More seniors are unhappy than happy with healthcare reform, according to a recent Gallup poll that also reflects what I’m hearing from older adults. Aware that the new healthcare reform law calls for Medicare cuts, many seniors are concerned that the cuts will chip away at their benefits. But the truth of the matter is that reform legislation will actually enhance Medicare benefits—and the practice of geriatrics.
The new reform law calls for significant future cuts in Medicare outlays, but these cuts focus on inefficiency, waste, and fraud that together cost Medicare billions
each year. Basic Medicare benefits are guaranteed by law. And under healthcare reform, greater care coordination and support for care within a broader context of wellness will improve both the quality of care that beneficiaries receive and its cost-effectiveness. By accomplishing the latter, the legislation will make Medicare more sustainable.
The reform law won’t solve all that ails Medicare—and I’ll get to a serious omission later. Yet, it has a great deal to offer older adults and those of us who care for them. It doesn’t do everything that needs to be done, but it’s a long-awaited, much needed, significant step in the right direction.
For starters, healthcare reform legislation will help address existing disincentives to choosing and continuing a career in geriatrics and, as a result, should help address current eldercare workforce shortages. Among other things, the new legislation will give geriatricians and other primary care providers a 10% Medicare bonus payment for specified primary care services for the next five years. The law will also institute periodic reviews to reevaluate physician services that appear to be inappropriately valued. It will create a physician “value-based payment program” that rewards improvements in quality of care and, in a related move, will require the U.S. Department of Health and Human Services to develop a national strategy for improving quality.
In order to build an eldercare workforce that can meet the demands of our aging population, we also need to invest more in training. The new law will do just this. It will enhance programs at Geriatric Education Centers and expand the Geriatric Academic Career Awards program. It will create new training opportunities for direct-care workers and family caregivers on whom seniors rely for essential day-to-day care. And it calls for increased funding for the National Health Service Corps and establishes a Graduate Medical Education policy that allows unused training slots to be reallocated in ways that will increase the ranks of—and older adults’ access to—primary care practitioners. We will still, however, need to continue to aggressively advocate for the funding of these new and expanded programs.
The reform law also tackles significant barriers to healthcare utilization by cutting seniors’ out-of-pocket costs. Beneficiaries who fall into the Medicare Part D “donut hole” coverage gap this year will get a $250 rebate to help them cover prescription drug costs. And starting next year, those who hit the gap will get 50% off all brand-name prescription drugs. The law will shrink the donut hole more each year, closing it entirely by 2020. The demise of the donut hole alone is expected to save the average senior roughly $3000 annually. Because the law will pare subsidies to private Medicare Advantage (MA) plans, which now cost an estimated 12% more than traditional Medicare, some plans may fold or will trim ancillary benefits, such as free eyeglasses and gym memberships for beneficiaries. But basic benefits won’t be touched, and the reform law will offer MA plans that meet specified quality standards bonuses that can help offset the planned reductions in their subsidies.
In a long overdue move, the healthcare reform law will also step up the evaluation and implementation of promising new models of care. It will create a “CMS Innovation Center” to test new payment and care delivery approaches aimed at improving quality and cost-effectiveness of care. In addition, it will fund a wide range of important demonstration projects to evaluate promising models of care, including those providing interdisciplinary team care to older adults with multiple chronic conditions or cognitive impairment. Preliminary research suggests that these models can both improve outcomes and save money. The law also will establish a demonstration project to provide home-based care to older adults with complex conditions and will provide programs with the goal of reducing preventable and costly hospital readmissions among Medicare patients.
At the same time, the healthcare reform law will bring about long overdue changes in long-term care. It will create a voluntary public long-term care insurance program in which all working adults 18 years and older can enroll (thereby creating a large risk pool) and will help states expand home and community-based long-term care services, giving more seniors viable alternatives to institutionalization. “With high numbers of adults over age 85 and the coming onslaught of aging boomers, [such initiatives] could not have come at a better time,” Bruce Chernof, head of the Scan Foundation, noted in a recent Los Angeles Times
op-ed piece about the benefits of the new reform law.
The American Geriatrics Society (AGS) has long been a staunch advocate of these and related healthcare reform initiatives. This year, as in years past, the AGS launched numerous advocacy campaigns supporting needed reforms. Leaders, members, the AGS’ Washington, DC–based team, and staff repeatedly met with, phoned, and wrote persuasively to key lawmakers involved in reform and their staff. Now, having established itself as a “go-to” organization in the field, and having seen many of the reforms it championed written into law, the AGS plans to work proactively to ensure that reform measures affecting elder healthcare are implemented appropriately. If you’re not already involved in the AGS’ advocacy efforts, I hope you’ll become involved by registering with the AGS’ Health in Aging Advocacy Center (http://capwiz.com/geriatrics/issues/alert/?alertid=7876796
As I write this column in mid-April, the AGS is urging Congress to find a workable alternative to Medicare’s Sustainable Growth Rate (SGR) formula. After failing to act to postpone a 21% cut in Medicare payments to physicians mandated by the SGR, lawmakers rescinded the cut and then temporarily deferred it, once again, until the end of May. AGS has long advocated for an end to such temporary “fixes” to the problems that the SGR creates. Washington’s failure to come up with a permanent fix is the “serious omission” I referred to earlier.
There’s no doubt that the new reform law has much to offer seniors and geriatrics healthcare professionals. It is, as I’ve noted, a significant, essential, long-awaited step in the right direction. But it must be followed by further steps that institute a viable alternative to the SGR, better value geriatrics care, adequately fund the geriatrics training programs under Title VII and VIII of the Public Health Service Act, and address other issues affecting the sustainability of geriatrics practices and seniors’ access to care.
1. Chernof B. Healthcare reform: What’s in it for our seniors? Los Angeles Times
. March 30, 2010. http://articles.latimes.com/2010/mar/30/opinion/la-oe-chernof30-2010mar30
. Accessed April 16, 2010.
Dr. Spivack is Associate Clinical Professor of Medicine, Columbia University, New York, NY; Consultant in Geriatric Medicine, Greenwich Hospital, Greenwich, CT; and Medical Director, LifeCare, Inc., Westport, CT.
Send comments to Dr. Spivack at: email@example.com