President Bush Signs Senior Falls Prevention Legislation
President Bush signed legislation aimed at preventing falls among older adults on April 23. The 'Safety of Seniors Act of 2007' (S 845), introduced by Sens. Mike Enzi (R-WY) and Barbara Mikulski (D-MD) in the Senate and Reps. Frank Pallone (D-NJ) and Ralph Hall (R-TX) in the House, authorizes new programs to help prevent falls among older adults through public education, research and demonstration projects.
The legislation will support the development of public and professional education strategies that raise awareness about and prevent elder falls; encourage research both to identify older adults who run high risks of falling and to evaluate falls interventions; and support demonstration projects aimed at preventing falls.
Falls are a leading cause of injury and death among those over 65. Among older people, falls account for approximately 13,000 deaths and 1.8 million emergency room visits each year. According to the Centers for Disease Control and Prevention (CDC), it costs more than $19 billion annually to treat injuries older adult sustain during falls.
"This is a serious public health problem that directly affects our seniors and their family members," said Sen. Mikulski, Chair of the Health, Education, Labor and Pensions (HELP) Subcommittee on Retirement and Aging. "This legislation provides a framework to reduce and prevent elder falls through public education campaigns and important research."
Many thanks to AGS members and other advocates of quality elder healthcare for joining the Society's advocacy efforts on behalf of this important legislation through AGS' Health in Aging Advocacy Center.
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Overall, Fewer Medicare Beneficiaries Skip Needed Drugs Since Advent of Medicare Drug Plan; But Sickest Beneficiaries Still Forego Meds Due to Cost Concerns
Fewer Medicare beneficiaries have been skipping needed medications due to cost concerns since the Medicare prescription drug benefit took effect in January 2006, but the sickest beneficiaries still forego prescribed drugs because they can't afford them, according to an April 23 Journal of the American Medical Association study.
In the study, researchers at Harvard Medical School analyzed results from a government survey of more than 24,000 Medicare beneficiaries in 2004, 2005 and 2006. The surveys found that 11.5% reported skipping medications in 2006 -- after the drug benefit was introduced -- compared with 14.1% in 2005. In addition, fewer beneficiaries reported cutting back on expenditures for basic needs such as food or housing, to afford medications after the Medicare drug benefit took effect. In 2006, 7.6% of beneficiaries reported cutting back on these expenditures, compared with 11.1% in 2005.
The sickest beneficiaries, however, were no less likely to report skipping their medications after than before the Medicare drug benefit was introduced. "These beneficiaries, who account for 27% of overall Medicare Part D enrollment, skipped pills at about twice the rate of healthier people in 2004 and 2005," Reuters reports.
A related study in the same issue of the Journal of the American Medical Association found that 36% of Medicare drug plan beneficiaries reported changing their medication regimens after enrolling in the benefit due to concerns regarding costs, or experienced "financial burden." Changes in medication regimes included switching to a less-costly drug, or failing to refill a prescription. The Kaiser Permanente Center for Health Policy Studies study surveyed more than 1,000 Medicare beneficiaries enrolled in the drug benefit. It also found that 60% of those surveyed were unaware their plans had "doughnut hole" coverage gaps.
"The new Medicare Part D program provides billions of dollars in new benefits for seniors, but also imposes complex and high levels of cost-sharing," said lead researcher John Hsu. "The study shows that many seniors have trouble understanding these benefits and that this poor knowledge limits their ability to manage their medication needs and costs."
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Majority of U.S. Doctors Support a National Health Insurance Program
More than half of U.S. doctors support legislation that would create a national health insurance program, according to a survey recently published in the Annals of Internal Medicine, Reuters reports.
The survey, which included more than 2,000 physicians, found that 59% support legislation to establish a national health insurance program, while 32% oppose it. In 2002, when the last survey was done, 49% of physicians supported national health insurance and 40% opposed it.
The survey also found that 83% of psychiatrists, 69% of emergency medicine specialists, 65% of pediatricians, 64% of internists, 60% of family physicians and 55% of general surgeons support a national health insurance plan.
