Celebrating the Medicare #DocFix

Photo credit: David W. Parke II, MD

This week, I made a pilgrimage to Washington DC to attend a reception in the White House Rose Garden at the invitation of President Obama. It was a heady moment for this new CEO of the American Geriatrics Society and the Health in Aging Foundation. My 91-year old mother and her friends were quite impressed–going so far as to ask me to put in a good word for older adults. Got that covered, Mom.

Putting aside the excitement of seeing the Rose Garden and shaking President Obama’s hand (I admit shaking a President’s hand is really exciting), why was this moment so important for geriatrics health professionals and the older adults they serve? Congress, in a rare bi-partisan, bicameral moment, had passed The Medicare Access and CHIP Reauthorization Act and President Obama signed it into law April 16, 2015.

I won’t go into all the details of the bill here—nor will I try to explain the Sustainable Growth Rate (SGR), which may be what you heard a lot about in the news related to this legislation. Suffice it to say, this new legislation finally fixes a huge problem for geriatrics health professionals and the older adults they serve.

Geriatrics health professionals are specially trained to care for older adults (learn more about these professionals here; we can even help you find one here). Having benefited from their expertise as a family caregiver, I know first hand how different it is to partner with someone with this kind of training when caring for my loved ones. They always start the care process by considering what matters to older patients and their families as people, and then work back to how they can help you get there.

Geriatrics healthcare professionals are pretty much wholly paid by Medicare, so a looming cut in payment of more than 20{c754d8f4a6af077a182a96e5a5e47e38ce50ff83c235579d09299c097124e52d} annually is a big deal when you still have practice expenses to pay (that’s what these health professionals faced under the old SGR system). We don’t often talk about the business of medicine, but if you are in private practice you have expenses just like any other business. These include rent, staff (most geriatrics health professionals work in teams), equipment, supplies; malpractice insurance and your own health insurance. Like any other business, a sharp drop in revenue could endanger your ability to provide services. And that, in a nutshell, was the broader threat of the old SGR formula. With a stroke of the President’s pen, that threat is gone.

President Obama addressing reception attendees.

The bill has done a lot for streamlining payment systems and providing for more efficient healthcare environment, but it isn’t just about making payment more fair. Indeed, the bill also makes important policy changes that will improve the care of older adults. It will:

Offer providers positive and stable payment updates as they transition to new payment models;
Give options to healthcare professionals to participate in improvements to quality, clinical practice, the meaningful use of electronic records, and the effective management of resources;
Create strong incentives for improvements to the quality of care for Medicare-enrolled patients;
Give funding to help small practices with these new quality guidelines and transition to alternative payment models; and
Extend funding for Community Health Centers, the National Health Service Corps Fund, and Teaching Health Centers, and other important services that will help older adults live healthy lives.

These are big wins for geriatrics health professionals and the older adults that they serve. And we owe equally big thanks to House and Senate leadership for working cross the aisle to get this legislation passed. House Speaker John Boehner (R-OH), Minority Leader Nancy Pelosi (D-CA), Senator Orrin Hatch (R-UT), Senator Ron Wyden (D-OR), Representative Mike Burgess (R-TX), Representative Frank Pallone (D-NJ), Representative Fred Upton (R-MI), Representative Paul Ryan (R-WI), among others, worked tirelessly on this legislation. They agreed on something and then they got it done. I am hoping we see even more of that collaborative spirit from the 114th Congress.

A friend asked me if I was still basking in the glory of my trip to the Rose Garden. As a matter of fact, I am. I’d like to go again! If I’m lucky (and if the geriatrics workforce is, too), Congress will take up Graduate Medical Education (GME) reform next. My hope is that any GME legislation would include a provision that calls for all physicians in training to learn about the principles of geriatrics. That would be another huge win for older adults given the shortage of geriatricians and other health professionals. And since the flowers of collaboration and bipartisanship appear to be in full bloom, let’s hope that the future is as bright as the White House Rose Garden on a beautiful April day.