Tag Archives for Medicare

Report on Falls, Injuries Released

PUblished in Woonsocket Call on October 20, 2019

Last Wednesday morning in Dirksen Senate Office Building 562, the U.S. Special Committee on Aging held a hearing to put a spotlight on the economic consequences on falls and to explore ways to prevent and reduce falls and related injuries. At the one hour and 55-minute hearing, titled “Falls Prevention: National, State, and Local Level Solutions to Better Support Seniors,” its annual report, Falls Prevention: Solutions to Better Support Seniors, was released.

According to the Senate Aging Committee, falls are the leading cause of both fatal and nonfatal injuries among older adults that incur $50 billion annually in total medical costs. That number is expected to double to $100 billion by 2030, and the majority of these costs are borne by Medicare and Medicaid.

“Falls are the leading cause of fatal and non-fatal injuries for older Americans, often leading to a downward spiral with serious consequences. In addition to the physical and emotional trauma of falls, the financial toll is staggering,” said Sen. Susan Collins (R-Maine), who chairs the Senate Aging Committee. “Now is the time, and now is our opportunity, to take action to prevent falls. Our bipartisan report includes key recommendations to take steps to reduce the risk of falls,” the Maine Senator noted in an Oct. 16 statement.

Pushing for Positive Change in Releasing Fall Report

“We must dispel our loved ones of the stigma associated with falling so that they can get the help they need to age in place – where they want to be – in their homes and communities,” said Sen. Robert P. Casey, Jr. (D-Pa.). “I am hopeful that our work over the past year will propel the research community to do more, get more dollars invested into supporting home modifications and encourage more older adults to be active,” said the Special Committee’s Ranking Member.

At the hearing, the Committee unveiled a comprehensive report that provides evidence-based recommendations on ways to reduce the risk of falling. The Committee received input from multiple federal agencies, including the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, and the Food and Drug Administration. In addition, approximately 200 respondents representing falls prevention advocates, hospitals, community organizations, home health agencies, and others shared their expertise on this issue.

The 34-page Aging Committee’s report made recommendations as how to raise awareness about falls-related risks, prevention and recovery at the national, state and local levels. It suggested ways of improving screening and referrals for those at risk of falling so that individuals receive the preventive care necessary to avoid a fall or recover after one. It noted ways of targeting modifiable risk factors, including increasing the availability of resources for home safety evaluations and modifications, so that older adults can remain in their homes and communities. Finally, it called for reducing polypharmacy so that health care providers and patients are aware of any potential side effects that could contribute to a fall.

Increasing Medicare Funding for Bone Density Testing

In an opening statement, Collins noted that falls are often times attributed to uneven sidewalks or icy stairs, medications, medical reasons or muscle strength. But one key cause of falling is osteoporosis, which can be especially dangerous for people who are completely unaware that they suffer from low bone density, she says.

According to Collins, although Medicare covers bone density testing, reimbursement rates have been slashed by 70 percent since 2006, resulting in 2.3 million fewer women being tested. “As a result, it is estimated that more than 40,000 additional hip fractures occur each year, which results in nearly 10,000 additional deaths,” she said, noting legislation, Increasing Access to Osteoporosis Testing Beneficiaries Act that she has introduced with Sen. Ben Cardin,” to reverse these harmful reimbursement cuts.

Casey stated, “I am particularly interested in sharing this report with the relevant agencies and learning how the recommendations will be implemented. Not just put in a report. Implemented,” adds Casey.

Peggy Haynes, MPA, Senior Director, of Portland-based Healthy Aging, MaineHealth that offers A Matter of Balance, an evidence-based falls prevention program, came to the Senate hearing to share details about its impact. “The health care community has a critical role to play in fall prevention – beginning with screening for falls, assessing fall risk factors, reviewing medications and referring to both medical and community-based fall prevention interventions. Our health system is focused on preventing falls in every care setting,” says Haynes.

“The need for a range of community-based options led MaineHealth to be a founding member of the Evidence Based Leadership Collaborative, promoting the increased delivery of multiple evidence-based programs that improve the health and well-being of diverse populations,” adds Haynes.

Haynes noted that older participants attend eight two-hour sessions to help them reduce their fear of falling, assisting them to set realistic goals for increasing their activity and changing their home environment to reduce fall risk factors. A Matter of Balance is offered in 46 states reaching nearly 100,000 seniors.

