Same problems on Medicare costs remain after election

If there is one constant that has emerged from the 2012 campaign season, it is that no matter who wins the White House, and no matter who controls Congress, reforming and modernizing our health care system will be an ongoing endeavor for years to come. The sheer magnitude of the challenge in the midst of America’s demographic transformation to an ‘older’ nation – where the young will increasingly help finance the health care needs of growing numbers of retirees – will require far more cost-conscious policymaking in Washington.

Despite what many consider an especially negative campaign, the back and forth on Medicare funding, and who deserves credit for intelligent reform proposals, the dialogue has served to focus just how important the program is to so many Americans today, and how critical it will be for so many tomorrow. Indeed, as hospitals are now being penalized for excessive numbers of patient readmissions, providers, consumers and lawmakers are increasingly sensitized to cost, quality and value variables in the health care marketplace – as well as the financial implications for not achieving them.
 
A perfect example of how increased access to cutting edge rehabilitative care is running headlong into the rising costs of the care itself is the growing popularity of knee replacements. The good news, according to the new Journal of the American Medical Association (JAMA), is that knee replacements and the extraordinary benefits they bring to patients, is up $161.5% among Medicare beneficiaries. The bad news, however, is that the $5 billion annual tab will continue to grow as America’s 77 million Baby Boomers age.
 
This brings us to November 7th -- the day after the 2012 campaign is over. Reigning-in Medicare costs will be a top tier policy item on both sides of the aisle on Capitol Hill, not just a key point in a stump speech on the campaign trail. The JAMA article, noting the cost issue, instructively points out that “relocating rehabilitations from in-patient clinics into the patients' homes… can lead to problems down the road for some patients and add costs and longer recovery times.”
 
Thus, one of the baseline requirements of Medicare funding reforms is not just improved coordination among the various healthcare providers, which requires vast improvement -- but taking better stock of individual providers’ ability to offer the best value and quality for various procedures, at the best price point for taxpayers.
 
In the dynamic post acute care marketplace, a variety of providers are capable of delivering high quality rehab care. Yet, the challenge – as well as the opportunity in terms of Medicare savings – is to help ensure the quality and cost advantages of the skilled nursing facility (SNFs) rehab setting is more fully realized for procedures such as knee replacements, where this specific post acute care setting has inherent advantages. Because of the enormous quality of life benefits, the demand for these procedures will continue to increase dramatically, and the benefits of SNFs are rightfully gaining more attention.
 
As reforms are imminent next year, Washington leaders should consider SNFs’ inherent ability to treat rehab patients -- at a lower cost to Medicare than other post-acute care providers for certain procedures. As a lower cost institutional setting, with the ability to provide high quality care to an increasingly broad range of patients, SNFs are poised to be a critical part of Congressional and Centers for Medicare and Medicaid Services (CMS) efforts to reduce overall Medicare expenditures, and help reform healthcare delivery.
 
Moving forward, we believe the next Administration, and next Congress – whomever is in control -- must examine more closely and objectively which providers can most optimally meet the growing demand for the critical rehabilitation care that sustains quality of life, independence and, ultimately, lower costs to taxpayers.
 
Rosenbloom is president of the Alliance for Quality Nursing Home Care (AQNHC), a coalition of 10 leading post-acute and long term care organizations providing Skilled Nursing Facility (SNF) care in approximately 1,400 facilities, in 44 states nationwide.
 

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