoria County-owned nursing home. The shift is brought on by a new way to determine who qualifies for nursing care.
One hallway at Heddington Oaks is flanked by bedrooms designated for Medicare patients. But the beds are empty. Interim Director Christy Delaware says the facility relies on those patients for a steady source of income.
“Typically those are your patients that are coming in directly from the hospital for short-term stays. They’re receiving therapy services and going home," Delaware said. "Because they’re requiring more care, the reimbursement rate is higher.”
Delaware says Medicare patients are instead being redirected to other options, chiefly home care. That’s where managed care companies come in.
Managed care became more influential after the passage of the Affordable Care Act because it aims to cut medical expenses by redirecting patients to more cost-efficient options.
Susie Mix is the CEO of a consulting firm that helps nursing homes and healthcare providers navigate the managed care relationship. Mix says with her clients she often sees this “us versus them” mentality.
“To a skilled nursing facility, that is exactly what it looks like. 'The folks that we’re used to seeing, the Medicaid, the Medicare patients, they’re being taken away from us,'" Mix said. "But the reality is that the state and the federal government are running out of funds.”
Mix says if nursing homes don’t adapt to managed care, by developing contract agreements or adding services, they may have to close their doors. Because managed care isn’t going anywhere anytime soon.
The County says Medicare money is more than 700-thousand-dollars short compared to this year's fiscal budget.