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CPSC Comment on the CMS Proposed Rule for the Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2010
The CPSC legislative agenda for 2009-2010 reflects our membership's professional priorities as we adapt to an increasingly complex, labor-intensive health care sector driven by a higher demand for specialized care from a rapidly aging U.S. population. The U.S. Department of Labor estimates the U.S. will need between 5.7 million to 6.5 million nurses, nurse aides, and home health and personal care workers by 2050 to care for the 27 million Americans who will require long term care - up more than 100 percent from the 13 million requiring long term care in 2000. With demand for care rising and our nation's supply of caregivers shrinking, it is incumbent upon federal and state lawmakers to ensure the nation's long term care workforce remains a vital, respected, growing segment of our nation's workforce commensurate with the monumental and historic health care challenges ahead.
At a time when Congress is considering major changes to our health care system, we urge policymakers to avoid cuts to Medicare payments in long term care as a method to fund other programs. One of the valuable lessons we have learned over the years is that given the shortfalls in Medicaid spending, Medicare needs to be adequately be funded. Health care reform is needed and supported by this coalition, but access to basic health care needs should not be funded on the backs of long term care.
CPSC's key issues agenda for 2009-2010 are:
Strengthening the U.S. Long Term Care Workforce
The provision of high quality nursing home care and services is contingent upon a stable, well-trained workforce. America's long term care system, however, is currently suffering from a chronic supply and demand problem when it comes to our specific sector's labor force. Addressing this staffing challenge is the only real means by which to sustain the provision of high quality long term care for seniors today and in the decades ahead.
Stop Proposed Cuts to Medicare
We believe that proposals by CMS to cut Medicare funding will hamper quality efforts and, if implemented, cost caregiver jobs.
The Obama Administration's FY 2010 budget includes a Medicare regulation first proposed by the Bush Administration which, according to the Administration's own budget officials, would cut seniors' Medicare Part A nursing home funding by approximately $840 million in FY 2010 and by $7.23 billion over five years. As CPSC strongly supported the passage of the American Recovery and Reinvestment Act (ARRA) and its rationale and intent of job creation, we oppose this Bush-era regulation that, in fact, will undermine our ability to create good-paying health jobs. The proposed regulation, sidetracked in 2008 by considerable bi-partisan congressional opposition, will also place at risk the health care delivery reforms now already making Medicare more efficient. Rescinding the proposed Medicare cut would advance both health care policy and job creation objectives, and best reflect moving forward in a manner that maximizes the interests of every long term care stakeholder.
On May 12, 2009, the Centers for Medicare and Medicaid Services (CMS) published a Notice of Proposed Rule Making (NPRM) to update Medicare payments for skilled nursing facilities (SNFs) in FY 2010 and to modify the SNF prospective payment system (PPS) in FY 2011. The CMS proposed rule once again seeks to accommodate for its FY 2006 projection error related to the adoption of new patient classification categories, which would slash $1.05 billion in Medicare funding for crucial skilled nursing care in FY 2010 - estimated to be $18 billion over a ten year period. The proposed cut will have far reaching impact on our nation's already faltering economy. In FY 2010 alone, the proposed cuts would result in job losses of more than 30,000, the elimination of $2.54 billion in business activity and an additional $1.1 billion in lost wages and income.
Medicaid Funding That Meets the Cost of Care
While 65 percent of nursing home residents rely on Medicaid to cover the care they need, Medicaid continues to be funded far below the actual cost of caring for the frail elderly in our country. An independent national study conducted by ElJay, LLP estimated the 2008 Medicaid shortfall to be $12.48 per patient per day less than the actual cost of care - a $4.2 billion national shortfall. Chronic Medicaid underfunding and billions of dollars in proposed Medicare cuts threatens to compromise the quality of care a dedicated long term "care force" can deliver due to existing staffing shortages and a potential loss of thousands of caregiver jobs. True healthcare reform will include sustained and adequate funding for our most vulnerable Medicaid beneficiaries in nursing homes.
Making the appropriate investment in Medicaid can help reduce the number and frequency of hospital admissions by improving resident health, and increasing the capability of skilled nursing facilities themselves to successfully treat more complex medical conditions. It is essential to ensure seniors are protected, care quality improvements are sustained, key staff jobs preserved and operating and staffing needs are met through adequate funding of Medicaid coupled with no reductions in Medicare reimbursement. In the absence of a federal statute requiring state Medicaid programs to reimburse the cost of providing care, long term care providers and the frontline long term care workforce will continue to struggle to care for some of our most vulnerable citizens.
Medicare Post-Acute Bundling
The inclusion of Medicare "post-acute bundling" in the FY 2010 budget represents a sweeping, untested policy change that, at a minimum, is premature. The potential risk to front line care staff and their patients is significant. CPSC is wary of complex theoretical proposals that may sound attractive in academic settings but have no proven track record of effectiveness on the front lines of care -- where it matters the most. Testing health care theories on meeting seniors' essential health care needs is risky, and prior to transitioning from budgetary theory to actual implementation in a manner that will actually impact the lives and health of seniors, more testing and objective analysis in clinical settings is mandatory.
Long Term Care Reform
Central to the health care reform policy debate moving forward is recognizing the changing nature and needs of America's elderly patient population, and improving caregivers' ability to do their jobs in the most effective manner possible. Increasing numbers of post-hospital patients, coupled with the continued presence of high acuity chronic care patients, creates both growing challenges and unique opportunities in the context of reform. In addition to achieving quantifiable, long term quality improvements, the ultimate policy goal for long term care reform must be to achieve the most efficient use of health care resources by ensuring patients receive care in the lowest cost setting that best meets their needs.
Improving the CMS Five-Star Nursing Home Ratings System
CPSC believes that reliably and accurately measuring quality -- and publicly disclosing the results -- will help consumers identify the facility that best meets their needs and specific condition. Timely public disclosure helps improve facility performance, increases accountability, and ultimately benefits patient and caregiver alike. Unfortunately, however, in the rush to announce the Five-Star ratings system before the last days of the outgoing Bush Administration, a system that has not been reliably validated -- and risks providing consumers with inaccurate and incomplete information regarding facility quality -- is now operational. We look forward to working closely with the Centers for Medicare and Medicaid Services (CMS) and Congress to make rapid and dramatic improvements in the accuracy and ultimate value of the ratings system.
