AMDA suggests White House Conference on Aging topics

AMDA–The Society for Post-Acute and Long-Term Care Medicine (AMDA) has recommended sub-topics within three of the four previously identified areas of focus for the upcoming White House Conference on Aging. In a Jan. 20 letter [PDF] to the conference’s executive director, Nora Super, AMDA President Leonard Gelman, MD, CMD, shared suggestions related to the subjects of long-term services and supports (LTSS), elder justice and healthful aging. He did not offer ideas related to retirement security.

As related to LTSS, Gelman wrote, AMDA supports policies that address service delivery, workforce and financing to transform care systems to best meet the needs of older adults. AMDA also advocates for timely access to pain medication for those it serves, including legislative and administrative efforts related to scheduling of hydrocodone and use of the nurse agent. Changes in the Drug Enforcement Administration’s interpretation of acceptable practice complicates members’ ability to get pain medication to nursing home residents in a timely manner, Gelman said.

Regarding elder justice, AMDA said it supports reducing the use of antipsychotic medications in long-stay nursing home residents as well as the delivery of person-centered care for those with dementia living in post-acute (PA) or long-term care (LTC) settings, which can improve quality of life. Also, AMDA identified hospitals’ use of the observation status as an elder justice issue. “Medicare beneficiaries are being denied access to Medicare skilled nursing facility…coverage under Part A because of their classification while in the hospital as outpatients receiving observation services,” Gelman wrote. “We endorse policies that count hospital time spent in observation status toward the three-day qualifying inpatient stay.”

Under healthful aging, the president listed as hopeful goals a permanent repeal of the sustainable growth rate (SGR), the formula used to reimburse physicians who treat people on Medicare; the development of an alterative(s) to the SGR; and the improvement of quality incentive programs to compensate physicians who work in PA/LTC settings in a “fair” way.

"Due to regulatory complexities, physicians who practice in PA/LTC facilities are compared to those practicing in office-based and other similar settings,” Gelman said. “This comparison means that physicians who treat the most vulnerable and ill, therefore most costly, patient populations in PA/LTC are subject to negative payment adjustments based on practice settings. We support changes to these payment models that will be fair and recognize the disparities in the populations being served in different care settings.”

Interoperable health information technology (HIT), enabling physicians, PA/LTC communities and pharmacies to share information, also would help residents age healthfully, he said. Physicians who see residents in nursing homes also maintain private practices and are penalized for not meeting the government’s HIT requirements because many PA/LTC facilities either have not adopted the necessary technology or do not meet the required core objectives, Gelman wrote. “AMDA supports policies that incentivize PA/LTC settings to adopt HIT technologies and that excludes PA/LTC patients from penalties until proper technology is widely available in these settings,” he said.

Paying physicians for advance care planning also would help residents age healthfully, Gelman said. “Many patients wind up getting unwanted, aggressive interventions because our healthcare providers are not taking the time to discuss prognosis and the likely burdens and benefits of such treatments," he wrote. “This results in hospitalizations, intensive care unit…stays, much pain and suffering, and a high cost to our healthcare system,” Gelman added. These issues could be addressed by the government’s adoption of billing codes for advance care planning services as well as the use of patient orders of life-sustaining treatment paradigm forms, he said.

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