AGS Viewpoint

Dear Readers,

As part of its sustained efforts to support and shape a legislative and regulatory agenda that makes geriatric care more viable, the American Geriatrics Society submits yearly comments to the Centers for Medicare and Medicaid Services (CMS) in response to its proposed regulations on Medicare payments to providers.

For the past two years, the AGS has partnered with the American Medical Directors Association (AMDA) to change the regulations to provide adequate payments to providers serving patients in the long-term care setting. In 2003, CMS recommended sharp cuts in multiple payment areas, or codes, to providers serving the nation’s nursing homes. AGS and AMDA collaborated to get CMS to withdraw the reductions. This year, CMS has recommended, on average, a 10% decrease in the nursing home payments. On a positive note, it is less of a decrease than the roughly 17% proposed last year. Still, we at AGS feel that a decrease is not merited based on the extensive work provided by long-term care providers and their ever-expanding patient load. In response, AGS is working again to get CMS to withdraw the decrease altogether.

At this time, it remains unclear whether we will be successful. On September 24, AGS wrote a letter to CMS officials that clearly articulated the potential harm of a decrease. CMS’ reductions in payments “will result in a significant decrease in the Medicare payment for nursing facility services, decreasing payments for various CPT codes associated with nursing facility visits,” the letter stated. We took care to give a nod to CMS’ response to comments our organizations submitted in 2003, when officials reconsidered the clinical staff time for various nursing facility codes. But the letter pointed out that this year’s recommendations for nursing home services continue to represent an overall decrease of 7%-10% in some cases.

“We believe this change is unwarranted,” the letter read, “as considerable office practice expenses associated with physician nursing home oversight continue to be undervalued.” As you know, work performed by the clinical staff of nursing home physicians in obtaining mandatory documentation and maintaining office records relating to the physicians’ plan of care is protracted and expensive, with frequent inter-visit clinical contacts with nursing facility clinical staff. The current recommendations include pre-/post-services times that we do not believe adequately reflect actual experience. Those who routinely provide care of nursing facility residents and office patients know that nursing facility supplemental work carries unique, inherent complexities that are often more time-consuming than office visits.

While success in this area is incremental and far from a sure bet, AGS will continue to advocate Medicare policies that strengthen care for older adults. We will spotlight the needs of long-term care providers that are not being met and continue our uphill battle for payments that alleviate the burden on them. As always, we welcome your input on how to do so.

Regards,
Linda Hiddemen Barondess Executive Vice President