Medicare Payments to Physicians, Title VII Funding, Payments to SNFs and Home Health Agencies, Elder Neglect and Abuse

CMS Proposes 5.1% Cut in Medicare Payments to Physicians in 2007; Proposal Comes Amid Other Calls for Changes in Payments and Reporting of Quality Data

The Centers for Medicare & Medicaid Services (CMS) in August proposed a 5.1 % cut in payments to physicians caring for Medicare beneficiaries. The proposal is one of several that would amend Medicare payments to physicians in various ways.

Medicare’s highly controversial Sustainable Growth Rate (SGR) formula mandates the 5.1 % cut—the formula automatically triggers cuts in physician fees if increases in these expenditures exceed growth in Gross Domestic Product. Unless Congress acts to block the 5.1% SGR-mandated cut, it will take effect January 1.

Since the SGR was established, the American Geriatrics Society and other organizations have advocated for the revocation of both the automatic cuts and the formula, and continue to do so. For the last three years, Congress has blocked SGR-mandated cuts in physician fees and several Congressional leaders announced this summer that they planned to prevent such cuts in 2007. Within days of those announcements, however, CMS Administrator Mark McClellan said the White House would likely press Congress to make any measures to block SGR-mandated reductions contingent on physician participation in quality reporting.

In Washington, efforts to link Medicare payment to quality by introducing pay-for-performance (P4P) policies into the program continue to gain momentum. A number of lawmakers this summer proposed measures to revise Medicare physician payments in ways that incorporate elements of P4P.

At the same time, CMS is proposing additional changes in physician reimbursement. In June the agency proposed revisions to Medicare’s Resource Based Relative Value System (RBRVS)—as part of its mandated five-year review of the RBRVS—including changes that AGS recommended and for which it has advocated. These changes would significantly increase payments to geriatricians and other physicians caring for beneficiaries. The most important change for geriatricians would revise physician work relative value units (RVUs) for evaluation and management (E/M) services by adopting the recommendations the RBRVS Update Committee (RUC) made as part of its five-year review process. The changes would result in the largest increases in payments for E/M services since the physician fee schedule took effect in 1992.The AGS was a key member of the coalition that reviewed the E/M codes and presented them to the RUC. In addition, AGS Board Chair Meghan Gerety, MD, chaired the RUC five-year review committee that determined the process the RUC used to evaluate the E/M codes. CMS is also proposing several other changes in physician reimbursement that the RUC recommended. AGS, which regularly comments on CMS’ proposals for amending the fee schedule, has endorsed some of CMS’ proposals, including its changes in payments for E/M services, but has recommended amendments to other CMS proposals.

Title VII Geriatrics Health Professions Program Funding Still Uncertain as Congress Returns from Summer Recess

As Congress returned to work after its August recess, it was still unclear whether legislators would restore Title VII Geriatric Health Professions Program funding in FY 2007. Last year, Congress eliminated all FY 2006 funding for these crucial geriatrics professions training programs, with disastrous results.

Though the Senate in March approved the Specter-Harkin Amendment—which called for $7 billion more in spending for health, education, and labor than the President’s FY 2007 spending plan, and would have made restoration of Title VII Geriatric Health Professions Programs funding possible—Senate appropriations subcommittees later trimmed that allocation by $2 billion. In another potential setback, the Senate Labor, Health and Human Services Committee in late July endorsed a FY 2007 spending proposal that included no funding for the programs. That could change, however, as a result of subsequent Senate action concerning the programs.

While the House budget resolution calls for about $900 million less for health, education, and labor programs than the Senate subcommittees’ spending plan, the House Appropriations Committee has earmarked $31.5 million for Title VII geriatrics programs in FY 2007. That move, which would restore Title VII funding to 2005 levels, was influenced by the intense advocacy efforts of AGS and Association of Directors of Geriatric Academic Programs members. The full House has yet to vote on the allocation, and may not do so until after the elections.

Ultimately, both the House and Senate must agree on allocations for Title VII geriatrics professions and other programs. The AGS continues to advocate for funding restoration—with ongoing meetings involving AGS staff, Title VII grantees, and key legislators—in the House as well as the Senate.

CMS Proposes 3.1 % Increase in Payments to Skilled Nursing Facilities and to Home Health Agencies that Report Quality Data

The Centers for Medicare & Medicaid Services (CMS) in August proposed a 3.1% increase in payments to skilled nursing facilities starting January 1.

At the same time, CMS also announced that it was developing a “Nursing Home Value Based Purchasing Demonstration” program. Through the program, nursing homes would qualify for additional payments by meeting specified quality measures.

In a related move, the agency proposed a roughly 3.1% increase in payments to home health agencies that submit data on the quality of care they provide, starting in January. Agencies failing to submit this data would get an increase of just 1.1%.

Legislation to Curb Elder Neglect and Abuse Wins Senate Committee Approval

The Elder Justice Act, legislation that would establish comprehensive, nationwide programs to combat and prevent elder abuse, neglect, and exploitation, won the Senate Finance Committee’s unanimous endorsement this summer.

The bill, sponsored by Sens. Orrin Hatch (R-UT) and Blanche Lincoln (D-AR), now goes to the full Senate. Rep. Peter King (R-NY) has proposed similar legislation in the House.

Backed by the AGS, the AARP, and other organizations, the act would, among other things, promote coordination of federal, state, and local efforts to address elder neglect and abuse. It would also fund research on comprehensive approaches to enhance prevention and detection of abuse, including research in forensic geriatrics. In addition, the legislation would support development of a uniform system to collect data on elder abuse, neglect, and exploitation nationwide.

The Elder Justice Act includes several provisions aimed at preventing and combating elder abuse in long-term care facilities. Noting that “staffing is critical in preventing abuse and neglect,” the bill would earmark funds both to encourage qualified applicants to pursue careers in long-term care and to develop benefits and other programs to improve staff training and retention. The act would also expand federal and state long-term care ombudsman programs aimed at preventing and responding to complaints of elder abuse, neglect, and exploitation in long-term care facilities.

In a letter to Sen. Hatch, chair of the AGS Board of Directors Dr. David Reuben expressed AGS’ strong support for the act. AGS is “particularly pleased” with elements of the legislation concerning staff retention and forensic geriatrics, the letter notes.

For more information and updates on these and other public policy issues affecting healthcare for older adults, visit AGS’ public policy news page at https://www.americangeriatrics.org.