"Conventional wisdom says that because there are a lot of medical specialty groups that don't support national health insurance, that doctors are not in favor. But almost twice as many doctors support it as oppose it," said Dr. Aaron Carrol, who led the study at the Indiana University School of Medicine.
"Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy," added Dr. Ronald Ackermann, who also worked on the survey.
While many countries, including Britain, France and Canada, have national health care programs, the U.S. relies on public insurance provided by federal and state governments, private insurance and employer-sponsored plans. A number of studies have found that the U.S. spends more per capita on health care than these countries -- without improving outcomes for patients.
Approximately 47 million people in the U.S. have no health insurance coverage.
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Vast Majority Want U.S. Health Care System Overhauled, According to Recent Survey
Ninety-five percent of the more than 26,000 U.S. residents responding to a recent online poll agreed with the statement, "health care in America needs fundamental change or to be completely rebuilt."
The majority of those participating in the poll, which was commissioned by the AFL-CIO and affiliate Working America, concurred with the statement, regardless of whether they had health insurance, according to the San Francisco Chronicle.
In addition, more than half of the Medicare beneficiaries completing the survey reported that their medications were not covered by the program or were unaffordable.
Most of the survey respondents were college educated and had jobs and health insurance. Union members accounted for 57% of respondents.
In the survey:
- One-third of respondents reported skipping necessary medical care because of cost concerns.
- 96% of respondents with health insurance indicated they were somewhat or very concerned about affording coverage in the next few years.
- 76% of respondents who lacked health insurance and 71% of those whose children were uninsured said that a family member did not see a physician after becoming ill in the past year -- because of cost concerns.
- 46% of respondents reported between $1,000 and $5,000 in out-of-pocket health care costs in the past year.
- 95% of respondents with health insurance said they were concerned about health care costs, and 62% said that they had concerns about quality.
- 71% of respondents with employer-sponsored health insurance worried about losing coverage and 61% said that the cost of their coverage had risen in the past few years.
- 79% of respondents named health care as a top campaign issue this year and 97% said they planned to vote in the upcoming elections.
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NCQA Releases New Medicare Measures Concerning SNPs; Many Reflect AGS Recommendations
The National Committee for Quality Assurance (NCQA) recently posted new Medicare Special Needs Plans (SNPs) structure and process measures, which took effect March 14, on its Web site. The measures reflect many of the recommendations that the American Geriatrics Society's Quality and Performance Measurement Committee submitted to the NCQA.
SNPs cover vulnerable Medicare beneficiaries - many of whom are elderly - including those in institutions, those eligible for both Medicaid and Medicare, and those with severe or disabling chronic conditions.
Under the direction of the Centers for Medicare and Medicaid Services (CMS) and with guidance from NCQA's Geriatrics Measurement Advisory Panel (GMAP) - which includes AGS members who act in an advisory role - NCQA developed measures concerning case management, member satisfaction, and clinical quality improvement.
"This is an important step in the development of quality measures," noted Tom von Sternberg, MD, a member of the AGS and Quality and Performance Measurement Committee (QPMC). "It is clear that most quality measures don't address the unique needs and characteristics of the older, frail, or disabled population."
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More Top Medical Students Passing Up Careers in Family Medicine and Primary Care for Dermatology and Other Higher Paying Fields
"Top tier" medical students are bypassing primary care and other fields focused on major diseases for specialties such as dermatology and plastic surgery that offer higher pay, better hours and more autonomy, the New York Times reports. As a result, dermatology, plastic surgery and otolaryngology are now among the most competitive residency programs, counting candidates with the highest median medical board scores.
While the average annual income for internists is roughly $191,525, it's $390,274 for dermatologists. In 2006, internists worked an average of 50 hours per week, while dermatologists worked about 40, according to an annual survey by the magazine Medical Economics. In addition, dermatology offers greater autonomy and independence from managed care paperwork and red tape because many cosmetic procedures aren't covered by insurance, so patients foot the bill themselves.
"Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses," the Times notes. "They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice."
"We have a shortage in America of primary care or family type doctors," Noel Felner, a cardiology professor and associate dean for clinical education at the Emory University School of Medicine told the paper. "We do need dermatologists, but I am more worried about the really sick people, and dermatologists aren't taking care of them."
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Senate and House Pass Budget Resolutions
Both the Senate and House this week approved $3 trillion fiscal year 2009 budget resolutions that would increase spending for healthcare and other domestic programs. Democrats drafted the budget resolutions in both houses.
The Senate budget resolution, which passed 51-44, includes $21.8 billion more for discretionary domestic spending than the President has requested. The House budget resolution, which passed in a 212-207 vote, surpasses the President's total for discretionary domestic spending by $25.4 billion.
Neither of the Congressional budgets calls for the $196 billion in spending reductions for Medicare and Medicaid that President Bush has proposed over the coming five years. The House budget resolution, however, charges the House Ways and Means Committee with presenting a reconciliation bill that, over six years, would produce $750 million in savings from mandatory programs, most likely from Medicare.
Before the Senate voted in favor of the budget resolution, it approved an amendment, 95-4, sponsored by Sens. Tom Harkin (D-IA) and Arlen Specter (R-PA) that would increase funding for the National Institutes of Health (NIH) by $2.1 billion. See Related Story. The Senate also voted on a number of other amendments concerning tax policy, entitlement spending, member earmarks and other issues.
House and Senate Republicans "assailed the Democratic budgets, charging that they called for too much spending on domestic programs, failed to curb the growth of Medicare and other costly entitlement programs and would lead to tax increases to millions of Americans," according to CQ Today.
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Sen. Boxer Introduces Geriatrics Loan Forgiveness and Training Legislation in Senate and AGS Endorses Bill; Washington Post Reports on Bill, Shortage of Geriatrics Professionals and AGS’ Advocacy Work
To help alleviate the growing shortage of geriatrics healthcare providers, Sen. Barbara Boxer (D-CA) introduced legislation last week that would create a loan forgiveness program for professionals who complete training in geriatrics or gerontology and care for older adults for at least two years afterward. Her “Caring for an Aging America Act,” would also expand training and advancement opportunities for long-term care workers. It would earmark $130 million in federal funds for the initiatives over five years.
The American Geriatrics Society, the National Council on Aging, the Alzheimer's Association, and the Alliance for Aging Research were among the organizations endorsing the legislation. AGS has long advocated for loan forgiveness programs for geriatrics healthcare providers.
An article about the loan forgiveness bill in today's Washington Post, in fact, notes that AGS has advocated "aggressively" for measures such as Sen. Boxer's, as well as for the Geriatrics Assessment and Chronic Care Coordination Act (GACCA) that Sen. Blanche Lincoln (D-AR) has introduced . The Post story begins with an anecdote illustrating the difference geriatrics care can make in the lives of older patients - and in healthcare spending. It relates what happened to one of Dr. Gregg Warshaw's patients, who developed pneumonia, but was spared a costly and difficult trip to the hospital because Dr. Warshaw determined that her condition wasn't serious enough to warrant hospitalization and stabilized her with antibiotics. The article goes on to report on the current shortage of geriatrics healthcare providers and adds that the supply of these providers is "falling seriously behind needed levels."
In its advocacy efforts on behalf of geriatric loan forgiveness, AGS has long noted that, given lower-than-market rate Medicare reimbursement rates, a career focused on caring for older adults can be particularly financially unattractive for physicians with increasingly large medical school loan debts. A loan forgiveness program will provide the incentives needed to bring more providers into the field of geriatrics.
Under Sen. Boxer's legislation, physicians, physician assistants, advance practice nurses, psychologists, and social workers who complete specialty training in geriatrics or gerontology and agree to provide care for older adults fulltime for a minimum of two years would be eligible for loan forgiveness. The bill would also expand the Nursing Education Loan Repayment Program to include registered nurses who complete specialty training and work with older adults in long-term care.
