Washington Update - June 2012

CMS Launches Initiative to Reduce Inappropriate Prescribing of Antipsychotics in Long-Term Care

In late May, the Centers for Medicare & Medicaid Services (CMS) announced its Partnership to Improve Dementia Care initiative, a major undertaking that aims to reduce inappropriate prescribing of antipsychotic drugs for nursing home residents. CMS estimates that as many as 40% of residents with symptoms of dementia—but no diagnosis of psychosis—are currently receiving antipsychotic drugs. Many of these residents have one or more noncognitive symptoms of dementia, such as wandering, agitation, aggression, or oppositional or psychotic behavior—but these medications are not indicated for such symptoms. According to the US Food and Drug Administration, antipsychotics are associated with a significantly increased risk of death among older adults with dementia.

The Partnership to Improve Dementia Care will include federal and state agencies, staff at long-term care (LTC)  facilities, and advocacy organizations. It aims to reduce inappropriate prescribing of antipsychotics for nursing home residents by 15% in 2012 alone. Among other things, CMS has developed a training program to acquaint LTC staff with nondrug approaches for residents with behavioral problems. The agency also plans to make each nursing home’s use of antipsychotic drugs available on the Nursing Home Compare Website starting next month.

“The American Geriatrics Society (AGS) applauds CMS’ commitment to ensuring that antipsychotic medicines are prescribed appropriately in long-term care settings,” said AGS CEO Jennie Chin Hansen.

In a related move, Sens. Charles Grassley (R-Iowa), Herb Kohl (D-Wisconsin), and Richard Blumenthal (D-Connecticut) proposed a measure to reduce the misuse of antipsychotics among older adults that may be incorporated into legislation later in the current Congressional session. As this issue of Annals of Long-Term Care^® went to press in June, the AGS was reviewing the proposal.

AGS Hails Proposed Alternative to Sustainable Growth Rate Formula And Offers General Recommendations for Payment Change 

Rep. Allyson Schwartz (D-PA) and Rep. Joe Heck (R-NV) introduced legislation in early May that would repeal Medicare’s untenable sustainable growth rate (SGR) payment formula and replace it, over time, with a series of different payment models for physicians and other healthcare providers. The bill, “The Payment Innovation Act of 2012,” would be financed with unspent Overseas Contingency Operations funds and would prevent the 30% cut in Medicare providers’ payments that the SGR is slated to effect January 1, 2013.

The AGS is encouraged by Reps. Schwartz and Heck’s efforts to repeal the SGR formula and replace it with a more equitable and sustainable payment system that better recognizes the importance of quality of care for older adults. The proposed legislation places strong emphasis on primary care, which is the cornerstone of high-quality, effective, and coordinated care for older adults with chronic and complex conditions. The legislation calls for a payment update for primary care services—including care coordination and preventive care services—for 2014 through 2017. It would provide incentives for quality, rather than volume, and help correct long-standing payment inequities for primary care services provided by geriatrics healthcare professionals and other primary care providers. In a letter to Congresswoman Schwartz and Congressmen Heck, the AGS offered comments and recommendations, which can be read at www.americangeriatrics.org.

The society encourages advocates of quality elder healthcare to visit its Health in Aging Advocacy Center online at www.americangeriatrics.org, and contact and urge their members of Congress to both repeal the SGR and institute comprehensive Medicare payment and delivery reform.

AGS Letter to House Warns That Current Medicare Payment Will Worsen Shortage of Geriatrics Healthcare Professionals 

In a related development, the AGS sent a letter outlining general recommendations for a new payment framework to the House Ways and Means Committee in May. The letter notes that the current inadequate payment system will continue to deter candidates from choosing careers in the field, exacerbating the growing nationwide shortage of geriatrics healthcare professionals. The letter calls for efforts to improve care coordination, efficiency, and quality of care for Medicare beneficiaries by enacting comprehensive payment reform. The current system is “strictly budgetary…with no tools for improving quality or efficiency, such as care coordination,” the letter notes, echoing criticism from by the Medicare Payment Advisory Commission. The letter urges that any new payment protocol should emphasize the importance of primary care, “which is the cornerstone of high-quality, effective and coordinated care.”

“The resources needed to care for very complex Medicare patients are vastly understated in the fee schedule as it currently exists,” the letter continues. “These services, such as patient counseling, care coordination, and teaching, particularly when furnished to a population of older, frail patients with multiple, chronic conditions and more comorbidities, are multidisciplinary and require a team approach and significantly more resources than the office-visit services furnished to younger, healthier patients.” Read the full letter at www.americangeriatrics.org. 

Affordable Care Act Requirement Increases Medicaid Payments for Primary Care 

Secretary of Health and Human Services Kathleen Sibelius proposed a new rule in early May that would require Medicaid to reimburse family medicine, general internal medicine, pediatric medicine, and related fields at higher levels for primary care. The cost of the higher rate would be covered entirely by the federal government with no matching payment required of states. AGS is reviewing the rule to determine whether geriatrics healthcare providers’ will qualify for the increased Medicaid payments. More than 150,000 primary care providers nationwide have received nearly $560 million in higher Medicare payments thanks to the Obama Administration’s Affordable Care Act, which recognizes the vital importance of primary care providers in the nation’s healthcare system.