Washington Update - June 2008

IOM Releases Report Finding U.S. “Woefully” Unprepared to Care for Aging Population; AGS Chief Testifies Before Congress On Behalf of Healthcare Reforms to Ready Nation for Age Boom

The Institute of Medicine (IOM) released its long-awaited report evaluating the readiness of the nation's healthcare workforce to meet the needs of an aging society April 14. The report, “Retooling for an Aging America; Building the Health Care Workforce,” concludes that the workforce “will be woefully inadequate in its capacity to meet the large demand for health services for older adults if current patterns of care and of the training of providers continue.” It recommends sweeping changes to prevent such a crisis.

Testifying before the Senate Special Committee on Aging two days after the report’s release, AGS Board Chairman Todd Semla, PharmD, urged lawmakers to support initiatives that would address these shortcomings in the nation’s healthcare system. The initiatives, for which AGS has long advocated, parallel many outlined in the IOM report. To increase recruitment into geriatrics, adequately train all healthcare providers who care for older adults, and ensure that older people get appropriate and cost-effective care, the report recommends, among other things, that:

•public and private payers offer a “specific enhancement of reimbursement” for healthcare services to older adults provided by practitioners with a "certification of special expertise in geriatrics.”
•state and federal governments offer loan forgiveness, scholarships, and other financing incentives to professionals who specialize in geriatrics.
•Congress expand the Geriatric Academic Career Award program to support junior geriatrics faculty in other health professions in addition to medicine.
•states and the federal government increase minimum training standards for all direct care workers.
•state Medicaid programs increase pay and benefits for direct care workers, who are poorly paid and often lack basic benefits, to improve recruitment and retention of these workers.
•public, private, and community organizations provide funding and ensure adequate training for family and other informal caregivers.
•Congress and foundations "significantly increase" support for research and demonstration programs that lead to development of new models of care in areas such as prevention, long-term and palliative care, and models of care that promote the effective uses of the workforce.
•public and private payers promote and reward new models of care for older adults that are shown to be effective and efficient. This might include coverage of key services, such as care coordination, that are currently not covered but are integral to quality care and may result in both improved outcomes and savings.
•healthcare professionals and regulators consider expanding the roles and responsibilities of healthcare providers to better meet the needs of an aging population.

“Retooling for an Aging America” could be a turning point in healthcare for older adults in this country, panelists discussing the report at the AGS’s Annual Scientific Meeting in May agreed. To bring about the changes the IOM recommends and effect other needed policy changes, however, advocates of higher-quality, more cost-effective care need to build on the report’s findings, and, most important, press policymakers for change, members of the expert panel concurred.

“AGS is already working toward this goal in a variety of ways,“ said panel moderator and AGS President John Murphy, MD, citing Dr. Semla’s appearance before the Senate Special Committee on Aging, the many interviews he and others in the field have had with media covering the report, and additional AGS efforts. Among other things, more than 150 AGS members met with nearly 80 senators and representatives during the Society’s Annual Scientific Meeting in Washington, DC, to discuss the report and advocate for measures it recommends. To build on the momentum that “Retooling for an Aging America” has generated, AGS will also meet in June with other likeminded organizations to plan collaborative efforts to further the report’s recommendations.

“I’ve been delighted by the response, including the Senate Special Committee on Aging hearing and the tremendous amount of print, radio, and TV attention it’s received,” said panelist John W. Rowe, MD, who chaired the IOM committee that drafted the report. But making real progress will require a concerted effort by everyone committed to ensuring higher quality care for older adults, he added. “We need everyone, including everyone here, to talk with people who can be influential, and bring this message to policy makers.”

President Signs Senior Falls Prevention Legislation

President Bush signed legislation aimed at preventing falls among older adults late last month. The legislation, the “Safety of Seniors Act of 2007” (S 845), was introduced by Sens. Mike Enzi (R-WY) and Barbara Mikulski (D-MD) in the Senate, and Reps. Frank Pallone (D-NJ) and Ralph Hall (R-TX) in the House. It will support the development of public and professional education strategies that raise awareness of and prevent falls in older people; encourage research both to identify older adults at high risk of falling and to evaluate falls interventions; and support demonstration projects aimed at preventing falls.

Falls are a leading cause of injury and death among those over age 65. Among older people, falls account for approximately 13,000 deaths and 1.8 million emergency room visits each year. According to the Centers for Disease Control and Prevention (CDC), the cost of treating injuries older adults sustain in falls exceeds $19 billion annually.

Joining AGS advocacy campaigns on behalf of the legislation, AGS members and other advocates of quality healthcare for older adults urged Congress to pass the bill.

MedPAC Recommends Changes to Medicare Reimbursements for Primary Care and Nursing Facilities; Also Considering a Pilot 'Medical Home' Program

The Medicare Payment Advisory Commission (MedPAC) voted last month to approve several recommendations to Congress concerning Medicare reimbursement for primary care and skilled nursing facilities and is considering recommending a pilot 'medical home' program.

The commission recommended an increase in payments to primary care-focused physicians. It also recommended changes in Medicare payments for skilled nursing facilities. One change would add a "separate non-therapy ancillary component" that includes prescription drugs and intravenous therapy; another would implement a provision for "outlier payments" for unusual financial losses.

The commission also proposed that the Department of Health and Human Services require skilled nursing facilities to report diagnostic information, dates of services on claims filed and "services they furnish separately" on patient assessments.

In addition, MedPAC is considering a recommendation to establish a patient-centered “medical home” Medicare pilot program. The proposal would require primary care physicians participating in the pilot to coordinate services, utilize healthcare information technology, conduct care management, provide access and communication to patients, and maintain updated records of patients' advance directives. The estimated three-year cost for the program is $400 million.

Senate Finance Chair Baucus Looks to Delay Medicare Physician Payment Cuts for 18 Months

Senate Finance Committee Chair Max Baucus (D-MT) met last month with representatives from several physicians’ groups to seek their support for a “modest” plan that would delay a pending 10.6% cut in Medicare payments to physicians that is slated to take effect July 1.

Baucus is proposing to block the cut for 18 months and provide a 1.1% increase in doctor payments instead. First, lawmakers must agree on a way to offset that cost.

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 set to kick in July 1. The fee cut is mandated by Medicare's controversial Sustainable Growth Rate (SGR) formula. The SGR trims Medicare payments to physicians whenever increases in these outlays exceed growth in Gross Domestic Product—unless Congress intervenes.

Congress’ December vote to delay the 10.1% pay cut followed sustained advocacy efforts—by the AGS, its members, and others—urging lawmakers to avert the cut. The AGS continues to urge legislators to both block the July 1 cut and revamp the method by which Medicare payments to professionals are determined.

Majority of U.S. Doctors Support a National Health Insurance Program

More than half of U.S. doctors support legislation that would create a national health insurance program, according to a recent survey in Annals of Internal Medicine.

The survey, which included more than 2000 physicians, found that 59% support legislation to establish a national health insurance program, while 32% oppose it. When last surveyed in 2002, 49% of physicians supported national health insurance, and 40% opposed it.

The survey also found that 83% of psychiatrists, 69% of emergency medicine specialists, 65% of pediatricians, 64% of internists, 60% of family physicians and 55% of general surgeons support a national health insurance plan.

“Conventional wisdom says that because there are a lot of medical specialty groups that don't support national health insurance, that doctors are not in favor. But almost twice as many doctors support it as oppose it,” said Dr. Aaron Carroll, who headed the Indiana University School of Medicine survey.