A looming cut in the amount Medicare reimburses to care for nursing home residents could threaten both access to nursing homes and the quality of care they can provide, says the head of Pennsylvania's skilled nursing home and personal care home trade association.

"Pennsylvania's skilled nursing facilities simply cannot absorb a Medicare cut of this size, especially at a time when their Medicaid reimbursements are so far below the actual cost of care," said physician Stuart Shapiro, president and CEO of the Pennsylvania Health Care Association/Center for Assisted Living Management.

The Harrisburg-based organization represents nursing homes, assisted care and personal care facilities, and related provider services.

Last Friday, officials at the federal Centers of Medicare and Medicaid Services announced an 11.1 percent cut for the fiscal year beginning Oct. 1, saying the lower rates correct earlier, unintended overpayments "and better align Medicare payments with costs."

As a result, Pennsylvania's 730 nursing homes stand to lose close to $200 million in revenue next fiscal year -- and there may be additional cuts due to changes in how services such as rehabilitative therapy are reimbursed.

A week after the government announcement, Dr. Shapiro says nursing home operators are still trying to assess the implications of the cuts, now less than two months away, and what adjustments they'll have to make.

"We think this is certainly going to further escalate the problems of access," he said. Already, he said, hospitals sometimes must call eight to 10 nursing homes to find an available vacancy for a patient on Medicaid.

Nursing homes rely on Medicare revenue to make up for financial losses they must absorb caring for Medicaid residents -- who comprise 65 percent of nursing home residents. Medicare recipients make up about 15 percent of nursing home residents, and those with private insurance represent less than 5 percent of the total. The remainder may be from Veteran's Affairs, managed care or other programs.