In addition, the bill would expand career opportunities for nursing and direct care workers by offering specialty training in long-term care through the existing Career Ladders Grants Program. Finally, the measure would create the Health and Long-Term Care Workforce Advisory Panel for an Aging America, which would examine and advise the Secretary of Health and Human Services, the Secretary of Labor and Congress on workforce issues related to elder healthcare.
“When our mothers and fathers and grandparents reach their golden years, they deserve quality care for their health and long-term care needs,” Sen. Boxer said. “But the medical and health community is already struggling to meet the demand for geriatric healthcare and support services, and the need for trained professionals is only growing. This legislation will provide incentives to help encourage qualified practitioners to join the geriatrics and gerontology fields.”
In May, Reps. Rosa L. DeLauro (D-CT), Ike Skelton (D-MO) and Bobby L. Rush (D-IL), introduced geriatrics loan forgiveness legislation in the House that would provide incentives to doctors and psychiatrists interested in pursuing additional training in geriatrics. Specifically, the measure would extend the National Health Service Corps Loan Repayment Program to geriatric training, forgiving $35,000 of educational debt incurred by medical students for each year of advanced training in geriatric medicine or psychiatry.
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Traditional Medicare More Efficient in Delivering Benefits than Medicare Advantage Plans, MedPAC Chief Reports
Traditional Medicare is more efficient in delivering benefits to beneficiaries than Medicare Advantage (MA) plans, Medicare Payment Advisory Commission (MedPAC) Chair Glenn Harkbarth told the House Ways and Means Health Subcommittee this week.
Medicare spends about $10 billion more a year on beneficiaries enrolled in MA plans than on those enrolled in traditional Medicare, but there's little evidence of added benefit to justify the extra spending, according to Harkbarth.
MA plan payments will be 113% of anticipated fee-for-service spending and 117% of payments to private fee-for-service plans, according to CQHealthbeat.
Hackbarth noted, however, that some MA plans cost less than traditional plans and deliver higher quality care. "The problem with this payment system is we're rewarding inefficient private plans," Hackbarth said. He singled out fee-for-service MA plans among the more costly, noting that they submit bids to the Administration that are more than 8% higher than the traditional Medicare rate and, in some states, receive payments that are as much as 20% higher than Medicare. "When Medicare pays a lot more for private fee-for-service in Texas or in Michigan, a lot of that money is going to higher administrative costs. ... It's going to insurance companies," he remarked.
Most Democrats support eliminating higher payments to MA plans but the Bush Administration and most Republicans strongly oppose such cuts.
Subcommittee Chair, Pete Stark (D-CA) said that he shared MedPAC's perspective on the plans. And Senate Finance Committee Chairman, Max Baucus (D-MT) and other Democrats have proposed cuts to Medicare Advantage plans as part of the Medicare legislation they are currently working on, Congress Daily reports.
Subcommittee ranking member Dave Camp (R-MI), however, has argued that such cuts would dramatically reduce the number of MA beneficiaries and that beneficiaries remaining in MA plans "would see their benefits slashed and out-of-pocket costs increase." "I want to be clear that I'm not suggesting we shouldn't look at savings opportunities in the Medicare Advantage arena," he added, "including adjusting benchmarks to recognize true market forces."
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Required by Law, Senate and House Introduce President's Controversial Medicare 'Trigger' Bill
As required by law, the House and Senate introduced President Bush's controversial Medicare proposal -- which would increase Medicare prescription drug benefit premiums for higher-income beneficiaries, require healthcare providers to use electronic health records (EHR), and cap non-economic damages in medical malpractice suits - in Congress this week.
