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The Pulse: December 3, 2012

The Pulse: December 3, 2012


The Fiscal Cliff

Widely covered in the news, the Fiscal Cliff automatic spending cuts for a host of federal programs will be implemented January 1 unless Congress acts. The 'fiscal cliff' negotiations that now consume Washington are increasingly complicated with likely significant impact on all Americans, particularly those working in health care. It is difficult to get a clear picture on what or how these changes will effect Americans however.  On November 27th The Washington Post provided a good overview and analysis on the 'cliff' issues. 

Click here to access The Washinton Post article.  

AARP has come out against major changes in entitlement programs, including increasing the Medicare eligibility age, saying that an increase in the age requirement may actually costs more money.  Click here for details.

These automatic spending cuts will adversely affect the people we serve and member ability to serve them. If not addressed, the Budget Control Act of 2011 will:

  • Reduce Medicare reimbursement to all health care providers, including home care and hospice;
  • Older Americans Act programs would experience an 8.2 percent cut (including substantial reductions to items like Meals on Wheels programs, senior transportation, adult day health, senior community service employment and family caregiver support);

Representatives of hospice and home care services are being asked to increase efforts to lobby Congress in hopes that they will not see such draconian cuts or additional costs like provider copays.  Provider groups such as the Partnership for Quality Home Healthcare and the American Hospital Association have also begun offering up alternatives to cutting reimbursement rates, one such approach is available by clicking here.

“True entitlement reform and approaches to change the health care delivery system are needed – not provider cuts,” according to AHA's list of budget alternatives.  Likewise, the Partnership for Quality Home Healthcare has begun distributing a report that illustrates how home-based care is less expensive for Medicare.  This report, dated 11/20/12, is available here.  (OHPI, 11/19/12)

NAHC Schedules Lobby Day

NAHC has scheduled a Lobby Day for December 5 and 6 and Urges Members to Take Part in Person or Virtually - The home care and hospice community must continue to be involved and present a unified message as lawmakers work to address the impending “fiscal cliff.” During the post election “lame duck” session, Congress will be grappling with how to reduce burgeoning deficits and offset the costs of fixing the flawed Medicare physician payment formula, among a host of other fiscal issues. If nothing is done about the “physician fix” by the end of the year, physician payments will drop by 27 percent.

NAHC has scheduled a “March on Washington” lobby day for Wednesday, December 5, and Thursday, December 6, and we are asking you to join us—in person, if possible, to visit your Senators and Representatives on Capitol Hill, or virtually using the NAHC Legislative Action Network and other means to contact them back in the states and districts. The message to lawmakers is “Oppose Medicare home health copays and payment cuts.” For hospice—“Reject efforts to cut the Medicare hospice benefit.”   One of the most effective means of communicating wth your Member of Congress or their staff would be to make an official visit to their district office. Click here for more information. 

Health and Healthcare in 2032: Report from the Robert Wood Johnson Foundation Futures Symposium

The Health and Healthcare in 2032 is a summary of the results of the RWJF’s look out to plausible futures of health and healthcare in 20 years. Below is a brief summary of the 48 page document, put together with the input of the nation’s top healthcare thought leaders. Click here to access the summary. 

First, the document looks into ‘Scenarios of Health and Health Care in 2032’ and proposed 4 potential futures:

  • Scenario 1: Slow Reform, Better Health
  • Scenario 2: Health If You Can Get It
  • Scenario 3: Big Data, Big Health Gains
  • Scenario 4: A Culture of Health

For each of the 4 scenarios above, the Summit group looked into: key aspects of the scenario, the US economy, culture and society, government, definition of health, health threats, medical advances, health care delivery, health insurance coverage, health information technology, and what healthcare spending would be in 2032 as a percentage of GDP in each of the four scenarios. The study then delves into opportunities and recommendations for the nation in each of the 4 scenarios.

The group concluded that these plausible scenarios are “worthy of consideration in relevant organizations’ planning”. The report suggests that there are “challenges that might surprise and opportunities that might be missed.” It suggests that each profession and or provider sector consider our own work in the context of these scenarios to help “challenge our assumptions, identify emerging risks and opportunities and to formulate robust strategies to advance our mission for the future.”

NHPCO / Hospice Action Network Analysis of 2012 elections

NHPCO’s Hospice Action Network provided an in-depth analysis of the 2012 elections and the drill-down on what they believe can be expected for the end of the year 2012, and then 2013 in terms of process, issues and politics. The bottom line for the hospice community is that the status quo outcome of the election means rough seas ahead for all Medicare providers. Possible Congressional gridlock, coupled with critical federal budget challenges, will likely mean that there is less opportunity for policy makers to get into the details on impact of their decisions and we could see additional across-the-board cuts to the provider community.  Click here for the NHPCO Policy Review in file. 


