A Sept. 4 IBJ letter to the editor from Messrs. Kleiman, Pelizzari, Smith and Thompson defending the leadership of Matt Gutwein of Indianapolis Health & Hospital Corp. in relation to its nursing centers deserves scrutiny.
Firstly, I want to acknowledge the authors for their non-profit volunteer service in making Indianapolis a better community. Nonetheless, they present an incomplete picture of HHC’s gross administrative, ethical and moral lapses in diverting revenue from its proprietary nursing centers across the state to fund HHC.
This financial shell game relies upon non-state-governmental entities like HHC purchasing nursing centers to tap a “supplemental” Medicaid rate through a peculiar section in federal regulations. As the authors note, “This is something done throughout the country. It is perfectly legal, and it is up to Congress to change the law if change is warranted.” Well. The health care sector as it serves everyone should uphold itself to higher standards: ubiquity and technical legality does not provide ethical or moral cover, nor make for good policy.
The original intent of the supplemental rate was to improve care and quality of life within the actual nursing center. Medicaid does not cover the full cost of care, especially in nursing centers. HHC’s scheme exacerbated this fact by turning the supplemental rate into a new revenue mechanism for hospital corporation projects. Moreover, lacking nursing center expertise, HHC contracted third parties to operate their growing portfolio of purchases. This extra administrative layer diverted yet more monies from patient care and a better quality of life, and as is well known and proven, provided an opportunity for a massive managerial fraud right under HHC’s nose.
With over 30 years of state and national work in nursing center law, I have never seen such callous disregard for aged, poor and seriously ill patients. HHC’s actions and after-the-fact handwringing suggest the only outcome that mattered was the corporation’s coffers, not nursing center patients and staff. Recently, the CFO of HHC assured the Indianapolis City-County Council their nursing centers’ quality metrics were at least in the upper half. To the executive leadership and governing board of HHC, a “C” grade is to be publicly celebrated? Instead of using the supplemental rate to improve nursing center quality, HHC leadership skimmed this new, “technically” legal revenue to hospital projects. We in the health sector have the ethical and moral duty to care for all individuals entrusted to us, not rob from Peter to better Paul.
Currently, the Indiana health care system is grappling with the pandemic, particularly nursing centers. As the Indianapolis Star reported, HHC’s 78 centers (only 14 of which are located within Marion County) reported 419 COVID-19 patient deaths; HHC’s patients constitute 11% of Indiana’s nursing center population, but disproportionately accounted for some 22% of nursing centers’ deaths (not counting employee illness or death).
Nursing centers are not designed to handle pandemics. However, with expert technical assistance they can and do rise to the occasion and many are delivering outstanding safety and care. Eskenazi Hospital has amazing nursing leadership and cutting-edge clinical management that provides innovative pathways and expert clinical outcomes benefiting the Indianapolis community. Were those resources inserted into their nursing centers to meet the unique and novel threats of COVID-19? HHC’s stewardship during the pandemic will require careful, impartial analysis and investigation. If history is any guide, HHC simply saw their nursing centers as a revenue stream whose day-to-day human responsibilities—patients and staff—could be buck-passed to “third-party managers.”
The authors’ letter mentions $135 million in charitable support, and I salute those efforts. My question: How much of that support was directed to nursing center patients? That need and opportunity remains pressing; as proprietors, this is HHC’s responsibility. If anyone deserves letters to the editor in their defense, it is not hospital executives, but rather thousands of our fellow elderly citizens who endured diminished, underfunded care and quality of life under HHC’s ownership.
Medicaid funding for nursing centers has been a very complex problem for far too long; resolution will require significant public policy courage, innovation and investment. The state of Indiana bears much responsibility, but Indianapolis governmental oversight must become real. Everyone in public service and those of us who serve on nonprofit boards have an overwhelming responsibility to moral and ethical decision-making protecting the vulnerable and serving everyone equally.
HHC chose to sail in these turbulent waters, but it did not have to chart such a lamentable course. Do not shed a tear for Mr. Gutwein or his leadership team. It did not have to be that way.
Richard L. Butler