American Nurses Association
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Contact: Joan Meehan, 202-651-7020 or Michelle Slattery, 202-651-7027 [email protected] www.nursingworld.org/RNrealnews
For Immediate Release: March 8, 1999
ANA Releases Proposal to Fix Ailing Medicare Program
Washington, D.C. --The American Nurses Association (ANA) today released its proposal to reform the ailing Medicare program. The proposal is based on the belief that Medicare should remain a broad-based social insurance program that is available to all eligible individuals regardless of income. The proposal reaffirms ANA's longstanding commitment to strengthening the Medicare program, recommends that much of its framework remain the same, and includes strong recommendations to simplify and improve the program to better meet the diverse health care needs of the growing population of older Americans.
"The American Nurses Association stands by its belief that the Medicare program is critically important to older and disabled Americans and their families," said ANA President Beverly L. Malone, PhD, RN, FAAN. "We have a window of opportunity to not only address the financial viability of the program but also to improve the program so that beneficiaries have access to the kinds of services that they need to maximize their health status," she said. "Our plan makes a number of recommendations about how to take this fundamentally sound '60s era program and retrofit it for the new millennium."
A fundamental underpinning of ANA's proposal is the transformation of the Medicare program to a "beneficiary-focused coordinated model of care" that focuses on primary health care services, prevention, wellness and early intervention. This is in contrast to the current "medical model of care" where the emphasis is on treatment of disease and where coordination of care among health care providers is negligible. "After close to 35 years, I think most would agree, it's time for a new model," said Malone.
ANA recommends a number of specific and structural changes. Among them are:
1. Combine Medicare Part A (hospital fees) with Medicare Part B (physician fees) and have a single deductible amount ($500);
2. Add a $3,000 "stop-loss" provision (a $3,000 cap on beneficiaries' annual out-of-pocket payments, including deductibles and co-payments);
3. Eliminate Medigap;
4. Reduce the age of eligibility for Medicare with a voluntary buy-in option for persons aged
62-64, with a similar option for displaced workers aged 55-64;
5. Add prescription drug coverage (with a $250 deductible and a 20% co-payment);
6. Ensure parity in payment for mental health services;
7. Expand home health coverage to avoid institutionalized health care;
8. Include additional preventive/screening services (including wellness programs, domestic violence screenings, and dental care) with no co-payment or deductible;
9. Employ "beneficiary-focused coordinated models of care" such as:
* using nurse case managers to manage/coordinate care and prevent unnecessary or inappropriate inpatient hospitalizations, emergency room visits, and facility admissions;
* expanding and incorporating Community Nursing Organizations (CNOs); CNOs receive capitated payment for community nursing and ambulatory care services provided to Medicare beneficiaries;
* expanding nurse managed clinics, which provide accessible and affordable patient care, especially in underserved areas;
* implementing disease management programs for beneficiaries with chronic conditions;providing improved end-of-life care, including the appropriate use of pain medications/palliative measures, and easier access to hospice benefits; and,
* encouraging utilization of preventive and self care measures.
The benefits of "beneficiary-focused coordinated care models" are illustrated by the findings of a research study published in the February 17, 1999 issue of The Journal of the American Medical Association. The study, "Comprehensive discharge planning for the hospitalized elderly," focuses on a high-risk group of older Americans who are living with chronic illness. The model uses a multidisciplinary team and involves comprehensive discharge planning, including determination of patient care needs outside of the hospital and follow-up in the home by advanced practice nurses specializing in geriatrics. The study found that this model of care resulted in fewer hospital readmissions, resulting in improved health outcomes and substantial cost savings.
In addition to structural improvements, ANA's proposal includes recommendations about how to raise the additional revenues necessary to address the Medicare program's projected shortfall, as well as for the additional costs incurred by adopting the enhancements proposed by ANA.
These include:
* extending certain elements of the Balanced Budget Act of 1997, including continuing update reductions beyond 2002;
* transferring DRG payments to account for increased post-acute care;
* integrating physician/other practitioner and facility payments for inpatient care;
* using competitive bidding and competitively set rates;
* reducing taxpayer subsidies for those beneficiaries who are able to pay more;
* reallocating the federal budget to ensure more funds for the increasing elderly population; and,
* raising new or increased revenue sources by raising taxes and utilizing budget surplus.
ANA was the first health professional association to support Medicare when it was introduced as legislation and has been an ardent supporter of the Medicare program since its inception in 1966. In September 1998, ANA delivered testimony before the National Bipartisan Commission on the Future of Medicare regarding its support for the program. Recognizing the significance of the debate and anticipating the release of the commission's report, ANA began development of its proposal last fall.
"We are eager to contribute to the current debate about the future of the Medicare program and welcome all opportunities to discuss our recommendations with members of Congress, the administration and others," said Malone.
Reporters who wish to request a pre-publication copy of ANA's Medicare Reform Proposal may call 202-651-7018 or e-mail [email protected].
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The American Nurses Association is the only full-service professional organization representing the nation's 2.6 million Registered Nurses through its 53 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice , promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.
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