Washington Update - October 2011

AGS Continues Concerted Advocacy Efforts on Behalf of Quality Elder Healthcare  

In late September 2011, the AGS continued to closely follow the work of the Joint Select Committee on Deficit Reduction, a bipartisan, 12-member congressional committee that has been charged with finding ways to reduce the federal deficit by $1.5 trillion over the next 10 years. Among other things, the committee has considered the possibility of repealing or reforming the flawed sustainable growth rate (SGR) formula that governs increases in Medicare payments to physicians. Some committee members view the deficit reduction process as the best venue for solving the perennial SGR problem, whereas others argue that the SGR should be addressed outside of these talks. The committee has a deadline of November 23 to come up with a plan. If it cannot agree on a plan by that deadline, or if Congress fails to promptly enact its recommendations, the government will automatically cut spending, across the board, for hundreds of programs, including Medicare. 

The AGS is working with its members and continues to advocate for its key policy priorities, including ensuring the viability of Medicare and building the eldercare workforce. 

As part of its efforts, the AGS continues to urge Congress to ensure that SGR repeal and reform are part of any deficit reduction plan. 

AGS Comments on CMS’ Proposed 2012 Physician Fee Schedule and Meets With Agency Officials

AGS completed a comprehensive review of the Centers for Medicare & Medicaid Services’ (CMS’) proposed 2012 Physician Fee Schedule and sent comments concerning several key proposals to the agency on August 30. The society also participated in two meetings with CMS, during which these proposals and related issues were discussed. AGS staff and leaders, including members of its Relative Value Scale Update Committee (RUC) “SWAT” team—chaired by Peter Hollmann, MD—drafted the comments sent to CMS. Among other things, AGS commented on agency proposals regarding: evaluation and management (E/M) codes, misvalued codes, Medicare’s annual wellness visits, and telehealth consultations. The complete, 13-page letter is available at https://www.americangeriatrics.org.

As mandated by Medicare’s problematic sustainable growth rate (SGR) formula, the 2010 fee schedule calls for a 29.5% cut in fees, effective January 1. The AGS has long advocated for a viable alternative to the unworkable SGR payment protocol, and again called for an alternative in its comments to CMS. The 29.5% cut will take effect unless Congress intervenes to block or defer it, as lawmakers have in previous years. Each time Congress defers the cuts, however, the SGR mandates steeper cuts the following year. 

AGS raised concerns about CMS’ E/M code recommendations both in its letter to the agency and in a meeting with CMS that included five other healthcare organizations, including the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the American Academy of Pediatrics (AAP), the American Academy of Home Care Physicians (AAHCP), and AMDA–Dedicated to Long Term Care Medicine. During the meeting, all organizations voiced their opposition to a CMS proposal that would have the RUC review E/M codes identified as the highest expenditures for each specialty. They also requested that the RUC prioritize review of the codes and provide recommendations regarding physician time, work relative value units, and direct practice expense inputs for at least half of the codes by July 2012. Following the meeting, AGS and AAHCP signed on in support of a joint comment letter (www.amda.com/publications/AMDA_AAHCP_AGS_JointLetter.pdf), spearheaded by AMDA, reiterating the groups’ shared positions on the aforementioned issues, and the AGS continues to urge CMS to more appropriately value E/M services and to revise CPT codes so they more accurately describe the services physicians provide.

In a second meeting, the AGS, ACP, AAFP, and the American College of Emergency Physicians (ACEP) met with CMS staff to discuss additional proposals related to the Five-Year Review of Work Relative Value Unit. During this meeting, the AGS voiced concerns about a CMS’ proposal, regarding observation codes, that the “acuity level of the typical patient receiving outpatient services …generally be lower than that of the inpatient level.” During the meeting, the society noted that proposals for observation codes were not consistent with the RUC’s recommendations regarding how to value physician work related to observation. The society followed the meeting with a letter to CMS reiterating its concerns. To read the letter, visit www.americangeriatrics.org.

Because AGS submitted comments regarding the fee schedule to CMS, the society was later invited to join an agency-led “refinement panel” evaluating the work associated with certain services under review. Alan Lazaroff, MD, represented AGS on the panel. 

AGS’ Alan Lazaroff, MD, Appointed to RUC As Committee Considers Request to Designate a Seat for Geriatrics 

AGS Public Policy Committee member Alan Lazaroff, MD, was appointed to the Administrative Subcommittee of the Relative Value Scale Update Committee (RUC) during the summer. Lazaroff has been AGS’ advisor to the RUC, which is administered by the American Medical Association, since 2008. One of the items on the RUC’s agenda is how to respond to calls for structural and procedural changes in the committee proposed by the American Academy of Family Physicians (AAFP). In a letter to the RUC this summer, AAFP supported designating a seat for geriatric medicine on the committee, something for which AGS has long advocated.  

AGS Recommends Changes to “Physician Compare” Website 

In another letter to the Centers for Medicare & Medicaid Services (CMS), the AGS recently outlined several recommendations regarding the public reporting of information about physicians on the agency’s new Physician Compare Website, which is expected to go live in January 2013.

The Physician Compare site will be modeled after CMS’s Hospital Compare Website, which allows users to compare hospitals based on quality and other factors. Physician Compare will also include, among other things, information regarding whether a physician has or has not participated in CMS’ Physician Quality Reporting System (PQRS) initiative and, if so, whether he or she has reported successfully. In its letter to CMS, the AGS recommended that:

• CMS include a disclaimer on the site stating that the PQRS is a voluntary program and that there are valid reasons why a physician may not have participated and why a participating physician may not have successfully reported. 

• Physicians have the option of updating or adding to their information on the Website; for example, by adding a link from the site to their own Website.

• CMS work with physicians to ensure they understand the implications of the self-designated specialty in terms of data collection and analysis, and the possibility that it could contribute to misleading, inaccurate, or confusing findings.

• Quality measures account for comorbidities and assess aspects of healthcare associated with multiple health problems.

• Providers not be penalized when they honor a patient’s preferences and cultural or religious beliefs regarding care.

• CMS continue to encourage the development of improved measures tailored toward the care of patients with multiple, chronic conditions and consider developing protocols for geriatric measures reporting.

Late-Breaking News 

Budget talks bogged down in the House as September came to a close, but the Senate Appropriations Committee moved forward, proposing funding Title VII Geriatrics Health Professions and Title VIII Comprehensive Geriatrics Education for Nurses programs at the same levels in 2012 as were provided this year. Stepping up its efforts to ensure that geriatrics teaching and research funding is preserved, the AGS launched an informational campaign and call-in to remind lawmakers how essential this funding is. The society also reached out to lawmakers likely to play key roles in budgetary decisions, urging them to support these crucial elder health programs.