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Department

Apr-08

April 2008

Doctors Seeing Fewer Medicare Patients Due to Threat of July 1 Medicare Physician Fee Cut; AGS Launches New Advocacy Campaign to Block the Cut

Nearly 25% of medical group practices responding to a recent national survey said they had either begun to limit the number of Medicare patients they treat or are not accepting any new Medicare patients, due to uncertainty surrounding Medicare payment rates, according to Congressional Quarterly’s “HealthBeat.”

The American Geriatrics Society (AGS) has launched a new advocacy campaign urging Congress to block the July 1 cut. For more information, and to join the campaign, visit www.healthinaging.org.

Nearly half of the more than 1000 practices responding to the recent Medical Group Management Association (MGMA) survey reported that the 10.6 % cut in Medicare physician payments scheduled to take effect July 1 had led them to stop accepting or to limit the number of beneficiaries they accept. Congress voted in December to delay for six months a mandated 10.1% Medicare physician pay cut scheduled to take effect January 1, and to substitute a 0.5% increase—setting the stage for the larger 10.6% cut slated to kick in July 1. Medicare's controversial Sustainable Growth Rate formula mandates cuts in Medicare payments to physicians when increases in these outlays exceed growth in Gross Domestic Product. Congress’ December vote to delay the pay cut followed sustained advocacy efforts, by the AGS, its members, and others, urging lawmakers to avert the cut and revise the process by which Medicare payments to physicians are determined.

Sen. Boxer Introduces Geriatrics Loan Forgiveness and Training Legislation in Senate, and AGS Endorses Bill; Washington Post Reports on Bill, Shortage of Geriatrics Professionals, and AGS’ Advocacy Work

To help alleviate the growing shortage of geriatrics healthcare providers, Sen. Barbara Boxer (D-CA) introduced legislation (S. 2708) on March 4, 2008, that would create a loan forgiveness program for professionals who complete training in geriatrics or gerontology and care for older adults for at least two years afterward. Her “Caring for an Aging America Act” would also expand training and advancement opportunities for long-term care workers. It would earmark $130 million in federal funds for the initiatives over five years.

The AGS, the National Council on Aging, the Alzheimer’s Association, and the Alliance for Aging Research were among the organizations working with Sen. Boxer on the legislation, and among the first to endorse it. AGS has long advocated for loan forgiveness programs for geriatrics healthcare providers.

An article about the loan forgiveness bill in the Washington Post, in fact, noted that AGS has advocated “aggressively” for measures such as Sen. Boxer’s, as well as for the Geriatric Assessment and Chronic Care Coordination Act (S. 1340) that Sen. Blanche Lincoln (D-AR) has introduced. The Post story reported the current shortage of geriatrics healthcare providers and added that the supply of these providers is “falling seriously behind needed levels.”

In its advocacy efforts on behalf of geriatric loan forgiveness, AGS has long noted that, given lower-than-market-rate Medicare reimbursement rates, a career focused on caring for older adults can be particularly financially unattractive for physicians with increasingly large medical school loan debts. A loan forgiveness program would provide the incentives needed to bring more providers into the field of geriatrics.

Under Sen. Boxer’s legislation, those eligible for loan forgiveness would be physicians, physician assistants, advance practice nurses, psychologists, and social workers who complete specialty training in geriatrics or gerontology, and who agree to provide care for older adults full time for a minimum of two years. The bill would also expand the Nursing Education Loan Repayment Program to include registered nurses who complete specialty training and work with older adults in long-term care.

Sen. Boxer’s bill would also expand career opportunities for nursing and direct care workers by offering specialty training in long-term care through the existing Career Ladders Grants Program. Finally, the measure would create the Health and Long-Term Care Workforce Advisory Panel for an Aging America, which would examine and advise the Secretary of Health and Human Services, the Secretary of Labor, and Congress on workforce issues related to elder healthcare.

President’s Proposed Budget, Which Would Dramatically Cut Medicare Spending and Eliminate Funds for Title VII Geriatrics Health Professions Programs, Draws Fire From Supporters of Quality Senior Healthcare

President Bush’s proposed $3.1 trillion budget—which would cut Medicare and Medicaid spending $196 billion over the next five years and eliminate all funding for Title VII Health Professions Programs, including Geriatrics Health Professions Programs—drew criticism from Congressional Democrats and advocates of quality healthcare for older adults.

Under the spending plan, most of the Medicare savings would come from freezing reimbursement rates for participating healthcare providers for three years and cutting payments to hospitals serving large numbers of the uninsured poor. Critical Title VII geriatrics training programs—geriatric faculty fellowships, geriatric academic career awards, and the nation's 50 Geriatric Education Centers—would receive no federal funding in fiscal year (FY) 2009.

Senate Democrats immediately challenged the “unrealistic assumptions” underlying the President’s proposed budget, according to Congressional Quarterly Today. “The Medicare cuts are not realistic,” said Sen. Pat Roberts (R-KS), criticizing provisions that would freeze or cut payments to providers and hospitals. "I urge you to take another look at that, ‘cause it's just not gonna happen.”

