BY RICK JURGENS

Granite State News Collaborative

New Hampshire officials plan to give nursing home owners and operators more control of a program that searches for signs of COVID-19 among 10,000 employees in the state’s high-level care facilities. 

But some of the people running the 75 nursing homes in the state are worried about uncertain test costs and the threat of large deficits.

The surveillance program aims to detect the presence of COVID before it can spread among the residents and staff of a facility. Currently, HHS coordinates a program under which nursing homes collect samples from staff and residents. Those samples are sent for testing at a laboratory in Dartmouth-Hitchcock Medical Center in Lebanon and other laboratories. The state pays the bill.

Health and Human Services Commissioner Lori Shibinette said Wednesday in a Zoom session with nursing home operators that in order to give them “more control over when and who they test,” the state would “move our surveillance program into a self-directed program.” 

The state, which since June has been picking up the tab for surveillance testing, would provide “some funding,” Shibinette added. 

But some nursing home operators say the proposed funding -- $100 a test -- won't cover the $175 they currently pay commercial laboratories for each test, and worry that they lack the bargaining power to cut better deals with big laboratory companies.

The program will change after a transition set to begin Oct. 12 and be completed by Oct. 26, Shibinette said. The state will step back from coordinating testing or paying directly to have samples analyzed at DHMC and other labs. The testing cycle, which currently aims to reach all staff members every 10 days, will be stretched out to reach all staff members monthly and a few – about 10% – each week. And residents will no longer be included in the surveillance testing program. That’s because the surveillance program has mostly been successful in identifying COVID among staff, Shibinette said.

The state will continue to operate a parallel program in which HHS oversees testing of all residents and staff in residences where COVID has been identified.

The prospect of financial shortfalls has dampened the enthusiasm of some of the nursing home operators who the state identifies as the beneficiaries of greater flexibility. “We’d love it if the state continued to do what they’re doing,” said Tom Argue, chief executive of Webster at Rye, a Rockingham County nonprofit that operates a 61-bed nursing home. 

Nursing homes have been ground zero for the COVID pandemic in New Hampshire. Of the 438 deaths attributed to COVID, 357, or 81.5%, occurred in nursing homes or other long-term care facilities, according to HHS. Surveillance testing played an important role in reversing that deadly trend, according to Shibinette. No COVID deaths have occurred in New Hampshire in the past week, according to HHS.

At a news conference on Thursday, Gov. Chris Sununu emphasized the success of the testing program to date. “We’re rocking it,” he said. We’re proud of what we’re doing.”

 New Hampshire’s nursing home surveillance testing began June 1 when a no-bid contract for up to $6 million and one year took effect with a small North Carolina limited liability company named Mako Medical Laboratories. In late July, the state transferred the contract from Mako to Dartmouth-Hitchcock, which committed to do up to 600 tests a day in its laboratory.

But starting in October, each nursing home owner or operator will need to line up its own testing partner. That could prove burdensome, said Brendan Williams, chief executive of the New Hampshire Health Care Association, an organization that represents owners of nursing homes and other senior living facilities. “I worry about my smaller members who don’t have the scale to negotiate with (a) laboratory,” he said.

Shibinette said that New Hampshire has budgeted to reimburse nursing homes $100 for each surveillance test through the end of the year. Surveillance testing will be “still a very robust program that is very much supported by state resources,” she added.

But Lisa Henderson, executive director of LeadingAge Maine and New Hampshire, an organization of nonprofit senior living providers, said that she had heard from caregivers that the current “price on the street” for the PCR tests that are used for surveillance is about $175.

Argue, the CEO at Webster at Rye, which has 160 employees in a facility that also has 89 beds of assisted living and memory care, said that the difference could add $187,000 of red ink onto his organization’s annual budget.

Anne Purrington, the chief executive of Presidential Oaks, which operates an 85-bed nursing home in Concord, wrote in a chat comment in the Zoom session that the proposed reimbursement rate could, on an annual basis, add to her annual budget up to $125,000 in new and unreimbursed costs: “This is not sustainable."

New Hampshire authorities have had an extended courtship with testers. Under its contract, Mako billed New Hampshire $70 a test. But the Mako program, which involved sending thousands of samples collected in New Hampshire nursing homes to a laboratory 700 miles away, generated complaints about inaccuracies and delays in test results.

The surveillance program “had some bumps at the beginning but it’s gone remarkably smoothly” since D-H took over testing, Argue said.

Jake Leon, an HHS spokesman, said that D-H has been "a good partner on surveillance testing," has had a turnaround time for test results of "about one day" and will continue doing testing for surveillance in "other institutional or congregate settings."

D-H also gave the state a bargain, according to a contract amendment dated Sept. 1. Each test at D-H cost $65.

At the news conference with Sununu on Thursday, Shibinette said that after accounting for testing done at other laboratories HHS had been paying an average of about $100 a test and that she was confident that "most facilities can go out and negotiate with the commercial laboratories for about that amount."

The new program will require monthly testing of all nursing home staff, complemented by weekly tests of 10% of facility staff. That change promises to ease the workload of nursing home managers who, under the current program, need to make all employees available for a test once every 10 days. The 10-day test cycle also includes 10% of residents.

Slowing the rate of nursing home testing could help the state extend surveillance testing to other vulnerable populations including seniors in assisted living facilities, homeless people and inmates, Shibinette said.

The testing shift comes as the COVID pandemic lingers, commitments to public health measures waver and the vaccine pipeline has yet to produce a safe and effective counter to the virus. “COVID-19 is still out there,” Benjamin Chan, the state epidemiologist, said in the Zoom session. “It’s still spreading.” 

“People are relaxing social distancing,” Chan added. “We can expect to see more community transition for that reason."

For New Hampshire nursing homes, which have historically coped with low reimbursements for a population in which residents covered by the state-federal Medicaid program predominate, the pandemic has been a budget buster. For example, Webster at Rye has posted monthly deficits of about $150,000 during the time of COVID, according to Argue.

The financial pressures continue to mount in an industry that provides critical care to 7,000 elderly and disabled residents in the state. Said Williams, of the nursing home trade association: “The entire sector is teetering, and we will see facility fire sales and closures.”

Contact Rick Jurgens at rjurgens_2000@yahoo.com or 802-281-6641

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