Health AGEnda

A Trifecta of Good News for Supporters of Elder Justice

older_Americans_400pFor those of us who have long advocated for a national agenda to prevent, detect, treat and report the mistreatment of older adults, developments over the summer have sparked some measure of hope and optimism.

The cause of elder justice hit the trifecta, with good news coming from all three branches of the federal government. First, the U.S. Supreme Court decision upholding the Affordable Care Act represented a victory for the Elder Justice Act as well. Enacted by Congress as part of the ACA, the Elder Justice Act targets the widespread issue of elder abuse in communities and long-term care facilities.

Then, at last month’s White House Conference on Aging, President Obama announced that a new rule to be issued by the end of 2015 will clarify that, among other approved uses, assistance funds from the Victims of Crime Act may be used to aid elder victims of abuse, financial exploitation, fraud, and neglect.

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Equality Does Not Equal Lowering Health Care Standards for the Poor

FrenchRevolution_177737175July is an important month in history, with Bastille Day, on July 14, coming just 10 days after our own 4th of July. So what better time to consider issues of justice and equality?

There are lots of different ways to interpret equality: equality of outcomes, equality of opportunity, or perhaps—as an even more complex relative equality—matching of resources to individuals’ needs.

In the context of improving health care delivery to older adults, there are several important examples of these principles of equality in what is called “risk adjustment.” And I find myself with very different reactions to the different kinds.

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Toward a More Effective CMMI

CMIinnovationlogofinal1Last week on Health AGEnda, I stuck up for  the Center for Medicare and Medicaid Innovation (CMMI) in the face of what seemed to me fairly unrealistic criticism from a Wall Street Journal op-ed.

I approached the issue from my perspective as a funder and as a very, very, much smaller player in the reform of the health care delivery system than CMMI. It got me thinking that, while I have offered advice directly to the Centers for Medicare and Medicaid Services (CMS) and CMMI staff and mentioned various concerns here on the blog in passing, I haven’t really tried to think through what our experience at Hartford suggests might help CMMI be as effective as possible.

CMMI is the big player in health care delivery reform—the changes to culture, training, regulation, payment, and organization in health care that we all hope will lead to higher quality care, a healthier public, and lower costs of care per capita.

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Debate Role of CMMI? Absolutely. Abolish it? No

WSJCapture400When I first saw the Wall Street Journal op-ed attacking the Center for Medicare and Medicaid Innovation (CMMI) for many purported sins, my first thought was that I should just congratulate CMMI for having arrived. After all, in our hyper-partisan environment, you aren’t anybody unless you are considered worth bashing by someone.

CMMI was set up and funded as part of the Affordable Care Act under section 3021of Title III, the hitherto relatively noncontroversial part of the law aimed at “IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE.” The agency’s goal is one that the John A. Hartford Foundation  has pursued on behalf of older Americans for 30 years and one that we feel passionate about:

The purpose of the CMI is to test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles. In selecting such models, the Secretary shall give preference to models that also improve the coordination, quality, and efficiency of health care services furnished to applicable individuals defined in paragraph (4)(A).

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No Single, Simple Explanation for High Health Care Costs

As we enter 2014, the topic of health care costs continues to be a major topic of conversation in the media and among policy makers. The topic is complex and can be spun in different ways.

You may have seen the recent news about how growth in health care spending in the United States has remained low for four consecutive years, for which the White House would like to take some credit. Or you may have seen news reports about how Medicaid expansion in Oregon led to higher emergency department use (and therefore higher costs), which is used by some to argue against the Affordable Care Act. The bottom line is that understanding health care costs is a complex task.

Clearly, the issue of out-of-control U.S. health care costs is of crucial importance and has been a serious challenge to increasing funding for other needs, such as improving infrastructure and education. It is also one in which the general public, pundits, and politicians look for simple, single reasons and matching solutions, e.g., obesity/calorie designations on menus; malpractice insurance/tort reform, too much government involvement/more private sector competition, etc.

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The Question of Long-Term Care: How Do You Eat An Elephant?

Dr. Tracy Lustig testified in August before the Commission on Long-Term Care.

One of my biggest surprises in the passage of the Patient Protection and Affordable Care Act (PPACA) was the inclusion of title VIII, the CLASS ACT, which created the possibility of a national, voluntary, premium-financed, and federally administered long-term care insurance program.

