April 2012 Washington Update

AGS Assists New CMS Initiative to Reduce Antipsychotic Drug Use in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) has asked the AGS to assist with its new initiative to improve behavioral health services and reduce the use of antipsychotic drugs among nursing home residents, particularly those with dementia. This nationwide initiative, which was launched in March, will take a multidimensional approach to ensure that all older adults have access to safe and effective mental healthcare. To achieve this, there will be efforts to raise public awareness of the risks of overuse of antipsychotics and of alternatives to these drugs; support of research and training in the treatment and management of dementia-related problems and mental health disorders; enhanced public reporting and regulatory oversight; and provision of technical assistance to nursing homes.

AGS Prepares Comments as EHR Program Advances to Stage 2 

As this issue of Annals of Long-Term Care^® went to press, the AGS was reviewing and drafting comments on new federal guidelines for the second stage of its initiative to encourage the “meaningful use” of electronic health records (EHRs). The three-stage initiative aims to streamline healthcare and reduce the incidence of medical errors. It calls on physicians and hospitals to significantly increase their use of EHRs, more fully engage patients in the process, and improve the transferability of records. The initiative offers incentives for progress in each of the three stages toward these goals.

During stage 1, providers must begin setting up an EHR system and recording basic information, including diagnoses and prescriptions, for a portion of their patients. The newly drafted objectives for stage 2 are similar but set higher goals, such as encouraging healthcare providers to order prescriptions electronically. Among other things, they require that at least 60% of patients have their medications and laboratory tests ordered electronically, compared with the 30% requirement during stage 1.

AGS Continues Advocacy for More Adequate Funding of Geriatrics Training and Research Initiatives  

Following release of President Obama’s proposed 2013 budget, which provides only a slight increase in funding for the National Institute on Aging (NIA) and the Veterans Affairs Office of Research and Development (VA ORD) and calls for cuts in funding for important geriatrics healthcare professionals training programs, the AGS continued to advocate for adequate investment in these essential geriatrics workforce training and research initiatives. The president’s proposed spending plan would cut funding for Title VII geriatrics training programs and Title VIII geriatrics nursing programs roughly 1% in 2013, despite the fact that the number of older adults in the United States is rising rapidly. The cut in funding for geriatrics training programs would come in the wake of a 7% cut in funding for these programs for the current fiscal year. The president’s proposed budget would increase funding for the National Institute on Aging (NIA) by less than 0.05% in 2013, bringing the total budget of this critical agency to roughly $1.1 billion. The proposed budget would increase funding for the VA ORD, which received $582 million in federal funding this fiscal year, by roughly $1 million in fiscal year 2013. 

As part of its geriatric training and research advocacy efforts, the AGS sent a letter to leaders in the House and Senate appropriations committees urging their support for significantly higher funding of the NIA. As a member of the Friends of the NIA—a coalition of more than 45 organizations committed to advancing medical research that benefits older Americans—the AGS also signed a coalition letter that calls on Congress to support a $300 million increase in funds for the institute in 2013. The letter notes that enhanced and sustained federal investment in aging research is essential if the nation is to ensure that the growing number of older Americans have access to appropriate healthcare. The AGS is also planning an advocacy campaign in support of increased funding for Title VII and VIII geriatrics training programs in fiscal year 2013 and for research initiatives within VA ORD.

The House and Senate voted in February to delay, for 10 months, a 27.4 % cut in Medicare payments to physicians and others compensated according to Medicare’s physician fee schedule. The cut was mandated by Medicare’s sustainable growth rate (SGR) formula, which dictates cuts in Medicare payments to physicians, advanced practice nurses, and physician assistants whenever outlays for their services exceed growth in gross domestic product.

The AGS and other healthcare organizations expressed alarm that lawmakers had, once again, simply deferred the cut, missing yet another opportunity to permanently replace the flawed SGR formula with a viable alternative. Rather than find a truly sustainable alternative to the SGR, Congress has deferred the cuts that the formula has mandated each year for several years. As a result, the SGR has dictated a higher cut each year. Next year, the SGR will mandate an estimated 32% cut in fees.

The cost of the new, 10-month “doc fix” will come to roughly $18 billion and will be paid for with cuts in other areas. These include a $5 billion reduction in the Prevention and Public Health Fund, which was created by the healthcare reform law.

