| Geriatric Times |  |
September/October 2002 | |
Vol. III | |
Issue 5 |
Breaux Elder Justice Proposal
by Stephen BarlasThe most significant aspect of Sen. John Breaux's (D-La.) Elder Justice proposal is the creation of two new federal offices. The U.S. Justice Department would take on law enforcement responsibilities while the U.S. Department of Health and Human Services (HHS) would administer a separate funding stream for state adult protective services programs.
These state programs, which are responsible for ferreting out elder abuse, currently receive funding from a complex maze of federal programs like the Social Services Block Grant (Medicaid) and the Violence Against Women Act. Total federal funding to state adult protective services programs is about $153 million a year, a small figure compared to the $520 million and $6.7 billion spent combating violence against women and children.
"The recent down-turn in the economy has resulted in freezes and reductions of adult protective services staff, cutbacks on travel and training, as well as the adoption of waiting lists for abuse investigations," explained Joanne Otto, M.S.W., executive director of the National Association of Adult Protective Services Administrators, in a hearing before the U.S. Senate Finance Committee on June 18. "These reductions put victims in increased danger of additional and more serious abuse."
Scott Mulhauser, a spokesperson for Breaux, told Geriatric Times that the Senator expected to introduce an actual bill based on the proposal prior to the congressional recess in August. Mulhauser predicted that the bill will have substantial Republican support. In addition to creating two new offices, it will authorize an increase in the current amount spent on adult protective services. The bill will also include provisions dealing with prevention, law enforcement recruitment, and training and research.
Though Breaux is pushing hard for action, he and others admit that no one knows the actual amount of abuse occurring among elders. Bob Blancato, president of the National Committee for the Prevention of Elder Abuse, told the Senate Finance Committee hearing in June that there were 470,709 reports of elder abuse in 2000 -- based on figures compiled by the National Center on Elder Abuse, which held its first national summit in December 2001. The 2000 figure was a 60% increase from 1996. According to Breaux, 84% of abuse instances are never reported, so the annual total is probably far above 470,000.
Carmel Bitondo Dyer, M.D., associate professor of medicine at Baylor College of Medicine and co-director of the Texas Elder Abuse and Mistreatment Institute in Houston, told the Senate Finance Committee, "Big gaps in the knowledge of this serious public health problem still exist. Health care professionals and others do not have all the information they need to accurately detect, effectively intervene and/or prevent elder abuse."
The problem of adult abuse has been associated mostly with substandard nursing home care. However, the "abuse" that Breaux is concerned with ranges beyond physical mistreatment in health care settings to include financial and psychological abuse in residential settings.
The nursing home industry supports Breaux's efforts, at least in concept. "No one supports finding the best ways to protect our seniors from neglect and abuse more than the front line caregivers throughout the nation, who are incredibly dedicated to their patients and their mission," stated Charles H. Roadman II, M.D., president and CEO of the American Health Care Association, in a press release. "The American Health Care Association stands for quality nursing home care. The vast majority of the nation's 17,000 facilities provide quality care, and we deplore any that do not."
Changes to Medicare Fee Formula Seem Assured
by Stephen Barlas
Even if the U.S. Congress does not take action this year, Medicare physician fees will not decrease in fiscal year 2003. The Centers for Medicare & Medicaid Services (CMS) recently announced that it wants to modify the methodology used to calculate the Medicare Economic Index (MEI), a measure of inflation in providing physicians' services. The proposed change will raise the estimated 2003 MEI update from 2.3% to 3.0%. The MEI is one element of a formula that is used to calculate the final annual update to physician fees. According to the CMS, it is estimated that physician fee schedule payments will be reduced by an average of 4.4% in 2003 using the new MEI methodology versus a reduction of 5.1% without it.
The American Medical Association had mixed feelings about the proposed rule. "CMS has corrected an unrealistic assumption by adopting a smaller productivity adjustment," said Timothy T. Flaherty, M.D., an AMA trustee, in a press release. "In the past, this negative adjustment has led to estimates of practice cost inflation that were far too low."
Flaherty added that the AMA was disappointed CMS did not make other administrative changes requested by physician groups.
Congress may change the fee formula (as opposed to the components, as CMS is proposing) drastically in order prevent physicians from having to face negative updates in the future. On June 28, the House passed the Medicare Modernization and Prescription Drug Act of 2002 (HR 4954) by a vote of 221 to 208. This bill provides a 6% increase in Medicare physician payments over the next three years rather than the 14.2% cut projected under current law. The House bill also requires the General Accounting Office to study Medicare's beneficiary access to physicians' services to observe if seniors are having difficulties making appointments and if Medicare fees are linked with access problems.