While the benefits might have been small and delivered through our only marginally adequate long-term care system, at least it was a start and a step toward recognizing the serious long-term care needs of our aging population.

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Medicare readmissions reduction reform is complex, scary—and absolutely necessary

NHPFlogo250Last Friday I was at a session of the National Health Policy Forum (NHPF) in Washington D.C. focused on Medicare’s readmission reduction program  The program, authorized under section 3025 of the Patient Protection and Affordable Care Act (PPACA), is the “stick” to section 3026’s “carrot.”

Section 3026 authorizes the $500 million Community-based Care Transitions Program that will pay partnerships of community-based organizations and hospitals to offer evidence-based, post-discharge services to reduce readmissions. Section 3025, in effect since October 2012, dropped the other shoe and requires the Centers for Medicare and Medicaid Services (CMS) to reduce payment for Medicare services to hospitals whose patients have higher than expected rates of rehospitalization within 30 days of discharge. (For more background, watch this Modern Health interview  with longtime John A. Hartford Foundation grantee Eric Coleman, MD, read this recent Reuters article featuring Coleman, and this post I wrote on Health AGEna in December 2010.

Clearly the audience at the session was very concerned about the program and seemed sure that it should changed, if not abandoned (See my response to a Wall Street Journal op-ed last month.). I see the matter very differently and I’d like to explain why. NHPF Sessions are off the record, so I won’t use any quotes or attribution.

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The National Health Policy Forum: A Wealth of Information

WashingtonCapitol300To outsiders, Washington D.C. is a mysterious place filled with smart and hardworking people. But it is very hard to know who has influence, whose opinion is respected, and where to start. It’s also a place where young staffers have incredible responsibilities to carry out the ideas and intentions of their elected bosses, but not a lot of background or time to master issues.

Who would have guessed six or seven years ago that the young staffers of the junior senator from Illinois would have been elevated to positions of enormous influence by their boss’s election to President? For us at the John A. Hartford Foundation, one way to help navigate these mysteries and to be sure that the issues and work of the grantees we support are communicated to policymakers is our relationship with the National Health Policy Forum.

Over the years—31, to be exact—the Hartford Foundation has funded 10 grants totaling more than $6.4 million to the National Health Policy Forum (NHPF or “the Forum”), located at George Washington University in Washington, D.C., and headed by its founding director, Judith Miller Jones. In the early days, the Hartford Foundation funded Judy and the NHPF to further the foundation’s work under its short-lived Health Care Cost & Quality initiative. A few years after that initiative ended, Hartford again commissioned Judy and the NHPF to further the Foundation’s current mission and work in aging and health care issues, which it has been doing since 1997 with six grants worth more than $5.7 million.

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Volk Lecture: Nurses Play Essential Role in Health Care Innovation

Jennie Chin Hansen, chief executive officer of AGS, delivers the Norman and Alicia Volk Lecture in Geriatric Nursing.

Jennie Chin Hansen, chief executive officer of AGS, delivers the Norman and Alicia Volk Lecture in Geriatric Nursing.

Delivering the 5th Annual Norman and Alicia Volk Lecture in Geriatric Nursing, Jennie Chin Hansen, RN, MS, the chief executive officer of the American Geriatrics Society (AGS), eloquently challenged her audience to renew their efforts to ensure that older adults receive better care in hospitals, in their communities, and at home.

A crowd of more than 300 nursing students, faculty, and guests attended the recent lecture at New York University’s College of Nursing. The topic was “Health Care Today and Tomorrow: How Can We Make a Difference?”

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Debate Over Hospital Readmissions Policy Is Essential to Better Care

TS_96071825_Debate300A recent New York Times article noted a “growing chorus of critics” questioning the fairness of new Medicare financial penalties on hospitals with high readmission rates. While it was certainly a well-written piece about a topic more people need to understand, the article paints an incomplete picture about the debate and goes too far in portraying hospitals as victims (although appearing in the Business section, maybe that’s not too surprising).

Since I gave a brief talk a few weeks ago at the American Society on Aging meeting that could be construed as adding to the critical chorus, I thought I’d try to provide additional context. I hope to point out the real story, which is less about fairness—or lack thereof—to hospitals, and really about how the robust debate occurring right now represents a sea change in the way hospitals and our health care systems think about accountability for their patients.

And that’s a good thing.

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