Washington Update-November-2012

In a move long championed by the American Geriatrics Society (AGS) and supported by other leading healthcare organizations, the Centers for Medicare & Medicaid Services (CMS) will begin paying physicians and other qualified healthcare providers for coordinating Medicare beneficiaries’ care transitions during the 30 days following their discharge from hospitals or skilled nursing facilities. The policy appears in CMS’ newly published 2013 physician fee schedule. It will take effect January 1, 2013.

“An estimated 20% of Medicare patients are readmitted within 30 days of being discharged due to inadequate coordination during transitions from one care setting to another,” said James Pacala, MD, AGS president. “CMS’ decision is a major step toward safer transitions for older patients, and we thank the agency, the American Medical Association (AMA), and the many other organizations and individuals who have worked with the society to make this happen.”

More than a decade ago, the AGS began spearheading efforts to ensure that Medicare beneficiaries receive coordinated care, including services that improve transitions of care. Since then it has worked closely with multiple other organizations, meeting with CMS officials to raise awareness of the need to improve transitions and identify avenues to do so. The organizations have also worked tirelessly through the AMA Specialty Society’s Current Procedural Terminology (CPT) process to develop new codes for these services. Under CMS’ new policy, specified healthcare providers will be paid for providing a range of services that promote more seamless and safer transitions, helping to prevent readmissions.

“Patients being discharged from inpatient settings can expect their providers to better coordinate their outpatient services by having a more active role in communicating with all the specialists and agencies involved in their care,” said Robert Zorowitz, MD, AGS CPT advisor. “Moreover, they can expect better assessment, monitoring, and reconciliation of their discharge medications with their previous regimen, better ensuring a rational regimen that is more cost-effective and less apt to result in redundancies and adverse effects.”

With the American Geriatrics Society (AGS) and other supporters of quality elder healthcare continuing to call for a viable alternative to Medicare’s flawed sustainable growth rate (SGR) formula, there were signs on Capitol Hill this fall that a resolution was likely, Politico reported in mid-October.

Congressional staff from both parties were predicting that lawmakers would agree on a “fix” in time to avert deep cuts in Medicare payments to physicians and others slated for January 1, 2013. If legislators don’t find a remedy by year’s end, payments for physicians and others compensated in keeping with Medicare’s physician fee schedule will be cut roughly 27%.

Both a key health policy adviser to Senator Tom Coburn (R-OK) and a Senate Finance Committee staffer last month told reporters that the SGR problem is something “both sides of the aisle agree must be dealt with.”

Assessing older patients’ needs for power mobility devices (PMD) is challenging, the AGS’ Jerome Epplin, MD, told members of the Senate Committee on Aging during a September hearing on the use and overuse of these devices, which are often covered by Medicare.

Representing the AGS, Epplin raised key issues surrounding the devices, including heavy television and direct mail advertising promoting the devices to older people. Among other things, he noted that some patients, having seen the advertisements, are under the impression that these devices can legitimately be used as a convenience rather than only when medically necessary.

Among other things, the hearing touched on a 3-year Centers for Medicare & Medicaid Services (CMS) demonstration project requiring prior authorization for PMDs in seven states that have seen high rates of fraud in this area. Speaking for the society, Epplin expressed hope that the demonstration will help differentiate patients who really need PMDs from those who would be better served by other means, and urged CMS to further streamline the application and authorization process.

Despite expectations that Medicare Advantage would be hurt by the Affordable Care Act (ACA), the Medicare Advantage plans appear to be thriving, according to a recent Centers for Medicare & Medicaid Services (CMS) report.

CMS estimates that Medicare Advantage rolls will have grown 28% over 3 years by 2013, while premiums will have dropped 10%, and benefits will have held steady. That’s a significant departure from earlier Congressional Budget Office expectations that the program would shrink due to reductions in payments under the ACA. In keeping with the ACA, benchmark payments to Medicare Advantage plans were frozen in 2011. Since then, their costs have declined relative to the costs of fee-for-service plans.