Under the Medicare Modernization Act of 2003, Medicare Trustees are required to estimate the year in which general revenues will exceed 45% of total Medicare spending. If, in two consecutive years, the trustees project the 45% level will be reached within the next seven years, they must issue a warning that requires the president to propose changes to cut general revenues as a share of Medicare spending. The warning, issued last April, also requires Congress to consider the President's proposal in an expedited fashion. See Related Story
Majority Leader Steny Hoyer (D-MD) and Minority Leader John Boehner (R-OH) introduced the proposal in the House; and Finance Committee Chair Max Baucus (D-MT) and Senator Judd Gregg (R-NH), in the Senate. Rep. Hoyer and Sen. Baucus noted that they were introducing the plan because they were required to do so, not because they supported it.
The response among Republican legislators was more positive. "[For] too long, the only so-called solutions offered for dealing with Medicare's economic woes have been to simply ignore the problem," said Minority Whip Roy Blunt (R-MO). "The proposed reforms introduced today mark a break from that sad trend."
In the House, the Ways and Means and Energy and Commerce committees share jurisdiction over the bill. Ways and Means Committee Chair Pete Stark (D-CA) said the Democratic leadership in the House would ultimately decide what ends up in the bill. Under Medicare law, the House must release the bill by June 30, and vote soon afterward.
In the Senate, the Finance Committee has jurisdiction over the proposal. "[I]t'll be different when it comes out of the committee," said Sen. Baucus, who added that, rather than focus on the President's bill, he plans to work on his own Medicare legislation this year. "That bill will increase access to preventative benefits and primary care, and will improve the quality of care delivered under the program," he said.
On Thursday, March 6, the Kaiser Family Foundation will hold a policy workshop, "Pulling the Trigger: How the Funding Warning Could Shape Medicare's Future," in Washington, D.C. The workshop, which runs from 9:30 AM to 11 AM, EST, will examine the "trigger" and its implications for this year's budget debate and Medicare's long-term fiscal health. RSVP: Tiffany Ford, tford@kff.org or (202) 347-5270. For more information, contact Craig Palosky at cpalosky@kff.org or 202-347-5270 or Tiffany Ford at tford@kff.org or 202-347-5270.
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GAO Study Finds Decline in American Doctors Choosing Primary Care; Overall Growth in Field Due to Increase in International Students
Though the number of primary care physicians in the US is growing, this is due, increasingly, to a rising influx of international physicians into the field. Fewer American physicians, a new General Accountability Office (GAO) report concludes, are choosing primary care.
In 2006, there were 22,146 American doctors in US residency programs specializing in primary care. That was down from 23,801 in 1995. The number of international medical graduates training in primary care, however, grew from 13,025 in 1995 to 15,565 in 2006, according to the GAO report.
"It is troubling to me that the number of Americans pursuing a career in primary care has declined," Senator Bernie Sanders (D-VT) told the Associated Press. "We are increasingly dependent on international medical school graduates to meet our needs. Currently, one in four new physicians in the U.S. is an international medical graduate."
The report also found that the number of American doctors training to be specialists increased from 45,300 in 1995 to 47,575 in 2006. The number of international physicians training to be specialists grew as well, from 11,957 to 12,611 over the same time period.
"There are simply not enough primary-care providers now and the situation will become far worse in the future unless we do something," Senator Sanders said. He urged doubling funds for the National Health Service Corps to $250 million next year. This program offers scholarships to students who agree to practice primary care in areas that need it most.
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President’s Proposed Budget Would Eliminate Funds for Title VII Geriatrics and Health Professions Programs and Dramatically Cut Medicare and Medicaid Spending; Lawmakers Plan to “Ignore” Bush Funding Plan
President Bush’s proposed $3.1 trillion budget would eliminate all funding for Title VII Health Professions Programs – including Geriatrics Health Professions Programs. Funding for these critical training programs, which include geriatric faculty fellowships, geriatric academic career awards, and the nation's 50 Geriatric Education Centers, totaled $31 million this fiscal year.
The President’s budget, released Monday, would also cut Medicare and Medicaid spending $196 billion over the next five years. Most of the Medicare savings would come from freezing reimbursement rates for participating healthcare providers for three years and from cutting payments to hospitals serving large numbers of the uninsured poor.
