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News Roundup: January 18, 2013

Home Care and Hospice Advocates Applaud Fiscal Cliff Outcome

Published by Home Health News
Jason Olivia
January 18, 2013

Home health care escaped the fiscal cliff unscathed with President Obama’s signing of the American Taxpayer Relief Act of 2012, prompting a sigh of relief among many fearing across-the-board spending cuts.

Upon Obama’s passing of the bill, President of the National Association of Home Care & Hospice (NAHC) Val J. Halamandaris expressed his praise for Washington’s efforts to reach a resolution.

“The efforts of the Members of Congress and their staffs, along with those in the Administration, who worked over the holidays to arrive at the resolution should be thanked and commended for their efforts,” Halamandaris said.

Though the fiscal cliff has been averted, NAHC’s President acknowledges that the problem of government spending and national debt will continue to be a subject of debate for years to come.

“The home health care industry believes now, as we have believed in the past that we can play a vital role in support of responsible and sustainable government spending,” Halamandaris said. “Home health care not only keeps families together and is overwhelmingly what patients prefer, it is far more cost effective for Medicare than institutional options.”

Citing that the Medicare home health benefit has already been cut by $77 billion over the next decade, Halamandaris urges that any further cuts to the program would be “devastating” for home care providers to continue with the high value services they give.

The law, which repeals the Community Living Assistance Services and Support (CLASS) Act and establishes a 15-member Long Term Care Commission, is the fruit of months of negotiations between Congress and President Obama to reach a deal by the new year.

“I am confident that the Congress recognizes the value of home health care and will encourage its use as we all mov forward to solve the economic challenges our nation faces,” Halamandaris concluded.

Seniors Rally at State House to Demand Home Care Funding

Published by BeaconHill Patch
Kimberly Ashton
January 17, 2013

Dozens of senior citizens stood outside Gov. Deval Patrick's office in the State House Thursday demanding that their concerns about cuts in home care spending be heard.

Chanting "Can you hear us now governor?" the seniors wanted Patrick to respond to a letter several senior advocacy groups sent him in September detailing what they say has been a $15 million cut since 2009 in home care services and asking for such funding to be restored.

Although Patrick didn't meet with the seniors, Ann Hartstein, his secretary of the Executive Office of Elder Affairs, took their questions and comments in a downstairs press room.

"The governor is totally communted to community-first," Hartstein said of the policy that promotes home care over nursing-home care. But advocates and seniors said Patrick isn't doing enough and that underfunding home care ultimately costs the state more money.

"Investing in home care produces a real dividend for the taxpayer as well as helping seniors stay in their own homes," said Mass Home Care Executive Director Al Norman. "We have made a big difference already but no one seems to know it or talk about it."

According to Massachusetts Senior Action Council numbers, home-care services have save the state $703 million annually by keeping seniors out of costly nursing homes.

But yet 1,221 seniors are on waiting lists to receive home care and may have to go to nursing homes as a result.

"A lot of us have been told that this is a community-first state but have not experienced that this is a community-first state," Massachusetts Senior Action Council Executive Director Carolyn Villers told Hartstein.

Even for those receiving some home care, the amount of help they get has dwindled over the years, according to Ruth Titus, a Nahant nurse working who has worked in home care since 1989. "I see a big difference in home care these days," she said, adding that fewer hours combined with family members working more, and therefore less able to provide help, has left seniors vulnerable.

Home care, says Winthrop senior Dottie Donofrio, "takes a tremendous burden off of families and gives an opportunity for a person to have some dignity."

The seniors pressed Hartstein to tell the governor to make sure home care is sufficiently funded in the budget he submits next week. "I think that you'll be pleased with what you see in the budget in terms of the elder budget overall," Hartstein said.

She told them to also make sure they voice their concerns to their legislators. "It's going to be a crucial time for us across the commonwealth ... make sure you advocate for the things you need," she said.