Virginia Demby, an 84-year-old visually-impaired retired nurse who is an advocate for Community and Older Adults, in Chester, Pennsylvania, came to the Senate hearing to support the importance of fall prevention programs. Despite living with low vision, Demby remains physically active by participating in exercises classes for older adults at the Center for the Blind and Visually Impaired in Chester. She is an advocate for older adults and now helps the local senior center wellness manager recruit more seniors to take falls prevention classes and find new places to offer the classes.

Kathleen A. Cameron, MPH, Senior Director, Center for Healthy Aging, of the Arlington, Virginia-based National Council on Aging, discussed the work of the National Falls Prevention Resource Center, which helps to support evidence-based falls prevention programs across the nation and highlighted policy solutions to reduce falls risk.

Finally, Elizabeth Thompson, chief executive officer, Arlington, Virginia-based National Osteoporosis Foundation, testified that bone loss and osteoporosis are fundamental underlying contributors to the worst consequences of falls among older Americans: broken and fractured bones. Osteoporotic fractures are responsible for more hospitalizations than heart attacks, strokes and breast cancer combined, she noted.

For details of the Senate Aging Committee report, go to http://www.aging.senate.gov/imo/media/doc/SCA_Falls_Report_2019.pdf.

Senators Seek to Identify Subpar Nursing Homes

Published in the Woonsocket Call on July 14, 2019

Last month, U.S. Senators Bob Casey (D-PA) and Pat Toomey (R-PA) succeeded in prodding the Centers for Medicare and Medicaid Services (CMS) to publicly release the April listing of underperforming nursing homes across the nation that require closer regulatory scrutiny but are not receiving any. Before CMS released the listing of candidates to the Special Focus Facility (SFF) program, the federal agency, charged with overseeing the care and quality in nursing homes, had not publicly identified these troubled facilities.

Less than 6 percent (88 facilities) out of more than 15,700 nursing homes nationwide are participants of the SFF program. CMS publicly identifies these facilities to the public. But an additional 2.5 percent (or approximately 400 facilities) qualify as candidates for the program because of having a “persistent record of poor care” but are not selected because of limited resources at CMS, according to a 26-page report, “Families’ and Resident’s Right to Know: Uncovering poor care in America’s Nursing Homes,” released in June 2019 by Pennsylvania’s two U. S. senators.

Nursing homes that are part of the SFF program have 12 to 18 months to correct any deficiencies and have two clean CMS surveys. If a facility fails to meet that target, it is are subject to increased regulatory enforcement, including being dropped from the Medicare and Medicaid programs.

Calls for Transparency

On March 4, 2019, Casey and Toomey wrote to CMS requesting information on its oversight of nursing homes in the SFF program. In that letter, the Senators requested the federal agency to provide the names of the 400 SFF candidates, calling for details about programs operations, scope and overall effectiveness. On May 3, 2019, CMS provided a written response and two weeks later, on May 14, the Senators received the listing of SFF candidates for April 2019. The names of these SFF candidates were not made public until Cassy and Toomey forced the issue by releasing this information in their report on June 5.

In CMS administrator Seema Verna’s May 14 letter to the two senators, Rhode Island-based participants and candidates in the SFF program were identified. They are: Charlesgate Nursing Center (SFF Candidate); Hebert Nursing Home (SFF Candidate); Oak Hill & Rehabilitation Center (SFF); St. Elizabeth Manor East Bay (SFF Candidate); and Tockwotton on the Waterfront (SFF Candidate).

In responding to the senators, Verma said that regardless of whether a nursing home is part of the SFF program, “any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement,” which includes civil money penalties, denial of payment for new admissions or termination from the Medicare and Medicaid programs. Verma also stressed that in addition to her agency’s regulatory oversight, its Nursing Home Compare website has been improved to include “new, more reliable sources for obtaining staffing and resident census data, as well as including more claims-based quality measures.”

“Regardless of participation in the SFF program, any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement remedies, such as civil money penalties, denial of payment f-or new admissions, or termination,” adds Verma.

