June 2011 Washington Update

AGS Asks Congress to Boost 2012 Funding for NIA and Geriatrics Training Programs

Despite dramatic growth in the number of older adults in the United States and an anticipated doubling of the US senior population by 2030, budgets for the National Institute on Aging (NIA), Title VII Geriatrics Health Professions Programs, and Title VIII Comprehensive Geriatric Education Nursing Programs have remained flat for several years. AGS recently wrote to the US Senate’s and the House’s respective Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, and made a compelling case for adequately funding the NIA and the Title VII and Title VIII geriatrics programs. For fiscal year (FY) 2012, AGS urged lawmakers to allocate $1.4 billion in funding for the NIA, which has been flat-funded since FY2003, as well as $46.5 million for Title VII geriatrics programs and $5 million for Title VIII geriatrics programs, both of which have been flat-funded since FY2007. “Continued Federal investments are needed to support the training of the healthcare workforce and to foster groundbreaking medical research so that our nation is prepared to meet the unique healthcare needs of the rapidly growing population of seniors,” wrote Barbara Resnick, PhD, CRNP, AGS president, and Jennie Chin Hansen, RN, MS, AGS chief executive officer. “While we fully recognize the fiscal challenges facing our nation, we also recognize that sustained and enhanced federal investments in these initiatives are essential to fulfilling the promise of health reform to deliver higher quality and better coordinated care to our nation’s seniors.”

Geriatrics Training Programs Spared Deep Cuts in 2011

In a related story, the Health Resources and Services Administration recently released its operating plan for fiscal year 2011, which showed a modest 0.61% cut in federal funding for most Title VII geriatrics programs. “At this difficult economic time, when funding cuts are widespread, we were relieved to hear that the programs will not suffer severe cuts,” said AGS chief executive officer Jennie Chin Hansen, RN, MS. Securing adequate funding for Title VII Geriatrics Health Professions and Title VIII Geriatric Education Nursing Programs is a legislative priority for AGS and an ongoing focus of the organization’s public policy advocacy work. “We will continue to advocate for these essential programs, which are critical to providing quality healthcare for older adults,” said Hansen.

Medicare’s Sustainable Growth Rate Formula Is Unsustainable AGS Tells House

Medicare’s Sustainable Growth Rate (SGR) formula for reimbursing physician fees was designed to prevent overuse of healthcare services, yet it appears to have had the opposite effect, the AGS notes in letters to leaders of the House Committee on Means & Ways and the House Energy & Commerce Committee. In the letter, AGS president Barbara Resnick, PhD, CRNP, and AGS chief executive officer Jennie Chin Hansen, RN, MS, detail a multistep approach for phasing out the problematic SGR and replacing it with a truly sustainable alternative. “The current system has incentivized increasing the volume of care rather than improving outcomes,” write Resnick and Hansen. “If anything, the SGR rewards excessive utilization as providers seek to take what they can before cuts are imposed. But the imposition of penalties is indiscriminate with respect to current efficiency. [The SGR] also significantly underpays primary care physicians, especially geriatricians, because it does not take into account the needs of older adults with multiple illnesses or the cost of providing coordinated, patient-centric care. ” The AGS letter explains that for an alternative to the SGR to be viable, it must properly compensate physicians and encourage them to provide coordinated, patient-centric care. This approach contributes to better outcomes, reduces the risk of complications, and helps prevent unnecessary hospitalizations. Such an approach also reins in spending, especially on behalf of geriatric patients with comorbidities, who are among Medicare’s most costly beneficiaries say the authors. A new reimbursement formula that more adequately compensates physicians for their efforts could increase the appeal of a career in geriatrics or one providing care to older patients with complex health needs, which is needed if we are to mitigate the growing shortages of healthcare providers who have expertise in eldercare note Resnick and Hansen. Finally, the letter calls on lawmakers to establish stable and predictable payment updates that accurately reflect increases in provider expenses. The full letter is available at the AGS Website at www.americangeriatrics.org.

Congressional Visits Program a Resounding Success

More than 60 AGS members met with their senators and representatives and with their legislative staff as part of the society’s recent Congressional Visits Program. Members impressed on lawmakers the critical role legislation plays in ensuring that older adults receive high-quality, patient-centered care. The Visits program coincided with the AGS 2011 Annual Scientific Meeting, held May 11-14, 2011, in National Harbor, MD. Prior to the meeting, members new to the AGS program attended a special policy and advocacy briefing. In all, AGS members met with congressional representatives from 25 states, including Sens. Barbara Boxer and Diane Feinstein of California; Sens. Charles Grassley and Tom Harkin of Iowa; Sen. Richard Durbin of Illinois; Sen. Harry Reid of Nevada; Sen. Bob Casey of Pennsylvania; Sen. Ron Wyden of Oregon; and Sen. Barbara Mikulski of Maryland. “The Congressional Visits Program was a great success,” said Mike Malone, MD, vice chair of AGS’ Public Policy Committee. “The enthusiasm which the program was met with is a testament to how dedicated our members are to educating our nation’s leaders on issues regarding older adult healthcare.”

