Congressional Democrats and Republicans Work Overtime to Meld Two Reform Plans That Offer Much for Eldercare

Senate Democrats were planning to meet to determine what route to take with healthcare reform following Massachusetts Republican Scott Brown’s January 19 Senate upset, as this issue of Annals of Long-Term Care went to press. Senate and House Democrats had been working overtime to try to reconcile differences between the chambers’ healthcare reform plans, but the Republican victory in Massachusetts makes it doubtful that Senate Democrats will be able to muster the 60 votes needed to surmount an anticipated Republican filibuster. When Brown takes office, Democrats will have only 59 votes in the Senate.

Leading Democrats had been reporting “significant progress in bridging remaining gaps” between the House and Senate reform packages. Key issues in negotiations included how to pay for reforms, whether to establish a single national health insurance “exchange” or numerous state exchanges, and what kind of subsidies to provide and to whom.

Both the House and Senate reform plans include provisions that would improve elder healthcare in a wide variety of ways. The AGS—which has long advocated for policies aimed at ensuring older adults access to quality, cost-effective care that meets their unique needs—will continue to advocate for such policy. (See related story below.)

Among other issues, the House plan would help address eldercare workforce shortages by establishing a Workforce Advisory Committee, redistributing unused Graduate Medical Education (GME) slots to increase access to primary care residencies, and creating training programs for direct-care workers and family caregivers. The House reform package would also begin to address Medicare payment policies that are disincentives to caring for older adults. It would, for example, make geriatricians eligible for a proposed primary care incentive payment of 5-10% by adding “specialization in geriatrics” to a list of qualifications for designation as a primary care practitioner. The House plan also calls for the reevaluation of Medicare payments for physician services that may be inappropriately valued. In addition, it would improve care coordination for older patients through “medical home” and related pilot programs, and through the extension of Medicare Special Needs Plans.

Like the House plan, the Senate reform package calls for bonuses for geriatricians and other primary care practitioners. It would also reevaluate inappropriately valued Medicare payments for physician services. Like the House version, the Senate plan includes provisions that would establish agencies to analyze and address eldercare workforce shortages, redistribute unused GME slots to boost primary care residency slots, and create training programs for direct-care workers and family caregivers. Senate provisions would also test, evaluate, and expand new provider payment models to encourage patient-centered care, improve quality, and slow increases in Medicare outlays. These models may include those providing geriatric assessment and care coordination and comprehensive transitional care for seniors at high risk of functional decline.

Other provisions in the Senate plan would focus on reducing hospital-acquired infections and preventable hospital readmissions, and require the Department of Health and Human Services to develop a national strategy for quality improvement. The package would expand the Geriatric Academic Career Awards program, fund Geriatric Career Incentive Awards for junior medical faculty pursuing academic careers in geriatrics, and enable Geriatric Education Centers to offer courses in geriatrics, chronic care management, and long-term care. In addition, the upper chamber’s plan would establish federal traineeships to prepare healthcare providers for advanced degrees in geriatric nursing, long-term care, and geropsychological nursing.

If you haven’t already done so, please join the Society’s efforts to ensure that these and other “geriatrics-friendly” provisions become policy by registering with AGS’ Health in Aging Advocacy Center, at http://capwiz.com/geriatrics/home/. The center makes advocacy work on behalf of quality eldercare quick and easy.

In Letter to President, AGS Hails 2010 Funding Increases For Geriatrics Training and Research, Asks for Adequate 2011 Budgets

In a January letter to the President, the AGS hailed Mr. Obama and Congress for proposing and approving increased funding for key elder healthcare agencies and programs, and encouraged him to “continue to prioritize programs and policies that will meet the unique healthcare needs of the rapidly growing population of older Americans.”

The letter lauded the President and lawmakers for boosting funding for Title VII geriatrics healthcare professions programs, the National Institute on Aging (NIA), and the Veterans Affairs Office of Research and Development (VA ORD) in fiscal year 2010.

Mr. Obama requested nearly $42 million for Title VII geriatrics healthcare professions programs in FY 2010, a substantial increase from the programs’ $31 million FY 2009 budget. Congress ultimately approved $33.7 million for the programs, which include the Geriatrics Academic Career Awards, the nation’s Geriatric Education Centers, and geriatric faculty fellowships. The NIA’s $1.11 billion FY 2010 budget reflects an increase of more than $29.34 million over FY 2009, and the federal economic stimulus plan includes an additional $275 million for the NIA through FY 2010. The VA ORD saw a more than $70 million increase in funding in FY 2010, which boosted its budget to $581 million.

