2012NursingHomeTrendsReport. December20,2013

Transcription

1 2012NursingHomeTrendsReport December20,2013

2 2012 Nursing Home Trends Report Executive Summary BlumShapiro presents the summary of the nursing home trends report for the year ended December 31, 2012, which includes all of Rhode Island s 84 nursing homes. This report provides a four-year history of patient mix, occupancy percentages and labor- and employee- related expenses on a per diem basis. These categories represent reliable benchmarks from which nursing home administrators, stakeholders and the financial community can analyze their facility operations against other organizations of similar scope and size. Also provided is a detailed per diem analysis by bed size range and overall per diem averages for the state of Rhode Island. These costs have been divided into cost centers that mirror the categories included in the price-based payment methodology in The last column on the right of the per diem analysis contains the state of Rhode Island payments in the related categories. This assumes a Medicaid case mix index of 1.0. Please be advised that the per diem analysis contains actual costs whereas the Medicaid payment is based upon allowable costs. The state of Rhode Island s payments are based upon 2010 allowed nursing home costs as follows: Direct Care Nursing: % of the statewide median weighted for Medicaid bed days Direct Care Other: % of statewide median weighted for Medicaid bed days Other Indirect Care: 93.48% of statewide median weighted for Medicaid bed days Trends While 2010 had a slight decrease in census, 2011 and 2012 sustained an upward trend. As one might expect, there has been a slight increase in the Medicaid occupancy with a corresponding decrease in private occupancy. Not surprisingly, Medicare occupancy has decreased from 2010 through 2012 due to issues that facilities have been encountering regarding observation days in the hospital. Total labor expenses on a per-day basis have increased from 2009 through However, the increase from 2011 to 2012 was only 1 percent. This is a direct result of a zero inflation factor adjustment from the state of Rhode Island on their payments to nursing home providers. Payroll taxes and workers compensation insurance has steadily increased from 2009 through Surprisingly, however, is the decrease in health insurance costs in This decrease is primarily due to facilities moving to higher deductible plans and shifting more of the costs to employees. healthcare.blumshapiro.com

3 Patient Mix 2012 Industry % 20.3% 4.5% 4.5% 8.4% 67.0% 9.1% 66.1% % 20.5% 4.4% 5.5% 9.1% 66.1% 8.6% 65.3% Medicaid Medicare Hospice Private & Other

4 Occupancy Percentages Industry % % % % 91.40% 91.60% 91.80% 92.00% 92.20% 92.40% 92.60% 92.80% 93.00% 93.20%

5 Labor Expenses - Per Patient Day Industry Industry '12 Industry '11 Industry '10 Industry ' Administrative Environmental Dietary Nursing Other Industry ' Industry ' Industry ' Industry '

6 Employee Related Expenses - Per Patient Day Industry Industry '12 Industry '11 Industry '10 Industry ' Payroll Taxes Health Insurance Workers' Comp. Other Employee Benefits Industry ' Industry ' Industry ' Industry '

7 SULLIVAN & COMPANY CPAs AVERAGE AVERAGE AVERAGE AVERAGE OVERALL MEDICAID A DIVISION OF BLUMSHAPIRO BED SIZE BED SIZE BED SIZE BED SIZE AVERAGE PAYMENT ANALYSIS OF NURSING HOME PER DIEMS December 31, 2012 RANGE RANGE RANGE RANGE AT CMI 1.00 DIRECT CARE > Direct Care - Nursing 4431 Health Insurance Other Employee Fringe Benefits Payroll Taxes A Workers' Compensation Insurance Salaries - R.N Salaries - L.P.N Salaries - Aides and Other Purchased Nursing Services Less: Direct Care - Other - Benefits (3.12) (2.31) (2.04) (1.73) (2.25) Less: Indirect Care - Benefits (8.21) (7.56) (5.68) (6.09) (6.83) Less: Ancillary - Benefits (0.32) (0.49) (0.36) (1.19) (0.56) Total Direct Care Costs Direct Care - Other Direct Care - Other - Benefits Director of Nurses Physical Therapist - Medicaid Other Therapeutic Services - Medicaid Raw Food Nursing Supplies - Medicaid & House Pharmacy Supplies - Medicaid & House Medical Director Salary or Fees Social Worker Salaries or Fees Recreational Activity Salaries Total Direct Care - Other Costs Direct Care - Non-Medicaid Ancillaries Ancillary - Benefits Physical Therapist - Other Other Therapeutic Services - Other Nursing Supplies - Other Pharmacy Supplies - Other Total Direct Care - Non-Medicaid Ancillaries TOTAL DIRECT CARE

