Washington Update - July 2012
Federal Watch
House Votes to Repeal Healthcare Law on Heels of Supreme Court Upholding Mandate
In mid-July, Republicans in the Senate were hoping to repeal the Affordable Care Act—as the Republican-controlled House of Representatives did in a 244 to 185 vote on July 11. The House vote came just days after the Supreme Court, in a historic decision, upheld most of President Barack Obama’s healthcare law. In a 5 to 4 vote, the Court ruled that Congress did not overstep its power in requiring most Americans to buy health insurance. The healthcare law still faces legal challenges, but so do efforts to repeal in the Democratic-controlled Senate. According to many pundits, the House vote was a largely symbolic move, an opportunity for Republicans to underscore their opposition as Election Day approaches. The American Geriatrics Society (AGS) continues to follow developments with the law.
Just last month, the Centers for Medicare & Medicaid Services (CMS) announced that the Affordable Care Act had helped 14.3 million Medicare beneficiaries get at least one preventive service at no cost during the first five months of 2012. In 2011, 32.5 million beneficiaries received one or more preventive benefits free of charge. One of the major goals of the Affordable Care Act is to help beneficiaries stay healthy by giving them the tools and services they need to take charge of their health and prevent health problems before they occur. Prior to 2011, Medicare beneficiaries had to pick up part of the cost of many preventive benefits such as cancer screenings. Under the Affordable Care Act, preventive benefits are free of charge, with no deductible or co-pay, so these are no longer a barrier for seniors. The law also added an important new service for people with Medicare—an Annual Wellness Visit with the doctor of their choice—at no cost.
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Proposed Medicare Fee Schedule Includes Pay Increase for Primary Care and Family Physicians
The Centers for Medicare & Medicaid Services’ (CMS) proposed Medicare Physician Fee Schedule (PFS) for fiscal year (FY) 2013, which was released on July 6, calls for a number of changes in the schedule and other Part B payment policies. The revisions are designed to ensure that payments reflect changes in medical practice and the relative value of services. Among other things, the proposed rule calls for a 7% pay increase for primary care and family physicians. It would also provide compensation for transitions of care management services. The American Geriatrics Society (AGS) has long called for reimbursement for such services as care coordination and care transitions. The society held numerous meetings with other specialty societies and CMS leadership to discuss the importance of the agency’s covering such services. “We are pleased to see these discussions reflected in this year’s Proposed Rule,” said AGS CEO Jennie Chin Hansen. AGS is now reviewing the rule in additional detail and plans to submit comments to CMS by the September 4, 2012, deadline.
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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 to 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 the June issue of Clinical Geriatrics® went to press, the AGS was reviewing the proposal.
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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 Congressman Heck, the AGS offered comments and recommendations, which can be read at the society’s Website at www.americangeriatrics.org/files/documents/Adv_Resources/AGS_Letter_to_Schwartz_and_Heck_Payment_Reform_Bill_May_2012.pdf.
The society encourages advocates of quality elder healthcare to visit its Health in Aging Advocacy Center online at www.americangeriatrics.org/ags_state_affiliates/state_affiliate_handbook/advocacy_center/, and contact and urge their members of Congress to both repeal the SGR and institute comprehensive Medicare payment and delivery reform.
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GS 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/files/documents/Adv_Resources/SGR.Letter.to.Ways.and.Means.May.25.2012.pdf.
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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.