Casey and Toomey believe that the list of SFF candidates is information that must be publicly available to individuals and families seeking nursing care for their loved ones. For that reason, the Senators have released the April 2019 list of SFF candidates and are continuing to work with CMS to make future lists public.

Through the release of the SFF candidate list and the Senate report, which details preliminary findings from surveys and public information about these candidate facilities, the Senators aim to provide Americans and their families with the transparency and information needed to choose a nursing home that would provide quality care to a loved one.

CMS Inquiry Identifies Issues

Casey and Toomey’s CMS inquiry into the SFF program put the spotlight on several issues. It became apparent to the two senators that a nursing home’s participation in the SFF program was not easily understandable to the public or would-be residents and their families. It became clear that CMS’s Nursing Home Compare, the agency’s online website, was not consistently updated to reflect any changes in the SFF program. “For example, in March 2019, the small icon used to indicate that a facility is an SFF participant was not on the webpage of five of the 17 newly-added SFF participants,” noted the Senate report. Most important, CMS’ website did not identify SFF candidates.

According to the released Senate report, only CMS and the state regulatory agency in which the nursing home is located and the facility itself, had knowledge of who is an SFF candidate. While CMS requires every nursing home to notify residents and its community of its regulatory SFF participant designation, these requirements do not apply to SFF candidates.

Aside from CMS recently updating its Nursing Home Compare webpage to more clearly indicate which nursing homes are SFF participants, it lacks details about the SFF program. There is no information explaining the reason for a facility’s participation in the program, the length of time it has been in the program or whether it has fixed the care issue. Most important, CMS does not include information on facilities that routinely cycle in and out of the SFF program, says the Senate report.

“There are few decisions more serious or life-altering than that of choosing a nursing home. I am pleased that CMS has taken the work that I have done with Senator Toomey seriously and is heeding our call to release the list of nursing facilities that are nominated to the Special Focus Facility program,” said Casey. “Our bipartisan work will ensure that families have all the information at their fingertips when choosing a nursing home. Now we must work in a bipartisan fashion to ensure the SFF program is working properly and that CMS has the funding it needs to improve underperforming nursing homes nationwide,” he says.

Adds, Toomey, “Ensuring that families have all the information they need about a nursing home will improve the quality of care at facilities across the country.”

Trump Spending Priorities Would Fray Social Safety Net Programs

Published in the Woonsocket Call on March 16, 2019

Last Monday, President Donald Trump released his proposed FY 2020 budget request to Congress. Lawmakers, who rejected many of these budgetary spending requests in the president’s previous two submitted budgets proposals, consider his latest to be “dead-on-arrival.”

But, Trump’s $4.7 trillion fiscal blueprint, outlined in the 150-page “Budget for a Better America,” gives us a clear picture of his spending priorities and policies he seeks to implement through executive orders and regulator changes.

Trump’s FY 2020 spending plan proposes funding increases for combating the opioid epidemic, improving veteran’s health care, fixing the nation’s crumbling infrastructure ($200 billion increase), even giving the Pentagon a 5 percent increase in spending exceeding what the military asked for. White House senior advisor Ivanka Trump successfully pushed for the FY 2020 budget to include $750 million to establish a paid parental leave program and a $1 billion one-time fund to provide childcare to under served populations.

Trump’s budget proposal makes a commitment of $291 million to eliminate the spread of HIV within a decade, it slashes the National Institutes of Health’s funding by 12 percent, and the budget for the Centers of Disease Control and Prevention by about 10 percent.

Trump does not back away from his controversial stance of building a wall, putting in an additional $8.6 trillion for the construction of a U.S. Mexico border barrier. Congress had earlier opposed his demand for $5.7 billion for the construction project.

Trump Budget Proposal Puts Senior’s Earned Benefits at Risk

In 2016, Presidential candidate Trump had pledged not to cut Medicare, Medicaid or Social Security, but he does in his submitted FY 2020 budget proposal.

Trump calls for a 5 percent cut in non-defense federal agencies, including a whopping $ 1.5 trillion in Medicaid over 10 years. The budget plan instead allocates $1.2 trillion to create “market-based health care grants,” (a.k.a block grants) for states that would start in 2021. This gives states the power to set their own rules for this program.

