U.S. Rep. Joe Courtney talks to Regency Heights residents about Medicare bill
By Denise Coffey - Staff Writer
Danielson - posted Mon., Apr. 1, 2013
U.S. Rep. Joseph Courtney (D-2) paid a visit to residents, their families and staff at Regency Heights Nursing Home in Danielson on March 27. The congressman answered questions, spoke briefly about HR 1179: Improving Access to Medicare Coverage Act of 2013 - which he sponsored - and toured the facility.
HR 1179 would attempt to amend Medicare rules to count outpatient observation services toward satisfying the three-day inpatient hospital requirement for skilled nursing facility coverage. The observation care designation is a big issue in Washington, as government and insurance companies struggle to determine appropriate payment schedules.
The issue, like most, boils down to money. An observation designation provides lower reimbursement to hospitals and higher costs to patients according to Day Kimball Healthcare Senior Vice President, CNO and COO Donald St. Onge. “We spend money validating whether it's inpatient or observation,” he said. “It doesn't solve the hurdles. It puts more of a burden on hospitals.” And it can leave patients footing bills totaling thousands of dollars before they can be admitted to nursing homes.
“The social workers I've talked with say this is happening all the time,” said Courtney. “The problem is the terrible ripple effect it has on getting follow-up care. My bill says the hospitals and government can knock themselves out fighting over whether it's a Part A or B Medicare Admission, but if you're in the hospital for three days, you're in the hospital for three days. If you are prescribed to go to a nursing home or health care agency, you should get that Medicare coverage.”
Courtney called streamlining Medicare and Medicaid two important challenges the government must face. The government pays out $580 million in Medicare. With baby boomers slated to hit retirement in huge numbers, getting those challenges in hand and eliminating waste and fraud are crucial.
Real progress had been made said Courtney. Hospitals are getting more efficient. The cost growth per capita is below 2 percent, down from 7 percent. And the first year of a simple follow-up by the Department of Justice recovered $5 billion in fraud. “It's worth every penny as long as we get rid of the fraud,” he said.
David Szpyrka asked Courtney about the changes to his mother's personal fund allowance. Agnes Palazzo is a Regency resident whose medical co-pays are slated to increase on her fixed income. Her Social Security goes to the Regency, and she will be required to pay more out of a Title 19, $60 monthly personal fund for co-pays, toiletries and necessary pedicures and manicures.
“The president and everyone else is saying we all have to do our fair share, but I don't hear about welfare recipients or food stamp recipients doing their fair share,” he said. “There are no watchdogs. We're obligated to take care of our elders. It's aggravating. You don't know who to believe.”
There are 30,000 Medicaid patients on any given day in Connecticut. The personal funds they are allowed are set by legislators in Hartford, not Washington. And Courtney can't impact the proposed state budget cuts set to trim $8 million from payments to Day Kimball Hospital over the next two years. “We're marshaling a lot of energy to come up with solutions,” said DKH President and CEO Robert Smanick. “The state cut is just not manageable.” Smanick and St. Onge planned to follow up with Courtney about getting DKH designated a rural hospital, something he could have an impact on. Such a designation would funnel higher payment schedules to the hospital.
Regency Heights Administrator Bill White said low income was a big challenge in northeastern Connecticut. “Continuing to sustain Medicare and Medicaid reimbursements is the most important thing for us,” White said. “He clearly supports that, which we appreciate. We're like any other business. We'd like a fair day's pay for a fair day's work.”