8 SULLIVAN & COMPANY CPAs AVERAGE AVERAGE AVERAGE AVERAGE OVERALL MEDICAID A DIVISION OF BLUMSHAPIRO BED SIZE BED SIZE BED SIZE BED SIZE AVERAGE PAYMENT ANALYSIS OF NURSING HOME PER DIEMS December 31, 2012 RANGE RANGE RANGE RANGE AT CMI 1.00 INDIRECT CARE > Indirect Care - Benefits Fuel Gas Electricity Insurance Salaries - Plant Operations and Maintenance Salaries - Dietary Purchased Dietary Services Salaries - Laundry & Linen Purchased Laundry & Linen Services Salaries - Housekeeping Purchased Housekeeping Services A Other Labor, Salaries, and Fees Office Supplies & Printing Communications Travel - Motor Vehicle Conventions & Meetings A Education and Seminars Advertising & Public Relations A Advertising - Help Wanted Licenses & Dues Home/Central Office State Franchise Tax Miscellaneous Water & Sewage Maintenance Supplies Purchased Services and Repairs Dietary Supplies Linens and Bedding Supplies Laundry Supplies Housekeeping Supplies Other Expenses Recreational Supplies Other Physicians' Salaries or Fees

9 SULLIVAN & COMPANY CPAs AVERAGE AVERAGE AVERAGE AVERAGE OVERALL MEDICAID A DIVISION OF BLUMSHAPIRO BED SIZE BED SIZE BED SIZE BED SIZE AVERAGE PAYMENT ANALYSIS OF NURSING HOME PER DIEMS December 31, 2012 RANGE RANGE RANGE RANGE AT CMI > Administrative Salaries Purchased Services A Utilization Review Medicaid Title XIX A Miscellaneous Labor & Payroll Related Dietary Consultant Pharmacist - Salaries or Fees TOTAL INDIRECT CARE HEALTH CARE PROVIDER ASSESSMENT Based Upon 8470 Provider Assessment Medicaid Rate PROPERTY TAXES 1451 Real Estate Taxes A Personal Property Taxes B Fire Tax TOTAL PROPERTY TAXES Facility Specific OTHER PROPERTY RELATED 3452 All Interest Rent A Lease/Rental of Equipment Amortization and Depreciation TOTAL OTHER PROPERTY RELATED Facility Specific TOTAL OPERATING EXPENSES

10 SULLIVAN & COMPANY CPAs AVERAGE AVERAGE AVERAGE AVERAGE OVERALL MEDICAID A DIVISION OF BLUMSHAPIRO BED SIZE BED SIZE BED SIZE BED SIZE AVERAGE PAYMENT ANALYSIS OF NURSING HOME PER DIEMS December 31, 2012 RANGE RANGE RANGE RANGE AT CMI > SUMMARY OF PER DIEMS BY COST CENTER DIRECT CARE - NURSING DIRECT CARE - OTHER DIRECT CARE - NON-MEDICAID ANCILLARIES TOTAL DIRECT CARE INDIRECT CARE HEALTH CARE PROVIDER ASSESSMENT PROPERTY TAXES OTHER PROPERTY RELATED TOTAL OPERATING EXPENSES PERCENTAGE OF OCCUPANCY FRINGE BENEFIT RATIO 94.7% 90.3% 93.9% 92.6% 93.0% 24.1% 24.7% 23.6% 23.8% 23.6%