The January 7 letter, signed by AGS President Cheryl Phillips, MD, asks that the President provide “the highest possible funding levels” for Title VII programs, Title VIII nursing programs, the NIA, and VA ORD in FY 2011. Noting that the healthcare reform plans the House and Senate have approved include several “crucial proposals to expand programs under Title VII and Title VIII that will increase the capacity of our nation’s geriatrics healthcare workforce,” the letter also requests that sufficient funds be budgeted to implement these proposals.

Congress Postpones SGR Cut Until March; AGS Continues to Advocate for SGR Alternative

The House and Senate voted in late December to approve a measure postponing a mandated 21.2% cut in Medicare payments to physicians until March 1 of this year. The pay cut, mandated by Medicare’s contentious Sustainable Growth Rate (SGR) formula, was slated to take effect January 1. The AGS, which has long called for an alternative to the SGR, hailed lawmakers for the move and again urged a substitute for the problematic formula.

The House earlier approved a bill to block the 21.2% cut and replace the SGR with a new reimbursement protocol. In keeping with the protocol, expenditures for most physicians’ services could increase as much as gross domestic product (GDP) plus 1% each year. To support primary and preventive care— which could result in earlier diagnosis and treatment of illnesses that can be more costly if treated later—Medicare payments for preventive and primary care services could increase as much as GDP plus 2%.

The bill is now before the Senate, but how it will fare there is still unclear. In October the Senate failed to muster the necessary votes to advance a proposal of its own that would have eliminated the SGR. Opponents in the upper house objected because the cost of the measure wasn’t offset by spending cuts or increased taxes. The House legislation, in contrast, is tied to statutory “Pay As You Go” rules and would require Congress to pass a binding law that would force it to offset new spending in any bill. But concerns that fiscal conservatives in the Senate will balk at the measure remain.

Following the Congressional vote, the Centers for Medicare and Medicaid Services (CMS) extended the deadline for physicians to enroll in or withdraw from Medicare for 2010—from January 31 to March 17. CMS also applied Relative Value Unit (RVU) increases to the pre- and post-service work for 10-day and 90-day global surgery codes. AGS estimates that increases in payments for 10-day and 90-day global services due specifically to this change will be small—just slightly more than 0.1% of total Medicare spending for physician services.

AGS Leaders Have Fruitful Meetings With AoA Chief, White House Staff Involved in Aging Policy

AGS President Cheryl Phillips, MD, and other Society leaders met with U.S. Assistant Secretary for Aging Kathy Greenlee and White House staff in December to discuss the unique role of geriatrics, public policy that supports eldercare, healthcare reform, and how the AGS can help federal officials advance quality care for seniors.

During the meeting, AGS leaders discussed eldercare workforce issues, interdisciplinary care, the value of the medical home model, appropriate transitions of care, chronic care management, and quality measures. They emphasized that members of the Society are expert sources of information about eldercare and that AGS is interested in assisting the administration in any way possible.

AGS leaders later met with Ann Widger, White House Deputy Associate Director of Public Engagement, and Caya Lewis, MPH, Director of Outreach and Public Health Policy in the HHS Office of Health Reform. Both staffers are integrally involved in efforts concerning healthcare for older adults.

“In our meeting with Ms. Widger and Ms. Lewis, we thanked the Administration for supporting Title VII and VIII, for increasing National Institute on Aging funding, and for supporting CMS payment scale changes,” Dr. Phillips said. (See related stories above.) “We also explained that we are very supportive of House and Senate healthcare reform provisions that would enhance care for seniors. We indicated our desire to partner with the Administration as experts when it’s time to implement changes in our healthcare system.”

Following these meetings, White House staff invited Dr. Phillips to a session at which President Barack Obama announced that he was allocating $600 million in stimulus funds for community health centers and a “medical home” demonstration project. “The idea here is very simple: that in order for care to be effective it needs to be coordinated,” President Obama noted. AGS has long supported and advocated for enhanced support for coordinated care for older adults, which is what the medical home demonstration project will investigate.

After the President’s announcement, Dr. Phillips again spoke with Ms. Lewis. “She volunteered that her meeting with the AGS team really caused her to think hard about where we might be able to do more work together,” said Dr. Phillips. “Ms. Lewis introduced me to another staffer involved in White House healthcare reform issues. It was a very productive (visit).”