As proposed back in May, Medicare rates for nursing facility services have been increased by $690 million, or 3.3%, in total, for FFY 2008. The Medicare final rule went on display yesterday and is to be published in the Federal Register August 3.
Per the state budget, Massachusetts Medicaid rates for SNFs have been increased by $80 million, or 4% on average, for SFY 2008, through emergency regulations promulgated last week.
So far, so good. The regulations are simply implementing legislative rate adjustment principles.
Well, not so fast: Those principles are hardly written in stone. Congress currently seems hell-bent on monkeying with all sorts of things as the SCHIP reauthorization bill, now known (in the House) as the Children’s Health and Medicare Protection Act of 2007 (CHAMP Act), rolls along. The industry association, AHCA, observes that the CHAMP Act, now in House Ways & Means, includes a cut of $2.7 billion over five years for Medicare services to seniors in nursing facilities. This follows up on our fearless leader’s (DOA) proposed five-year, $2.8 billion Medicare nursing facility payment cut in his FFY 2008 budget, based on a negative inflation factor.
So NF reimbursement looks stable, back on the upswing, even — but only so long as the basic rules don’t get changed.
Unfortunately, while health care seems to have the nation’s attention, nobody seems to want to pay for it; talk of negative inflation factors trigger outpourings of invective from the provider communities (cf. the SGR issue for docs), but nobody else seems to care enough to sit down and work hard at structural change.
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I’m not sure that anyone really knows what to do, or has the stomach for it. And as has been typical pretty much forever, health care for the aging is usually at the bottom of the list of priorities. All these years after McCarthy, and still no one is brave enough to suggest we go to a state-funded and regulated health care system for fear of being labeled a socialist. Meanwhile, the biggest industry players, drug and insurance companies, hold so much sway that no one is quite brave enough to stand up to them. As a result, we wind up with a lot of clamoring and very little proposed practical solutions, at least solutions that will have any sort of sweeping effect. I would assume that, within the next ten years to twenty years, as baby boomers reach not just retirement age but an age when geriatric care matters, there may be a new sense of urgency in this area, but will it be too late then, with most people who would be affected already removed from political power?