A lawmaker's alternative to the ever-shifting plans
A lawmaker’s alternative to the ever-shifting plans
It sounds good, but don’t tell the AHA
Despite all the arguments against the shift in the home health benefit from Medicare Part A to Part B to prevent Medicare Part A Trust Fund insolvency, few alternatives have been voiced. But Congressman Bill Thomas (R-CA) has advanced one almost guaranteed to cheer the home care community and likely to cause the American Hospital Association some sleepless nights.
Backed by other House Republicans, Thomas has put forth a plan to shift Graduate Medical Education (GME) spending from Part A to Part B, along with indirect medical education (IME) funding, and disproportionate share hospital (DSH) payments instead of home health.The Congressional Budget Office (CBO) estimates this would relieve the Part A Trust Fund of nearly $69 billion in payments over five years.
A legislative aide to Thomas, Teresa Houser, says that after further analysis, the GME/IME/ DSH shift is estimated to save about $82 billion. Thomas’s reasoning, the aide says, is that shifting GME to Part B would give it a broader tax base to draw from, which is more equitable because "educating doctors helps everyone, not just Medicare beneficiaries," she says.
Medicare currently is the largest explicit federal source of funding for physician training in teaching hospitals. In fiscal year 1995, Medicare paid $2.3 billion for GME and nearly $5 billion for IME.
The DSH program provides increased payments to certain hospitals that serve a disproportionate share of low-income patients. These payments first became available in 1990.
Houser says the details of the congressman’s proposal have not been worked out yet, but it likely will be similar to one he advanced in 1996 and later withdrew. The Medicare provision of the 1995 balanced budget act also included a provision for shifting GME, but the bill was defeated. The political climate may be right for another try.
"If you want to shift something, shift payments to teaching hospitals and educate physicians out of Part B," says Ron Kolonowski, executive director of Hospital Home Care Association of America, an affiliate of the National Association for Home Care in Washington, DC. "Let’s see what the AHA says if Congress wants to shift physician education instead of home care."
Asked what the reaction of the AHA might be, Houser replied, "I expect they probably will not be supportive."
By the time Hospital Home Health went to press, calls to officials at the AHA had not yet been returned.
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