Resend of NY Times Article on 1500 Cap

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From the June 3, 1999 NY Times

Head of Medicare Panel Says Some Payments Should Be Increased

By ROBERT PEAR

WASHINGTON -- The head of a federal advisory commission, an influential

Republican, said Wednesday that Congress should increase Medicare payments

for certain nursing home and hospital services because budget cuts appeared

to be harming the quality of care for some patients. The statement by Gail

Wilensky, chairwoman of the Medicare Payment Advisory Commission, was a

breakthrough for health care providers, who have been pleading with

Congress to restore some of the money cut by the 1997 budget law. Just

three months ago, Dr. Wilensky, who ran the Medicare program under

President Bush and is respected by lawmakers of both parties for her

technical knowledge of the program, said she had not seen enough evidence

to justify increases in Medicare payments. She said then that it was too

early to know whether the 1997 cuts were adversely affecting patients. But

on Wednesday Dr. Wilensky said she agreed with some health care providers

that certain patients were vulnerable, particularly those with complex

medical problems who are in nursing homes and those needing outpatient

hospital services or physical therapy. She spoke with reporters as the

commission issued one of two annual reports to Congress. Medicare accounted

for a huge share of the law's savings, $116 billion of the $127 billion

that was to be saved over five years. The law, in turn, was a major factor

that helped balance the federal budget in 1998, for the first time in three

decades. Congressional aides said Wednesday that Congress seemed likely to

take Dr. Wilensky's advice. Medicare issues have traditionally been

Democratic issues, but Republicans are aware that increasing numbers of the

elderly now vote Republican, and in the last three years, Republican

lawmakers have given hundreds of speeches insisting that they want to

protect Medicare. Dr. Wilensky said she was recommending " targeted and

limited changes " in the Balanced Budget Act of 1997, not a wholesale

revision or repeal of its Medicare provisions. Specifically, Dr. Wilensky

said, Congress should provide more money for physical therapy, eliminating

what she described as an arbitrary limit of $1,500 a year in Medicare

payments for physical therapy for any beneficiary. In addition, she said,

Congress and Medicare officials should devise some way of increasing

payments to nursing homes for patients who need the most costly and

extensive care. These patients include nursing home residents who are on

ventilators, require infusion therapy, need prosthetic devices or have

several medically complex conditions. Some hospitals say they have had

difficulty discharging these patients. Some nursing homes have refused to

take such costly patients because the homes consider Medicare payments

inadequate. Finally, Dr. Wilensky said she tended to agree with hospitals

that say Medicare is paying too little for outpatient services, which

include a wide range of diagnostic tests, treatments and procedures. As

significant as what Dr. Wilensky said is what she did not say. She did not,

at this time, endorse pleas by teaching hospitals for more money. And she

did not endorse the pleas of home health agencies that say beneficiaries'

access to home care has been impaired by the Medicare cuts. Dr. Wilensky

said she knew that some teaching hospitals had reported major reductions in

revenue. " We have reports of a lot of hospitals suffering a lot of pain, "

she said, " but it's hard to know how much of that is due to Medicare. " Many

private insurers have also cut back payments to hospitals. Likewise, in a

report issued Wednesday, the Medicare commission said, " Preliminary data

suggest that fewer Medicare beneficiaries are receiving home health care

than in the recent past, and the number of visits per user has decreased. "

But, the panel said, it is " impossible to assess the degree to which these

changes are appropriate, " because Medicare does not systematically evaluate

the medical condition of patients who receive home care. Moreover, Dr.

Wilensky said, it is important to remember that the cutbacks made in 1997

followed " 10 years of explosive growth " in Medicare spending for home

health care. Spending soared to $18.1 billion in 1996, from $1.9 billion in

1986. The General Accounting Office, an investigative arm of Congress, said

that 14 percent of Medicare's 10,524 home health agencies had closed since

October 1997, but that beneficiaries still appeared to have " appropriate

access " to home health services. The accounting office said that high-cost

patients, including those with Alzheimer's disease or multiple sclerosis,

might have more difficulty obtaining home health care in the future. So

far, Dr. Wilensky said, savings from the Balanced Budget Act appear to be

" much greater than expected " in 1997. Health care providers want a

wholesale revision of the law, Dr. Wilensky said, but " I don't get any

sense from Congress " that lawmakers will agree. Indeed, she said, " The

Balanced Budget Act is something we should not undo in haste. "

R. Kovacek, MSA, PT

Email Pkovacek@...

313 884-8920

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