Senate Democrats immediately challenged the President’s “unrealistic assumptions” about health care spending and other issues concerning the proposed budget, CQ Today reports. Legislators “made it plain that they would ignore the president's proposals to cut Medicare and Medicaid spending," according to the Philadelphia Inquirer.
”The Medicare cuts are not realistic," said Senator Pat Roberts (R-KS), criticizing provisions that would freeze or cut payments to providers and hospitals. "I urge you to take another look at that, 'cause it's just not gonna happen."
Congress eliminated 2006 funds for Title VII Geriatrics Health Professions Programs–with disastrous results – but restored fiscal year 2007 funding and allocated $30 million for the programs for 2008 in the wake of numerous AGS and ADGAP advocacy campaigns on behalf of the programs. On the heels of advocacy campaigns on behalf of appropriate Medicare reimbursement for providers, Congress has blocked mandated cuts in these payments, and instituted pay increase, several times. Legislators recently voted to delay for six months a mandated 10.1% cut in Medicare physician pay rates that was slated for January 1, and increase these payments 0.5% through June 30.
The President's budget proposal is only a blue-print. Ultimately, Congress appropriates funds in its lengthy budget process. AGS will continue to advocate for Title VII Geriatrics Health Professions Programs funding, adequate Medicare reimbursement for physicians, and other programs and initiatives central to ensuring older Americans access to appropriate healthcare.
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Sen. Lincoln Urges DHHS' Mike Leavitt to Reconsider Title VII Geriatrics Health Professions Programs Funding, Following Release of Presidential Budget Plan That Would Eliminate Funds for the Programs
Title VII Geriatrics Health Professions Programs are so essential to ensuring older Americans access to appropriate healthcare - now and in the future - that policymakers should reconsider the impact of cutting funding to the programs, Sen. Blanche Lincoln (D-AR) told Department of Health and Human Services Secretary Mike Leavitt during a Senate Finance Committee hearing the day after President Bush unveiled his budget.
The $3.1 trillion spending plan that the President proposed February 5 would, among other things, eliminate all funds for the programs (See related story). Funding for the programs, which include geriatric faculty fellowships, geriatric academic career awards, and the nation's 50 Geriatric Education Centers, totaled $31 million this fiscal year.
"The programs are certainly critical because we have such a high percentage of seniors who need that quality care," Sen. Lincoln told Leavitt. "And when you poll those individuals, or they are interviewed, they say that the programs that they go through in these facilities are enormously helpful in their ability to better provide quality care and, certainly, cost- effective care, to the aging population. [If] we just put them out of business, there's no longer going to be the kind of training programs that are training not only academic geriatricians, geriatricians as physicians, but also providing the additional geriatric training for nurses and a whole host of other things. "
During the hearing/session, Sen. Lincoln asked Leavitt how DHHS could justify eliminating funding for the programs when the population of older Americans is growing rapidly and expected to nearly double by 2030.
"We went through all of the programs and tried to make an evaluation of those that, first of all, were providing services and not necessarily infrastructure," he answered. "This is a decision we made based on the fact that we want to provide services as a priority to infrastructure. In many cases, these are about providing basic infrastructure."
"But you can't provide the services if they're not trained," Sen. Lincoln replied.
"There are some systemic changes that time won't allow us to talk about today, but that I believe can, in fact, begin to help us meet that demand; ideas such as beginning to measure competency, as opposed to measuring the time people spend in their seat being trained. We can use existing facilities for workers, et cetera," Leavitt responded. "And so that's not exactly on point to your question, but I did want to be on the record as saying I'm deeply concerned about our incapacity to meet the demands using the current system.
"Well, that sounds good, I suppose. But it doesn't help us solve the problem," Sen. Lincoln noted, again pointing out that the nation already faces a shortfall of geriatrics training programs - a shortfall that will be exacerbated by cuts to the Title VII geriatrics training programs.
"[W]e should think about that before we institute the law or before we put together the packages and create the cuts," Sen. Lincoln urged.
