Annals of Long Term Care

Healthcare Reform Becomes Law, Offers Many Benefits for Seniors, Geriatrics Healthcare Providers
Capping a contentious, more than year-long effort, President Obama signed sweeping healthcare reform provisions into law in late March. Among other provisions, the Patient Protection and Affordable Care Act (PPACA) includes a wide range of measures that will benefit older adults, the healthcare providers who care for them, and the field of geriatrics.

“The new reform law, while not perfect, has a great deal to offer geriatrics,” says American Geriatrics Society (AGS) President Sharon A. Brangman, MD. “Thanks to the tireless advocacy efforts of AGS’s leadership, staff, members, and other champions of quality eldercare, the law includes numerous provisions that are good for seniors, good for geriatrics healthcare providers, and good for our field.”

For starters, the new law will begin to tackle two leading contributors to geriatrics workforce shortages: insufficient Medicare reimbursement and inadequate training opportunities. To address the former, the Act will offer geriatricians and other primary care providers a 10% Medicare bonus payment for specified primary care services for five years, beginning next year. It will also institute periodic reviews of physician services that appear to be inappropriately valued, and establish a physician “value-based payment program” that offers financial rewards for quality improvement.

To tackle serious and widespread shortages of geriatrics healthcare providers, the health reform law takes a number of approaches. It will expand programs at Geriatric Education Centers (GECs) and open the Geriatric Academic Career Awards (GACA) program to build additional capacity and enhance the capabilities of additional health professionals on the geriatrics team, including physicians, advanced practice nurses, physician assistants, pharmacists, psychologists, and clinical social workers. The Act will create new training programs for direct-care workers and family caregivers. It will boost authorized funding levels for the National Health Service Corps, and it will institute a Graduate Medical Education policy that allows the reallocation of unused training slots in ways designed to increase the ranks of geriatricians and other primary care practitioners.

The new law will also enhance several benefits for those enrolled in Medicare. It guarantees basic benefits for all Medicare enrollees and makes preventive services free for most. It also shrinks the Part D “donut hole” coverage gap a bit more each year, closing it entirely by 2020.

To enhance care for the most vulnerable older adults, the reform law will step up the evaluation and implementation of promising new models of care for complex older patients who have multiple chronic illnesses or cognitive deficits, or who are homebound. These include models that provide interdisciplinary team care in the office and in seniors’ homes.

The new law also includes provisions to improve care transitions and enhance continuity of care for older adults who are seen by multiple healthcare providers or who receive care in multiple settings. Improving continuity of care during transitions from, for example, home to hospital to rehabilitation faculty and home again, can significantly improve outcomes and lower risks of hospital readmissions—especially for seniors who have many health problems or who take multiple medications.

The healthcare reform law will help address long-term care (LTC) needs in a couple of important ways as well. It will establish a voluntary, public LTC insurance program, known as the Community Living Assistance Services and Supports (CLASS) program. Designed to create a large risk pool, the program will be open to all workers age 18 years and older.