Letter: Clearing up misconceptions about Health and Hospital

We write to address misconceptions that seem to have developed regarding nursing facilities owned by Health and Hospital Corporation of Marion County. Two of us are board members of HHC, three are board members of the Eskenazi Health Foundation and one is a former United States Attorney familiar with both health care fraud investigations and health care funding structures.

Our information is drawn from data and other information publicly available to those wishing to explore it.

Recent newspaper reports suggest that the quality of care in HHC’s nursing homes is low. The fact is that HHC’s nursing facilities provide extraordinarily high-quality care to their residents. Numerous independent sources confirm this. For example, 86% of HHC’s nursing facilities are rated four or five stars (the highest ratings) for the quality of resident care by the federal Centers for Medicaid and Medicare Services. CMS uses 16 measures, audited by the federal government, to rate the quality of resident care, demonstrating whether facilities actually achieve positive outcomes for patients. HHC’s average CMS quality-of-resident care rating, 4.45 stars, greatly exceeds the Indiana and national averages.

The Indiana State Department of Health inspects Indiana’s nursing facilities and provides each with a score. HHC’s average score is again significantly better than the statewide average—and the only two Indiana nursing facilities receiving a deficiency-free survey in 2020 are both owned by HHC. Since the COVID-19 pandemic started, the Indiana State Department of Health and CMS have conducted over 115 unannounced infection control surveys at HHC’s nursing facilities, and 97.5% of those surveys found zero deficiencies. Fifty-five of HHC’s 78 nursing facilities have received national awards for quality of care by the American Health Care Association. Importantly, HHC’s nursing facilities provide these exceptional quality outcomes while caring for residents who are much sicker and experience more comorbidities than those in the average Indiana nursing facility.

Recent articles have also suggested that there is something wrong with HHC’s use of federal funding for services to the poor (known as UPL), a program created by Congress decades ago and administered by the federal government in partnership with the states. The use of UPL funds to support care to nursing home residents and improve access to health care for the uninsured and under-insured is exactly what Congress had in mind when it created this perfectly legal program, strongly supported and continually reauthorized by the State of Indiana. UPL funds have made it possible for HHC to hire more skilled and costly staff at its nursing homes, such as respiratory therapists, physical therapists and dietitians—none of which are counted as “staff” in the federal measurement system, but all of which provide highly specialized care critical for patients with significant illnesses and comorbidities. That describes the bulk of the patients cared for by HHC and its management partner for the homes, American Senior Communities. The program has also made it possible for HHC to invest greater than twice the Indiana average in technology, equipment and facilities at its homes.

Our community is extremely fortunate that HHC has been expressly authorized by both our state and federal governments to use a portion of these funds to expand access to quality care at Eskenazi Health to uninsured and under-insured residents of Marion County. Our most vulnerable and under-served populations are able to receive high-quality care at Eskenazi Health, rather than being condemned to an inferior system just because they are poor.

There also seems to be some suggestion that HHC was not fully compensated for its losses after it was victimized over five years ago by the former CEO of American Senior Communities and his co-conspirators. The truth is that the U.S. Attorney’s Office, after an exhaustive investigation, established that the defendants caused $10 million in provable losses to HHC, a finding adopted by the U.S. District Court. HHC was able to recover a full $15.5 million to cover its losses, plus over $3 million in expenses, ensuring that the taxpayers were made whole.

Finally, we wish to express our full support for the tireless and dedicated efforts of HHC’s CEO, Matthew Gutwein, whose commitment to excellent care for nursing home residents as well as patients served by Eskenazi Health is unmatched. We have been concerned about apparent attacks on his integrity, which we know to be of the highest order and beyond reproach. Marion County and Indiana have been extremely fortunate to have the leadership of Mr. Gutwein, and we wish to thank him.

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Gregory S. Fehribach

Dr. James D. Miner

Deborah J. Daniels

Dennis D. Oklak

John T. Thompson