Groups blast Medicare cuts

Even as the federal government proposes Medicare and Medicaid spending cuts for 2009, long-term care organizations are pushing to reform the financing of elder care and to promote increased use of technology to help improve care and make it more efficient.

The Alliance for Quality Nursing Home Care immediately blasted the Bush administration’s fiscal year (FY) 2009 budget released February 4 as being “far off the mark” and said the plan would have “serious and lasting negative repercussions on efforts to maintain the economic stability critical to sustained quality improvement in nursing home care for 1.5 million frail, elderly and disabled citizens.”

At a minimum, the Alliance said, the budget would slash Medicare payments to nursing homes nearly $1 billion in FY 2009 and $17 billion over five years by eliminating any inflationary increases for three years and making permanent less than inflationary increases in subsequent years.

“We pledge to work with Congress in a bipartisan manner to ensure these Medicare cuts, which undermine the growing post-acute and skilled nursing care needs of our most vulnerable citizens, are rejected,” declared Alan G. Rosenbloom, president of the Alliance. He said the budget plan “would be devastating to the ability of nursing homes to sustain quality improvement.”

Meanwhile, the American Association of Homes and Services for the Aging (AAHSA) criticized the Bush spending plan because it:

  • Provides no funding for preventive health

  • services and Alzheimer’s Demonstration grants.

  • Reduces from $1.7 billion to $1.2 billion Social Service Block Grants to states to help pay for adult day services and in-home programs.

  • Provides no funding increase for supportive services, the National Family Caregiver Support Program, and congregate and home-delivered meal programs. Funding for these programs has not kept up with inflation, AAHSA said, noting that the National Family Caregiver Support Program was cut 1.7% in last year’s budget.

AAHSA acted immediately to mobilize its members, urging them to “persuade Congress not to accept these damaging cuts in programs that enable us to provide a variety of services to seniors in their communities.”

Only a few days before the proposed 2009 federal budget was released by the White House, the Alliance, along with the National Center for Assisted Living (NCAL) and the American Health Care Association (AHCA), proposed their own plan to reform financing and delivery of long-term and post-acute care.

That was followed a day later by a briefing and technology demonstration of innovations in services for seniors held on Capitol Hill by the Senate Special Committee on Aging, the House Medical Technology Caucus, and the Center for Aging Services Technologies (CAST). At the briefing, experts on technology for the aging discussed the potential of using technology to facilitate independence and allow older Americans to remain in their homes. They called for public policies that would accelerate bringing to the marketplace technologies that they said could transform the lives of older adults and their caregivers. Also encouraged was approval of S. 908, the Consortium on the Impact of Technology in Aging Health Services Act of 2007.

The new long-term care reform proposal would provide what its backers call “a new model for financing and delivering long-term care and post-acute care that is sustainable, patient-centered, and more cost-efficient.” They said it would replace current patchwork financing with a voluntary federal system while increasing private financing and streamlining post-acute and long-term care delivery systems.

The proposal provides new incentives for individuals to save and plan for future long-term care expenses by offering federally financed catastrophic coverage for those individuals “who make a significant personal planning commitment to their future long-term care costs.” It would establish new financial products, including improved reverse mortgages, federally endorsed long-term care insurance products, and new long-term care savings accounts, with incentives to consumers to purchase them.

Under the plan, the Centers for Medicare & Medicaid Services (CMS) would implement a new Medicare post-acute payment system based on the condition, needs, and characteristics of the patient, regardless of the site where care is delivered, thus further encouraging and enhancing consumer choice, the sponsors said.

A post-acute patient assessment tool would replace the existing site-specific model and help to determine patient placement, care plan development, continued stay, and discharge decision making, development of quality indicators, and payment calculation. The new Medicare payment model would replace the current system under which each site of care has its own reimbursement system determined by varying types of patient classifications.

“We are offering solutions that provide more comprehensive coverage, broader consumer options, and responsible use of government resources,” said Bruce Yarwood, president and CEO of AHCA. “We also seek to generate far more debate in the 2008 election about how we can affect immediate health policy changes that can help improve seniors’ care quality today and in the years ahead. The next President will be required to work with Congress to take bold, decisive action to ensure seniors will have ready access to quality long-term and post-acute care, because the crisis is now upon us,” he said.

At the technology briefing, CAST, a program of AAHSA, brought together technology companies and universities for a demonstration of technologies that sponsors said offer hope for improving quality of life while reducing costs, encouraging healthy behavior change, and providing caregivers with support.

Some of these technologies include:

  • Embedded sensors that can assess and improve an individual’s health status at home, including sensors in chairs that measure vital signs and a “smart cane” that uses sensors to detect changes in a person’s step, signal instability, and prevent falls.

  • Wearable sensors that collect health information and offer treatment over the Internet.

  • A computer program that uses touchscreen technology and a phone handset to test memory automatically. Other brain fitness technologies include integrated online gaming to help slow memory loss and the use of virtual communities to encourage social interaction and diminish isolation and loneliness.

  • A “Medication Advisor” system that signals to a senior when it is time to take medication.

“Technological innovation is a key to improving advancements in the quality of life,” said Sen. Herb Kohl (D-Wis.) “However, the question remains: How do we get such technology into the hands of seniors who need it in an efficient and affordable way? The Consortium on the Impact of Technology in Aging Health Services Act of 2007 will help us find that answer.”

The consortium, which would be established under S. 908, of which Kohl is a sponsor, would be charged with evaluating the potential of technologies to help the nation meet the needs of the aging population. It would be a public-private partnership that goes beyond medical records to explore the potential of new technology to help older adults and their caregivers in areas such as promoting independence, facilitating early disease detection, promoting greater support to caregivers, and minimizing medication error.

The consortium would include 17 members appointed by the President, Senate Majority and Minority Leaders, the Speaker of the House and the Minority Leader of the House. Members would be selected from aging services providers, technology companies, universities, physician and healthcare providers, and insurance, and pharmaceutical companies.

Bob Gatty has covered governmental developments for the trade and business press for more than 30 years. He is founder and president of G-Net Strategic Communications, based in Sykesville, Maryland.

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