After meeting with Hartstein the groups went to Speaker Robert DeLeo's office, President Therese Murray's office and the Ways and Means office.

Who Knew? Patients’ Share Of Health Spending Is Shrinking

Published by Kaiser Health News
Jay Hancock
January 13, 2013

Consumer-driven medical spending may be the second-biggest story in health care, after the Affordable Care Act. As employers give workers more "skin in the game" through higher costs from purse and paycheck, the thinking goes, they'll seek more efficient treatment and hold down overall spending.

But consumers may not have as much skin in the game as experts thought, new government figures show.
Despite rapid growth in high-deductible health plans and rising employee contributions for insurance premiums, consumers' share of national health spending continued to fall in 2011, slipping to its lowest level in decades.

"I'm surprised," says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology. "All the news is about the move to high-deductible health plans. Based on that logic … I would have expected it to go up."

True, medical costs are still pressuring families. Household health expense has outpaced sluggish income growth in recent years, says Micah Hartman, a statistician with the Department of Health and Human Services, which calculates the spending data.

But from a wider perspective, consumer health costs continued a trend of at least a quarter-century of taking up smaller and smaller parts of the health-spending pie. Household expense did go up. But other medical spending rose faster, especially for the government Medicare and Medicaid programs.


Economists measure three kinds of consumer health costs: insurance premiums paid through payroll deductions or for individual policies; out-of-pocket costs for deductibles and co-pays; and Medicare payroll taxes. Such outlays fell to 27.7 percent of the health care economy in 2011, down from 28 percent in 2010 and from 32 percent in 2000, according to the national health expenditures report issued by HHS last week.

That's in spite of the fact that one worker in three is covered by a plan with a deductible of at least $1,000, up from one in 10 in 2006, according to the Kaiser Family Foundation. (KHN is an editorially independent program of KFF.) Among small firms, half the workers are now in high-deductible plans.

One factor holding down costs even for families with consumer plans has been patent expirations for expensive, commonly used medicines such as Prevacid and Flomax.

"People these days are spending a lot less out-of-pocket on prescription drugs," said Peter Cunningham, director of quantitative research at the Center for Studying Health System Change. "A lot of that has to do with the shift from brand name to generics."

Nobody thinks consumer-driven medicine has run its course. Insurers and employers are still building tools for patients to shop for care by comparing costs for MRI scans, for example, or researching hospital quality records.

High-deductible plans are expected to win a large share of the business sold next year through the health law's state insurance exchanges. Many companies say they intend to offer high-deductible insurance -- especially plans with tax-favored health savings accounts -- as the only option.

"I've heard of nothing but acceleration" of employers into consumer-directed health insurance, said Roy Ramthun, a benefits consultant who was a senior health policy advisor in President George W. Bush’s administration. "More local units of government, school districts and even some union plans are starting to move more aggressively into these areas."

High deductible plans are already getting credit for helping with an overall slowdown in medical spending growth. Among other factors, economists suspect that the prospect of higher wallet costs has made consumers even more likely than usual to avoid doctor visits in the middle of a sluggish economy. (Public health officials fear this will backfire with a later spike in illness.)

Sooner or later, households’ share of the medical-cost pie will start to get bigger, analysts say. The declines have been getting smaller, suggesting the trend will reverse.

One reason is continued growth of high-deductible plans. Another is that, starting in 2014, the health act requires individuals to start buying coverage or pay a penalty. Another is that federal health spending has risen more than three times as fast as consumer health spending since 2007, which can’t continue.

Even with recent tax increases on high-income households, the huge Medicare program for seniors and the disabled is growing at an unsustainable pace, says Joseph Antos, a health economist at the pro-markets American Enterprise Institute. That means Medicare, too, will need to seek higher premiums, deductibles or co-pays from the patient’s pocket, he said.

"Medicare is on a fiscal slide," he said. "Things are going to have to happen. Eventually, whether you call it premium support or not, we’re going to have to move to some kind of budgeted system in Medicare."