Title VII Geriatrics Health Professions Programs are so essential to ensuring older Americans’ access to appropriate healthcare, now and in the future, that policymakers should reconsider the impact of cutting funding to the programs, Sen. Blanche Lincoln (D-AR) told Department of Health and Human Services Secretary Mike Leavitt during a Senate Finance Committee hearing the day after President Bush unveiled his budget.

Two members of the House, Reps. Diana DeGette (D-CO) and Cathy McMorris Rodgers (R-WA) subsequently circulated, and numerous representatives signed, a Title VII "Dear Colleague" letter urging others in the chamber to earmark funds for Title VII programs in FY 2009. Geriatrics Health Professions Programs will receive $31 million in federal funding this fiscal year.

On the heels of AGS’ and other advocacy campaigns on behalf of appropriate Medicare reimbursement for providers, Congress has blocked mandated cuts in these payments, and instituted pay increases, several times in recent years. This past December, legislators voted to delay for six months a mandated 10.1% cut in Medicare physician pay rates that was slated for January 1, and increase these payments 0.5% through June 30. (See related story above.)

Congress eliminated 2006 funds for Title VII Geriatrics Health Professions Programs—with disastrous results—but restored 2007 funding and allocated $30 million for the programs for 2008, in the wake of numerous AGS and the Association of Directors of Geriatric Academic Programs (ADGAP) advocacy campaigns on behalf of the programs.

The President's budget proposal is only a blueprint. Ultimately, Congress appropriates funds in its lengthy budget process. AGS will continue to advocate for adequate Medicare reimbursement for physicians, Title VII Geriatrics Health Professions Programs funding, and other programs and initiatives central to providing appropriate healthcare for older Americans.

GAO Study Finds Decline in American Doctors Choosing Primary Care; Overall Growth in Field Due to Increase in International Students

Though the number of primary care physicians in the U.S. is growing, this is due, increasingly, to a rising influx of international physicians into the field. Fewer American physicians, a recent General Accountability Office (GAO) report concludes, are choosing primary care.

In 2006, there were 22,146 American doctors in U.S. residency programs specializing in primary care, down from 23,801 in 1995. The number of international medical graduates training in primary care, however, grew from 13,025 in 1995 to 15,565 in 2006, according to the GAO report.

The report also found that the number of American doctors training to be specialists increased from 45,300 in 1995 to 47,575 in 2006. The number of international physicians training to be specialists grew as well, from 11,957 to 12,611 over the same time period.

“There are simply not enough primary-care providers now, and the situation will become far worse in the future unless we do something,” Sen. Bernie Sanders (D-VT) told the Associated Press. He recommended doubling funds for the National Health Service Corps to $250 million next year. The program offers scholarships to students who agree to practice primary care in areas that need it most.

Senate and House Introduce President's Controversial Medicare “Trigger” Bill

As required by law, the House and Senate introduced President Bush's controversial Medicare “trigger” plan in Congress in late February. The plan would, among other things, increase Medicare prescription drug benefit premiums for higher-income beneficiaries, require healthcare providers to use electronic health records (EHR), and cap non-economic damages in medical malpractice suits.

Under the “trigger” provisions of the Medicare Modernization Act of 2003, Medicare Trustees are required to estimate the year in which general revenues will exceed 45% of total Medicare spending. If, in two consecutive years, the trustees project the 45% level will be reached within the next seven years, they must issue a warning that requires the President to propose changes to cut general revenues as a share of Medicare spending. The warning, issued last April, also requires Congress to consider the President's proposal in an expedited fashion.

Majority Leader Steny Hoyer (D-MD) and Minority Leader John Boehner (R-OH) introduced the proposal in the House; Finance Committee Chair Max Baucus (D-MT) and Senator Judd Gregg (R-NH) introduced it in the Senate. Rep. Hoyer and Sen. Baucus noted that they were introducing the plan because they were required to do so, not because they supported it.

The response among certain Republican legislators, however, was positive. “[For] too long, the only so-called solutions offered for dealing with Medicare’s economic woes have been to simply ignore the problem,” said Minority Whip Roy Blunt (R-MO). “The proposed reforms introduced today mark a break from that sad trend.”

In the House, the Ways and Means and Energy and Commerce committees share jurisdiction over the bill. Ways and Means Committee Chair Pete Stark (D-CA) said the Democratic leadership in the House would ultimately decide what ends up in the bill. Under Medicare law, the House must release the bill by June 30, and vote soon afterward.

In the Senate, the Finance Committee has jurisdiction over the proposal. “It’ll be different when it comes out of the committee,” said Sen. Baucus, who added that, rather than focus on the President's bill, he plans to work on his own Medicare legislation this year. “That bill will increase access to preventative benefits and primary care, and will improve the quality of care delivered under the program,” he said.

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