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$3.1 Trillion Bush Budget Would Cut Medicare and Medicaid Spending, Freezing Healthcare Provider Reimbursements and Cutting Fees for Hospitals Serving Uninsured
Though the $3.1 trillion budget President Bush sent Congress Monday is the nation's first $3 trillion dollar budget and proposes both increasing overall spending 6% in 2009, and boosting military outlays significantly, it would cut funding for Medicare and Medicaid $196 billion over the next five years. The proposed cuts are roughly three times those the President proposed, and Congress rejected, last year, The New York Times reports.
Much of the Medicare and Medicaid savings would come from freezing reimbursement rates for participating healthcare providers for three years and from cutting payments to hospitals serving large numbers of the uninsured poor. "A much smaller effort by Bush in this area last year went nowhere in Congress," The Times notes.
The President's new spending plan also calls for 3%, or $2 billion, in cuts for the Department of Health and Human Services, and flat funding for the National Institutes of Health. The Food and Drug Administration, however, would get a 6%, or $2.4 billion, boost to fund additional food and drug safety initiatives.
President Bush's budget, which would result in near record deficits in the $400 billion range for each of the next two years, essentially freezes domestic spending at current levels, after taking into account inflation and population growth. Education spending would be frozen with no increase for inflation.
In keeping with the spending plan, outlays for Defense spending -- excluding spending on the wars in Iraq and Afghanistan -- would jump $35 billion to $515 billion. Another $21 billion would be for nuclear weapons programs and $70 billion for a ''bridge fund'' for the Iraq and Afghanistan wars designed to "give the next president time to consider options, with tens of billions of dollars more needed regardless of any strategy shift," according to The Times.
The President's proposal is just that -- a proposal. Ultimately, Congress appropriates funds in its lengthy budget process. AGS will continue to work directly, and with its coalitions, to advocate for adequate funding for programs and initiatives aimed at ensuring older Americans access to quality healthcare.
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The American Geriatrics Society and AMA Conducting Physician Practice Information Survey
For the first time in nearly a decade, the American Geriatrics Society (AGS), the American Medical Association (AMA), and more than 70 other health care professional organizations, have worked together to coordinate a comprehensive multi-specialty survey of America's physician practices. The survey will collect up-to-date characteristics of thousands of physician practices from virtually all specialties, and be used in efforts to positively influence national decision makers to ensure accurate and fair representation for all physicians and patients.
Getting our nation's policy-makers to understand today's landscape and the requirements for care is critical. These data will allow medicine to articulate the challenges of running a practice that provides expert patient care, while operating a business that is sustainable. The study results will not only help in the short-term but will allow future generations of doctors to continue providing superior care to their patients.
One particularly important section of the study pertains to practice expenses and the amounts that are attributable to you. The Centers for Medicare and Medicaid Services have indicated that the results of this study will be used to help determine physician payment. Please encourage your staff to make this information available as the survey's success depends on accurate and complete data. This information will remain confidential. The survey firm, Dmrkynetec, will not identify any individuals or entities participating in this research.
Dmrkynetec, a survey firm with extensive experience in the area of physician practice finance, has been retained to administer the survey. Dmrkynetec will contact randomly selected physicians and practice managers in order to collect their confidential responses. Please watch for this survey and complete it thoroughly and accurately. Do your part to represent our profession. Physician Practice Information Survey Frequently Asked Questions
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Comptroller General Warns that Combination of Rising Healthcare Costs and Aging Population Could "Bankrupt" US Unless Fiscal Policy Changes Soon
Soaring healthcare costs and the growing number of aging Baby Boomers nearing retirement will necessitate steep cuts in federal programs and stiff tax hikes unless Washington acts, within the next five years, to get spending under control, Government Accountability Office chief David Walker told the Senate Budget Committee on January 29, 2008.
The "federal budget is on an imprudent and unsustainable path," said Walker, who reported that the nation's debt now totaled $9 trillion -- up from $5.8 trillion in 2001.
