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Washington Update - July/August 2014
VA Legislation to Improve Access and Care
The Veterans Access, Choice, and Accountability Act (HR 3230) recently passed both the House and the Senate and will be signed by the President. The legislation makes it possible for eligible veterans, who are unable to get an appointment at the Veterans Health Administration within 30 days, to receive care outside the VA system. Physicians who participate in Medicare will be able, through provider agreements with the VA, to deliver care for these veterans.
The legislation also includes provisions to enhance the VA’s healthcare provider workforce, including funds to hire additional primary and specialty healthcare providers along with other clinical staff. The measure would also provide enhanced incentives for more physicians, nurses, and other healthcare professionals to join the VA. VA’s Access to Care Audit found that the need for additional physicians, nurses, and other medical providers was the highest barrier or challenge to care access. The legislation also provides the authority to add up to 1500 new graduate medical education residency positions. Primary care and mental health slots are given priority. During the legislation’s implementation, the AGS will be working with the VA and Congress to make sure that the unique and often-complex care needs of older veterans are addressed.
New Legislation on Medical Education
On August 1, Senator Patty Murray (D-WA) introduced legislation to extend the Teaching Health Center Graduate Medical Education (THCGME) program to continue to fund medical resident education through 2019; previously, the funding had been set to expire in 2015. The program is anticipated to train approximately 550 residents each year as a means of addressing the looming shortage of physicians practicing in rural and other underserved communities. At the beginning of 2019, the legislation proposes replacing the THCGME program with a permanent, mandatory funding stream under Medicare. A key aspect of the legislation is that it emphasizes the training of primary care providers, including those in geriatric medicine, and team-based care.
In response to the legislation, current American Geriatrics Society (AGS) president Wayne McCormick, MD, MPH, released the following statement:
“The AGS appreciates Senator Murray’s efforts to strengthen our nation’s graduate medical education system and ensure continued access to primary care and geriatrics through her new legislation, the Community-Based Medical Education Act. The development of a new primary care teaching program that will fund 1,500 new residency spots—geriatrics included—is an important first step in building a healthcare workforce trained to care for the rapidly growing population of older Americans. We also wholeheartedly support the bill’s inclusion of measures that address coordination of care across sites and working in interprofessional teams—both a hallmark of geriatrics care. AGS looks forward to working with the Senator to move this important legislation forward.”
Institute of Medicine Report on Graduate Medical Education
AGS has long advocated that graduate medical education (GME) programs should be aligned with the nation’s need for a workforce that is competent to care for our rapidly growing older adult population. Congress and a number of independent agencies, including MedPAC, have discussed changes to the program. On July 29, the Institute of Medicine (IOM) released a report, Graduate Medical Education that Meets the Nation’s Health Needs, which proposes a widespread overhaul of the current financing system for GME. The expert panel recommends keeping funding at its current level, while transforming the program to a performance-based system and phasing out the current system over a 10-year period.
AGS is in the process of reviewing the report in more detail and has not yet issued a formal comment or response to the IOM; however, several organizations have come out in opposition to the report. These organizations have criticized the IOM’s proposal to cut GME funding up to 35%. They have also pointed out the report’s failure to propose a workable solution to the current workforce shortage.
Fiscal Year 2015 Appropriations
On July 24, the Senate Appropriations Committee released the fiscal year (FY) 2015 Labor, Health, and Human Services Education appropriations draft bill language and its accompanying committee report. The measure’s funding for geriatrics programs and the language included in the committee report reflect the joint work of the AGS and the Eldercare Workforce Alliance (EWA; www.eldercareworkforce.org), which AGS chief operating officer Nancy Lundebjerg co-convenes. Through meetings and other ongoing communications, AGS and EWA have educated key policymakers on the Senate Appropriations Committee on how important the Title VII and VIII primary care training programs are to ensuring that the healthcare workforce is prepared to care for older adults. The language in the committee report, which expresses the Senate’s priorities, states the following:
“The Committee reiterates its support for geriatric education and the effort to ensure that the wider primary care provider community has the skills and training to provide high-quality and coordinated care to older adults.”
Funding for the geriatrics programs under Title VII would receive a slight increase, while the nursing program under Title VIII is level funded. Also included in this draft bill is funding for the National Institute on Aging, which would receive an increase of $100 million with a total of over $1.26 billion for FY 2015.
“In the current funding environment, maintaining level funding or achieving small increases in funding, can be considered a victory,” noted Ms. Lundebjerg. “EWA has had a series of Hill meetings with appropriators to highlight the importance of the geriatrics health professions programs, and we work with the Friends of the National Institute on Aging to advocate for increased research funding,” she said.
AGS will continue to actively advocate on behalf of older adults and their healthcare providers through the annual congressional appropriations process.
CMS Physician Fee Schedule Proposed Rule
AGS continues to advocate for and lead a coalition of over a dozen other medical societies working towards the inclusion of care coordination codes in the fee schedule that would address the needs of the most complex and chronically ill Medicare beneficiaries. In early July, the Centers for Medicare & Medicaid Services (CMS) issued proposed changes to the Medicare physician fee schedule for 2015. The rule includes CMS’s proposals for implementing a chronic care management code with a payment rate of $41.92 that providers can bill per patient once a month. Of note, CMS is not proposing to establish separate standards that practitioners and practices furnishing services would have to meet to bill for such services. A few other highlights include changes to the Open Payments program (the Sunshine Act), expansion of telehealth services for Medicare beneficiaries, and new measures to fill existing gaps in the Physician Quality Reporting System program. AGS is currently reviewing the proposed rule and will submit detailed comments to CMS.
