Hospitals and post-acute care providers, Medicare drug providers, and older adults could see substantial changes in payments and benefits if President Obama’s 2015 fiscal year budget proposal is passed as presented.
The president’s $3.9 trillion plan includes more than $400 billion in cuts over the next decade in Medicare and Medicaid spending, as well as changes in provider reimbursement to place greater emphasis on quality. As Politico reported, additional savings would come from higher premiums of wealthier beneficiaries, changes in Medicare Part D payments to drug companies, and reimbursement cuts to post-acute providers like skilled nursing facilities and home health care agencies.
AARP criticized the proposal for “simply cost shifting.”
“We know that brand name prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs, said AARP Executive Vice President Nancy A. LeaMond in a statement. “But instead of shifting additional costs onto Medicare beneficiaries, we must look for savings throughout the entire health care system, as the rising cost of health care threatens people of all ages.” Continue reading
Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.
For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes. Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.
Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Continue reading
Image by Amanda M Hatfield via flickr.
Patient care advocates, drug companies, and both Republicans and Democrats are arguing against a proposal from the federal Centers for Medicare & Medicaid Services to eliminate protections for certain classes of drugs, including those for depression and schizophrenia.
Reporting on the proposal last week, Katie Thomas and Robert Pear wrote in The New York Times, “Opponents warn that the proposal, if enacted, could harm patients. Federal officials say it would lower costs and reduce overuse of the drugs.”
CMS estimates that the proposal will reduce overuse of some drugs and result in cost savings of $720 million by 2019, according to an AP article by Ricardo Alonso-Zaldivar.
Opponents say the proposal could result in increased hospital and physician services if patients can no longer get or afford the medications in six classes of drugs: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals and immunosuppressants. Antidepressants and immunosuppresants would lose protected status in 2015 and antipsychotics would lose it in 2016. The other three classes (anticonvulsants, antineoplastics and antiretrovirals) would continue to be protected in 2015 pending further review by CMS, the proposal said. Continue reading
Providing mentally ill older adults with home based services can be logistically daunting and expensive. However, a study in the March 3 issue of The American Journal of Geriatric Psychiatry found 10 long-standing programs that the authors say can serve as successful models for other communities.
Being homebound is a significant barrier to the detection of mental health problems and mental health services delivery. A growing number of communities are developing programs designed to improve the identification, treatment, and ongoing care of mental health problems in homebound older adults, according to authors Burton V. Reifler, M.D., and Martha L. Bruce, Ph.D. Many can benefit from successful models that have proven effective over years, or decades.
About 10 percent of the 40 million people over age 65 are considered homebound and require home-based care. Homebound older adults are twice as likely to be suffer from depression and other mental disorders as their community dwelling counterparts. Inadequately treated or undiagnosed mental health problems can lead to poorer medical outcomes, greater functional limitations, increased social problems and increased risk of premature death. It also leads to higher rates of health care use and premature institutionalization. Continue reading
Image by Tobyotter via flickr.
Non-restorative sleep is the strongest, independent predictor of widespread pain onset among adults over the age of 50, according to a new study in Arthritis & Rheumatology. Researchers in the United Kingdom found anxiety, memory impairment and poor physical health among older adults may also increase the risk of developing widespread pain.
Chronic pain affects more than 100 million Americans at a cost topping $600 billion annually, according to the Alliance for Aging Research. Musculoskeletal pain is more prevalent as people age, with up to 80 percent of people 65 years of age and older experiencing daily pain. Widespread pain that affects multiple areas of the body – the hallmark feature of fibromyalgia – affects 15 percent of women and 10 percent of men over age 50 according to previous studies. While there is no cure for chronic pain, several studies suggest that exercise and Vitamin D supplements may be beneficial. Continue reading
The recently released 2014 work plan sets up how the Inspector General’s office of U.S. Department of Health and Human Services will scrutinize claims CMS pays to hospitals, nursing homes, and home care agencies, as well as for prescription drugs, medical equipment and other care services. Continue reading
An agreement has finally been reached in both houses of Congress that replaces the Medicare physician sustainable growth rate formula, or SGR, with plan that provides stable funding updates based pay-for-performance and increases reimbursements by 0.5 percent annually for the next five years. The SGR, part of the 1997 Balanced Budget amendment, essentially ensured that the yearly increase in the expense per Medicare beneficiary does not exceed the growth in GDP.
However, as health care costs began to outpace inflation, the SGR began to fall short of the actual cost of health care services and Congress has repeatedly stepped in to suspend or adjust the payments (“doc fix”). Many physicians groups, including the AMA, have called for a more permanent, less formulaic, solution. Continue reading
The Centers for Medicare & Medicaid Services (CMS) released interim financial results for its various ACO and bundled payment initiatives today which show savings in excess of $488 million.* These included cost savings analyses for Medicare Accountable Care Organizations, Pioneer ACOs, the Physician Group Practice demonstration and expanded participation in the Bundled Payments for Care Improvement Initiative. Many of those programs are discussed in detail in the AHCJ tip sheet “Latest innovations in Medicare.”
“These innovative programs are showing encouraging initial results, while providing valuable lessons as we strive to improve our nation’s health care delivery system,” HHS Secretary Kathleen Sebelius said in a statement. “Today’s findings demonstrate that organizations of various sizes and structures across the country are working with their physicians and engaging with patients to better coordinate and deliver high quality care while reducing expenditure growth.”
CMS said that In their first 12 months, nearly half (54 out of 114) of the ACOs that started program operations in 2012 already had lower expenditures than projected. Of the 54 ACOs that exceeded their benchmarks in the first year, 29 generated shared savings totaling more than $126 million. These ACOs generated a total of $128 million in net savings for the Medicare Trust Funds. Medicare shares in any ACO savings generated from lowering the growth in health costs while meeting high quality care standards.
Final performance year-one results will be released later this year. Continue reading
The Medicare Rights Center, a national, nonprofit consumer service organization, just released its first report analyzing the top issues facing people who called its national consumer help line in 2012.
“Medicare Trends and Recommendations: An Analysis of 2012 Call Data from the Medicare Rights Center’s National Helpline,” details stories representative of the problems faced by older adults, their families, and those caring for them.
According to a press release, three major trends emerged from more than 14,000 questions fielded on the helpline: Continue reading
Gout is a devastating disease at any age, but can hit older adults especially hard. It is the most common inflammatory arthritis seen in the elderly. As this tip sheet by Eileen Beal describes, gout is very painful, manifesting with pain, swelling, heat, tenderness and stiffness in the joints.
A report published in the Jan. 15 issue of Annals of the Rheumatic Diseases shows an escalating incidence and prevalence of gout among people in the UK. As Medscape reported, researchers found gout prevalence increased by some 63 percent (from 1.52 percent to 2.47 percent) and incidence rose from 1.36 to 1.77 per 1,000 person-years between 1997 and 2012. A similar increase had been previously seen among people in the U.S. According to a 2011 study, researchers thought the higher rates were likely due to rising incidence of obesity and hypertension. Gout is also linked to a higher incidence of heart attack or stroke. Continue reading