House Republicans Hold Leadership Elections; Batchelder to Remain Speaker of 130th General Assembly

In its leadership elections for the 130th General Assembly, House Republicans voted unanimously to retain William Batchelder (R-Medina) as speaker.  Batchelder is restricted by term limits from running for another two-year term.

Rep. Matt Huffman (R-Lima) moves up in leadership as speaker pro tempore; Rep. Barbara Sears (R-Sylvania) has been selected as majority floor leader; Rep. John Adams (R-Sidney) selected as assistant majority floor leader; and Rep. Cheryl Grossman (R-Grove City) selected as majority whip. Rep. Jim Buchy (R-Greenville) has been added to the leadership team and will serve as assistant majority whip.

Senate Republicans Hold Leadership Elections; Faber Elected Senate President; Widener, Patton, Obhof in Leadership

In its leadership elections for the 130th General Assembly, Senate Republicans elected Sen. Keith Faber (R-Celina) as president. Chris Widener (R-Springfield) will be president pro tempore, Sen. Tom Patton (R-Strongsville) was re-elected as majority floor leader, and Sen. Larry Obhof (R-Medina) was selected to move into the majority whip spot.

House Dems Keep Leadership Team for 130th General Assembly; Budish To Remain House Minority Leader

The House Democratic Caucus Monday unanimously re-elected its current leadership team. Rep. Armond Budish (D-Beachwood) will remain House minority leader, Rep. Matt Szollosi (D-Oregon) as assistant House minority leader, Rep. Tracy Heard (D-Columbus) as minority whip, and Rep. Debbie Phillips (D-Athens) as assistant minority whip.

Senate Dems Keep Leadership Team; Kearney Re-elected Senate Minority Leader

Senate Democratic Leader Eric Kearney was unanimously chosen to maintain his leadership position. In addition, the caucus re-elected Kearney’s leadership team: Assistant Minority Leader Joe Schiavoni (R-Boardman), Minority Whip Nina Turner (D-Cleveland) and Assistant Minority Whip Edna Brown (D-Toledo).

Ohio Announces Plan for Health Insurance Exchanges

Gov. John Kasich announced Friday that Ohio will retain its responsibilities to regulate insurance plans in a health insurance exchange and set Medicaid eligibility, but would cede all other administrative responsibilities. He wrote that, "At this point, based on the information we have, states do not have any flexibility to build and manage exchanges in ways that respond to unique needs of their citizens or markets. Regardless of who runs the exchange, the end product is the same."  Click here to access the letter.

By retaining its authority to regulate insurers operating plans in the exchange and to set eligibility for Medicaid, the state will maintain some ability to shape the way the exchanges conduct business.

"I am confident that Ohio will meet federal standards to maintain its control of these responsibilities. In the meantime I urge you to promptly issue the guidance and rules Ohio needs to align plan management and Medicaid Eligibility with an otherwise federally-facilitated health benefits exchange," Kasich wrote. "Now that Ohio has arrived at a greater level of certainty on how its insurance exchanges will be managed, it is important that they be developed in such a way that Ohio consumers will have streamlined access to all of the benefits for which they are eligible," said HPIO President Amy Rohling McGee.    (OHPI, 11/19/12)


Click here for Month in Review 


OIG Issues Advisory Opinion on Hospice Volunteer Program for non-skilled services to terminally ill patients who do not qualify for hospice care, November 2012

Many hospice providers may have heard about the OIG rendering an opinion regarding whether or not a hospice can establish a volunteer program to provide non-skilled services to terminally ill patients who do not qualify for hospice care.  While the OIG provided a favorable opinion for this request it is critical that other providers note that the opinion is limited to the provider named, their specific situation, and shoud not be inferred to mean approval for such general practices across the industry.  Click here for the opinion. 

Companies Reduce Full-Time Workers due to Health Law Changes

The upcoming requirement that states, "businesses with 50 or more full-time workers to pay health insurance or pay a fine," is already changing the employment practices in some industries. Papa John's Pizza announced that they will be reducing workers' hours to under 30 hours per week to reduce their number of full-time employees. Others including Kroger grocery stores, Darden Restaurants, CKS restaurants, Pillar Hotels & Resorts are either making the change or contemplating the change.  (PPS Newswire, 11/13/12)

David Joyce
 (R-Ohio, 14th district)

Named to replace Republican Rep. Steven LaTourette on the general election ballot in August after LaTourette’s surprise retirement announcement, Joyce suddenly finds himself in Congress after a long stint as a prosecutor. Joyce has kept his ideological temperament something of a mystery.

Brad Wenstrup 
(R-Ohio, 2nd district)

Podiatrist Brad Wenstrup’s primary victory in March was the first stunner of the 2012 season. An anti-incumbent super PAC helped push him past Rep. Jean Schmidt, who wasn’t exactly in the bad graces of conservative activists, in a solidly Republican district.