Medicare Official Praises AGS’ Efforts at Society’s Annual Meeting

Delivering this year’s Public Policy Lecture at the AGS’ annual meeting, Peter V. Lee, JD, acting deputy director for Policy and Programs at the Center for Medicare & Medicaid Innovation, highlighted the new agency’s interest in partnering with AGS to improve elder healthcare. He praised AGS and its members as experts in elder care and affirmed the Center’s commitment to working together on making care for seniors better and more cost-effective. Lee told the packed ballroom that AGS members are recognized as the nation’s experts in determining how to enhance the system of care for older adults. He also called on society members to share their ideas for implementing promising new models of care. The Center for Medicare & Medicaid Innovation was established to test new models of payment and service delivery designed to reduce Centers for Medicare & Medicaid Services expenditures and improve the quality of care for subscribers. “The Center will focus on the overall health outcomes of populations by addressing underlying causes of poor health, such as inactivity, behavioral risk factors, lack of preventative care, and poor nutrition,” explained Lee. “Moving forward, new ideas and programs can come to life, allowing for a streamlined process with more agility and adaptability.”

AGS Recognizes Chair of Senate Special Committee on Aging with Award

During the AGS annual meeting in May 2011, AGS leaders presented the society’s 2011 David H. Solomon Distinguished Public Service Award to Sen. Herb Kohl, chair of the Senate Special Committee on Aging, who recently announced he would not seek reelection in 2012. “We thank Sen. Kohl for his dedication to advancing health policies that support older adults,” said AGS president Barbara Resnick, PhD, CRNP. “Sen. Kohl has made it a top priority to support geriatrics education and training across the country. He has done a tremendous job making prescription medications more affordable to older adults and protecting this growing population against investment fraud, elder abuse, and nursing home neglect. Senator Kohl has also understood the vital role that caregivers—estimated to number 52 million—fill when caring for older people.” During Kohl’s tenure on the committee, he spearheaded a wide range of legislative initiatives aimed at improving the health and quality of life of older adults. In recent years, he has increasingly focused on the acute, growing shortage of physicians and other healthcare professionals and of direct care workers trained to meet the unique needs of older adults. Kohl championed the “Retooling the Health Care Workforce for an Aging America Act,” and key elements of this legislation were incorporated in the Affordable Care Act, passed in 2010 to reform healthcare. In the time remaining of his term, Kohl is leading an effort to ensure that patients in long-term care facilities receive pain relief medication in a timely manner. “In recent years we have made progress on policy that will help make the lives of all Americans a little better as they grow older. We still have a lot of work ahead of us to improve our nation’s nursing homes, lower healthcare costs, and increase retirement security for all,” said Kohl in accepting the award. “I’m honored to receive this award and will continue my efforts to further the ideals it represents,” he added.

Legislation to Forgive Educational Loans of Geriatric/Gerontology Providers Reintroduced

May was Older Americans Month and a bipartisan group of senators chose this month to reintroduce legislation that gives physicians, nurses, social workers, and other healthcare professionals with specialized training in geriatrics and gerontology access to loan repayment opportunities in exchange for a commitment to provide healthcare services in underserved areas. The proposed legislation is designed to help address a critical decline in the number of healthcare professionals trained to meet the unique healthcare needs of older patients. AGS has long supported this type of legislation and hailed Sens. Herb Kohl, Barbara Boxer, Bernie Sanders, and Susan Collins for reintroducing the Caring for an Aging America Act. “At a time when the population of older adults is expected to reach about 72 million by 2030, our nation cannot afford to falter in its efforts to provide loan forgiveness to future healthcare professionals pursuing training in eldercare,” said AGS president Barbara Resnick, PhD, CRNP. “This legislation will serve to prepare our healthcare workforce to provide quality care for the fastest growing segment of our population, and will provide incentives to encourage healthcare professional trainees to pursue careers in geriatrics and gerontology.” The loan forgiveness legislation is in keeping with recommendations contained in the 2008 Institute of Medicine’s report “Retooling for an Aging America: Building the Health Care Workforce.” It also builds on ongoing efforts by the Health Resources and Services Administration to open up the National Health Service Corps to primary healthcare professionals who have training in geriatric specialties. The need for more medical professionals to specialize in geriatrics and gerontology is imperative. A recent report from the Eldercare Workforce Alliance—an organization co-convened by AGS chief operating officer and executive vice president Nancy Lundebjerg—estimates an additional 3.5 million eldercare workers will be needed by 2030 and predicts critical shortages of geriatricians, geriatrics healthcare professionals, and direct care workers in the coming years.