Medicaid expansion under the Affordable Care Act (ACA) would be eliminated by Trump’s FY 2020 budget proposal by ending ACA’s protections for people with pre-existing conditions and causing millions of people to join the ranks of the uninsured. About 15 million more Americans have joined Medicaid since the ACA expansion was enacted.

Trump’s budget proposal also cuts Medicare by $845 billion over the next decade by cutting payments to hospitals and physicians, rooting out fraud and abuse, and by lowering prescription drug costs.

Meanwhile, the Social Security Disability Insurance program takes a huge budgetary cut of $25 billion and the Social Security Administration’s (SSA) operating budget is slashed by 1 percent, at a time when the agency is working hard to ratchet up its customer service provide to SSA beneficiaries.

Trump’s budget proposal would cut $220 billion from the Supplemental Nutrition Assistance Program (SNAP), popularly referred to as the food stamp program. The program currently serves 39 million people. Under this budget, beneficiaries would be required to be employed for 20 hours a week to be eligible for assistance and replacing the EBT-debit card used to purchase groceries with the delivery of a “Harvest Box” filled with non-perishable foods like cereal and pasta, canned goods and surplus dairy products.

Housing and Urban Development’s 202 housing program for seniors and people with disabilities takes a $36 million hit, says long-time aging advocate Bill Benson, principal of Washington, D.C.-based Health Benefits ABC, in the March 15th issue of Aging Policy and Public Health News.

According to Benson, several Older Americans Act programs including the Family Caregiver Support program would be cut in Trump’s budget proposal. The Long-Term Care Ombudsman Program would be cut by $1 million. Elder Justice Programs would also be cut under the President’s budget including a $2 million cut to the Elder Justice Initiative at Administration for Community Living.

” Cruelest of all [budgetary cuts] is the proposed out-right elimination of the Social Services Block Grant (SSBG) which is the only source of sustained federal funding to states for Adult Protective Services (APS),” says Benson. Some 37 states use SSBGs to support their APS programs. SSBG is also used by states for a number of other services benefiting older adults including home-delivered meals and case management.

Shortchanging Seniors

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare (NCPSSM) warns that Trump’s budget proposal shortchanges seniors. “In combination with 2017’s tax cuts for the wealthy and the administration’s failure to allow Medicare to negotiate with Big Pharma, the Trump budget shows that his administration is not plugged into the realities of being elderly in America,” he says.

Richtman says that Trump’s budget plan also proposes to eliminate federal grants that help pay for programs under the Older Americans Act, such as Meals on Wheels and home heating assistance for the elderly poor.”

According to Richtman, the 116th Congress gives seniors hope with introduced legislation that would boost Social Security benefits and expand Medicare coverage to include dental, hearing and vision services, changes that an overwhelming majority of Americans support. He calls on Congress to “quickly reject this callous budget proposal — and take decisive action to enhance the well-being of older Americans.

Robert Greenstein, president of the Center on Budget and Policy Priorities, sees Trump’s newly released budget proposal as very troubling, too. “It sharply cuts funding in the part of the budget that invests in future economic growth through education and training, scientific research, infrastructure, and the like,” he says.

“It reverses progress in making affordable health care available to people who don’t have employer coverage or can’t afford private coverage. It cuts basic assistance substantially for families, children, and elderly and disabled people who are in need and struggle to get by. And, it doubles down on policies that take away health care, food, and housing when adults aren’t able to meet a work requirement,” says Greenstein.
“Despite bemoaning deficits, it calls for making the costly 2017 tax cuts — which largely benefit those who already have high incomes and wealth — permanent,” he adds.

Richtman believes that Trump’s 2020 spending proposal serves as a warning of what the administration would do if it were not for the firewall known as the Democratic-led House of Representatives. “These draconian ideas – though rejected by voters in the 2018 mid-terms – remain in the conservative political bloodstream, requiring continued advocacy on the part of seniors and their champions in Congress,” he says.

The release of Trump’s FY 2020 budget program begins the Democratic party’s efforts to retake the White House and Senate in the 2020 presidential election, just over 598 days away. By making major cuts in Social Security and Medicare and turning Medicaid into a state block grant program, Trump is giving Democratic challengers in the 2020 presidential election fodder to create politically-charged themes for ads to turn senior voters against him for seeking cuts in these popular domestic programs.

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, healthcare, and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.