The AGS has launched a new grassroots advocacy campaign and is urging supporters of quality elder healthcare to visit the society’s Health in Aging Advocacy Center at https://capwiz.com/geriatrics/home, where they can easily compose an e-mail asking lawmakers to repeal the SGR and effect comprehensive Medicare payment reform. The society plans to continue advocacy efforts on behalf of a viable payment system throughout the year.

AGS Prepares Comment on Obama Administration Draft Plan for Alzheimer’s Disease

In late March, the AGS was preparing a response to a draft of a plan, written by an advisory council convened by the Obama Administration, to increase investment in efforts to address Alzheimer’s disease in the United States. The draft emphasizes the importance of expanding and better coordinating research concerning Alzheimer’s disease, particularly through public–private partnerships; better preparing the healthcare workforce to provide appropriate care for those with the disease; enhancing public outreach; and providing families affected by the disease with financial and other support. The report includes specific recommendations for reaching these goals, such as by creating registries to better encourage patients with Alzheimer’s disease to participate in clinical trials, and establishing a national inventory of research in this area.

Earlier in the year, the Obama Administration announced that its efforts to address Alzheimer’s disease would include making an additional $50 million available for cutting-edge Alzheimer’s research this fiscal year; another $80 million for such research the coming fiscal year; and $26 million more for caregiver support, provider education, public awareness, and improvements in data infrastructure. The additional research funding will support both basic and clinical research, including efforts to identify genes that increase the risks of Alzheimer’s disease, and efforts to test therapies among those at highest risk of developing the disease. Funds will also be used to develop better databases to assess the burden of cognitive impairment and dementia.

In written comments to the Department of Labor, the AGS voiced its support for an Obama Administration proposal to extend Fair Labor Standards Act (FLSA) protections to home care workers during the department’s February comment period. The AGS has long supported such a move, as has the Eldercare Workforce Alliance (EWA), which is co-convened by AGS Chief Operating Officer Nancy Lundebjerg. The extension of these protections to home care workers was one of the first issues the EWA championed.

The nation’s nearly two million home care workers are currently excluded from federal minimum wage and overtime protections. The AGS recognizes that direct-care workers, who provide an estimated 70% to 80% of the paid day-to-day care older Americans receive, are essential members of the interdisciplinary care team.

Despite the Republican-led House of Representative’s early February vote to repeal the Community Living Assistance Services and Supports Act (CLASS Act), the AGS and other organizations continue to advocate for this important legislation. The CLASS Act, designed to provide affordable long-term care insurance, was part of the 2010 healthcare reform law. Under the act, workers would pay a monthly premium while working, and, if disabled later in life, would receive a daily cash benefit of up to $50 that would help cover long-term care costs.

While the Department of Health and Human Services concluded in October 2011 that there was no way to make the program financially solvent, the White House has indicated that it does not support the repeal of the program. AGS and other advocates continue to urge the Senate to fix the legislation rather than scrap it.

CLASS Act was designed to address a growing problem in long-term care: roughly 10 million Americans need long-term care services, but only about 8% buy private long-term care insurance, which is costly. The number of older people in need of long-term care is expected to increase dramatically as the baby boomers age.

AGS Lends Its Support The AGS recently lent its support to:

Infectious Diseases Society of America (IDSA). The AGS supported IDSA’s efforts to address the serious and growing problem of antimicrobial resistance by cosigning an IDSA letter urging Congress to consider a new drug approval pathway designed to encourage the development of new and critically needed antibiotics. This issue is important to the AGS because seniors, especially those residing in nursing homes, are especially likely to contract drug-resistant organisms.

Society of Thoracic Surgeons (STS). The AGS signed a letter from the STS to Social Security Administration Commissioner Michael Astrue regarding the agency’s recent decision to limit access to the Social Security death reports that it receives from the states. The letter raises concerns about the decision and requests Astrue’s assistance in finding a legislative solution that would enable physicians and researchers to access this data to evaluate medical interventions and track other medical and public health–related trends. AGS is concerned about the effect this change would have on patient registries and medical research since it may pose an obstacle to tracking patients/subjects who have died, thereby affecting the quality of reported data.