GCCMA Reintroduction Brings Promise of Reform

In the past, Medicare policies have often been designed with great emphasis on acute care, to the diminishment or exclusion of the overwhelming need for care that manages the complex overlap of chronic conditions in millions of older adults. Last June, in an encouraging sign, the Geriatric and Chronic Care Management Act (GCCMA) (S. 2593) was introduced in both chambers of Congress, picking up where the 2003 Geriatric Care Act (S. 387/H.R. 102) left off.

As we indicated previously in this column, AGS joined the American College of Physicians, the American Academy of Family Physicians, the Alzheimer’s Association, and other groups in vigorously supporting the GCCMA, but in an election year crowded with other priorities, no action was taken on the bill. Fortunately, Senator Blanche Lincoln (D-AR) again took the lead as our ally in attempting to steer Medicare reforms toward coverage of geriatric assessment and chronic care management services. On January 24, she was joined by cosponsors Jeff Bingaman (D-NM), Patty Murray (D-WA), Mary Landrieu (D-LA), Barbara Boxer (D-CA), Paul Sarbanes (D-MD), and Susan Collins (R-ME) in the reintroduction of the bill, now S. 40. Representative Gene Green (D-TX) introduced a companion bill in the House.

If enacted, the GCCMA will direct Medicare to help physicians manage the sizeable costs and time-consuming logistics of caring for the chronically ill. The bill spells out key data on this population’s chronic care needs: 82% have at least one chronic condition; two-thirds have more than one; and 20% have more than five. This last group accounts for more than two-thirds of all Medicare spending. This presents an open-ended series of challenges to geriatrics health care professionals across the country, who depend on Medicare to keep their practices solvent but can’t currently bill for much of the work associated with chronic care management and can’t bill adequately for geriatric assessment, as well as policymakers who must update the system to serve the needs of both beneficiaries and their providers.

The bill accurately states that chronic care coordination services are not explicitly recognized and specifically paid for under current provisions, that physicians are “incentivized to provide episodic care and to generate more individual patient visits to the doctor’s office and hospital for separately reimbursed tests and procedures.” Additionally, as in last year’s version, the bill also attempts to integrate the concept of geriatric assessment as a billable service into the debate over Medicare, an important step that raises awareness of some of the unheralded work of geriatric care providers.

At the heart of the GCCMA is the following statement: “We must redesign the Medicare system to provide high-quality, cost-effective care to a growing population: elderly individuals with multiple chronic conditions.” Such reforms have for years been a major goal of the American Geriatrics Society’s grassroots and advocacy efforts, and we are pleased to see progress, however incremental, on this front. Please continue to visit the public policy section of www.americangeriatrics.org for detailed information and updates on the bill, and do not hesitate to contact your state congressional officials to express your support.

Regards,
Linda Hiddemen Barondess
Executive Vice-President