Tax cuts and the cost of the wars in Iraq and Afghanistan have contributed to America's growing indebtedness but the chief contributor is healthcare spending for older Americans, the poor, and veterans, he argued. According to Walker, the cost of healthcare has outstripped inflation by an average of 2% a year for the last 40 years, Congress Daily reports.
"If there is one thing that could bankrupt America, it's rising health care costs," added Walker, the Comptroller General of the US.
The European and Asian nations financing the nation's debt with credit may be less inclined to do so as debt mounts, he warned. At the very least, creditor nations will start charging higher interest rates, limiting America's economic growth and global competitiveness.
Addressing the Senate panel, Walker praised Senate Budget Chairman Kent Conrad (D-ND) and ranking member Judd Gregg (R-N.H), for their proposal to create a bipartisan task force on entitlements to address the issue.
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President Bush Plans to Approve Billions More in ‘Contingency’ Funds for Veterans
President Bush plans to approve $3.7 billion in “contingency” emergency funding for veterans’ programs, ending speculation that he might block release of the funds. The lion’s share is expected to go toward medical services, administration, and facilities and research.
The funding was included in the $555 billion omnibus spending bill that the President signed last month. Although the Bush Administration did not oppose the contingency funding, it asked Congress to offset the funding with reductions in other spending. Congress, however, refused, and insisted on designating the allocation “emergency” funding. Spending caps do not apply to emergency funding.
The president must formally request the money from Congress. He has until January 18 to approve the funding.
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President Signs Omnibus Spending Package Funding Title VII Programs in FY 2008 and Medicare Bill Delaying Physician Fee Cut; Senate Finance Chief Calls for Further Medicare Reform
Title VII Geriatrics Health Professions Programs will receive approximately $31 million in federal funds in fiscal year (FY) 2008 -- about 1.7% less than the $31.5 million earmarked for the programs in FY 2007 -- under a $555 billion omnibus budget package the President signed December 26. A few days later, President Bush signed into law a Medicare bill that, among other things, delays a pending 10% physician fee cut that would have taken effect January 1.
The omnibus spending package provides $194 million for all Title VII Health Professions Programs. Though this is 5% more than earmarked for the programs in FY 2007, the majority of programs will receive a 1.747% across-the-board downward adjustment. Among Title VII programs, only the Health Careers Opportunity Program (HCOP), the Centers of Excellence (COE), and public health programs will receive increases under the plan.
The $555 billion omnibus spending bill includes the fiscal year 2008 Labor-Health and Human Services-Education appropriations bill and 10 other FY 2008 appropriations bills that had yet to be finalized. The Labor-HHS-Education bill includes $600.1 billion in total spending and $145.1 billion in discretionary spending.
The new Medicare legislation will, among other things, delay for six months a mandated 10.1% cut in Medicare physician pay rates and increase these payments 0.5% through June 30. The cut, mandated by Medicare's controversial Sustainable Growth Rate Formula, was scheduled to take effect the first of this year. Congress will have to address the issue again in mid-2008 to keep another physician pay cut taking effect July 1.
The Medicare measure also extends the State Children's Health Insurance Program (SCHIP) through March 2009 and makes several changes to the Medicaid program.
Although a Medicare demonstration program based on provisions in the proposed Geriatric Assessment and Chronic Care Coordination (GACCC) Act of 2007 (S. 1340 and H.R. 2244) had been under consideration for inclusion in the Medicare bill, the program was ultimately dropped from the legislation. The demonstration program would have been conducted at up to 20 sites, where geriatricians and other qualified health providers would have provided geriatric assessments and chronic care coordination services to eligible beneficiaries with multiple chronic conditions, including dementia. It is possible that the demo program could be resurrected when the Senate Finance Committee works on new Medicare legislation in 2008.
"The Finance Committee will move aggressively on broader Medicare reform in the next session of Congress," Senate Finance Committee Chairman Max Baucus (D-MT) promised. "Changes that make every part of Medicare better for seniors are sorely needed. A hard look at Medicare Advantage is now overdue. Work on comprehensive Medicare legislation will continue and see completion in the early part of 2008."
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