Annals of Long Term Care

In a close 220 to 215 vote, the House of Representatives approved a landmark healthcare reform bill in early November, shortly before this issue of Annals of Long-Term Care went to press. The bill, expected to cost $1.1 trillion over 10 years, would extend healthcare coverage to 36 million currently uninsured Americans and includes important provisions that would significantly improve healthcare for older adults—provisions for which the American Geriatrics Society (AGS) and its members have long advocated.

Among other things, the House bill would help address eldercare workforce shortages by establishing a Workforce Advisory Committee, redistributing unused Graduate Medical Education (GME) slots to boost access to primary care residencies, and creating training programs for direct care workers and family caregivers. The bill also would begin to tackle serious problems with Medicare payments 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. In addition, the bill calls for the reevaluation of Medicare payments for physician services that may be inappropriately valued. The House legislation would also improve care coordination for older patients through "medical home" and related pilot programs, and through the extension of Medicare Special Needs Plans.

Within days of the House approval, Senate Majority Leader Harry Reid (D-NV) announced that he planned to bring his chamber’s health reform proposal to the floor the following week and to finish work on the bill by Christmas. Key Senate lawmakers earlier merged the two Senate reform plans—one drafted by the Senate Finance Committee, the other, by the Senate Health Education Labor and Pensions (HELP) Committee—but had yet to release details about the resulting proposal as of mid-November. As of mid-November, the Congressional Budget Office (CBO) was still analyzing the cost of the proposal. Sen. Reid cannot bring the proposal to the Senate floor until the CBO completes this analysis. Most observers said it was unlikely that the legislation would reach President Obama’s desk before year’s end.

The Senate Finance and HELP reform plans include a wide array of provisions—championed by the AGS—that would also significantly enhance Medicare and eldercare. Like provisions in the House bill, these would offer bonuses to geriatricians and other primary care practitioners and reevaluate inappropriately valued Medicare payments for physician services. As with the House bill, the Senate plans include provisions that would establish an agency to 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. In addition, Senate provisions would evaluate and expand new provider payment models, including those covering care coordination for seniors at high risk of functional decline, and create a pilot program in which physicians and nurse practitioners would direct home-based care teams to provide coordinated care to such seniors. Other provisions in the Senate plans would focus on reducing hospital-acquired infections and preventable hospital readmissions. Senate provisions would also expand the Geriatric Academic Career Awards program; fund Geriatric Career Incentive Awards for junior medical faculty pursuing academic careers in geriatrics; enable Geriatric Education Centers to offer courses in geriatrics, chronic care management, and long-term care; and establish federal traineeships to prepare healthcare providers for advanced degrees in geriatric nursing, long-term care, and geropsychological nursing.

The AGS continues to advocate for these important provisions in the House and Senate proposals.