Advocacy / AMAC Action On Capitol Hill / Politics

Bundling and Coordinating Post-Acute Care Act of 2014 – H.R. 4673

On May 23, 2013, AMAC offered support to Representative David McKinley’s (R-WV) latest bill, the “Bundling and Coordinating Post-Acute Care Act of 2014.”  H.R. 4673 is designed to strengthen Medicare, improve care in a patient-centered manner, expand choices for seniors, and generate significant savings for the Medicare program.  This bill establishes a clinical condition-specific, site-neutral, bundled payment model for post-acute care services under Medicare.  AMAC recognizes that bundled payments incentivize providers to be more efficient in the delivery of health care, can lead to better patient outcomes, and achieve greater health savings.  For these reasons, AMAC has supported bundling in the past as a way to strengthen the health care system.  Moreover, H.R. 4673 works to address Medicare’s unstable fiscal future in order to protect the program for Americans for many years to come.  AMAC continues to advocate for health reforms that empower patients by giving them more control over their health care and that ultimately build a stronger, more responsive health care system.  AMAC is pleased to support H.R. 4673 and believes it to be an innovative and practical step forward for health care in America.

Click Here to Print Letter

May 23rd, 2014

The Honorable David McKinley
1st District, West Virginia
412 Cannon House Office Building
Washington, DC 20515

 

Dear Representative McKinley,

On behalf of the 1.2 million members of AMAC, the Association of Mature American Citizens, I am writing to offer our support to H.R. 4673, the “Bundling and Coordinating Post-Acute Care Act of 2014.”  This important piece of legislation is designed to strengthen Medicare, improve care in a patient-centered manner, expand choices for seniors, and generate savings for the Medicare program.

H.R. 4673 establishes a clinical condition-specific, site-neutral, bundled payment model for post-acute care services under Medicare.  Each bundle created will then be managed by a care coordinator who will supervise patient care in consultation with the patient and his or her doctor.  Patients will have the authority to select who their care coordinator will be – giving them greater choice over their health care and the ability to improve their health outcomes.  H.R. 4673 empowers patients and health care providers to build a stronger, more sustainable, and more responsive health care system.

Moreover, AMAC recognizes that bundled payments incentivize providers to be more efficient in the delivery of health care, can lead to better patient outcomes, and achieve greater health savings.  Studies and modeling suggest that H.R. 4673 could yield savings of up to $100 billion over 10 years, without having to resort to rate adjustments in Medicare.  Given that Medicare remains on an unstable fiscal path, AMAC feels it is imperative that Congress enact commonsense reforms – like those presented in this bill – in order to protect the program for future generations of Americans.

As our health care system continues to undergo significant transformations and the future of Medicare remains uncertain, AMAC remains wholly committed to ensuring that mature Americans and seniors maintain access to high-quality, affordable health care.  Thanks to your concern for this issue and your willingness to address the problems afflicting the Medicare program, AMAC is pleased to support H.R. 4673, the “Bundling and Coordinating Post-Acute Care Act of 2014.”

Sincerely,

Dan Weber
President and Founder of AMAC


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Ivan Berry
8 years ago

Following is my e-mail to AMAC (under “Contact”)–I hope most of you will approve:

Subject: Bundling and Coordinating Post-Acute Care Act of 2014-H.R.4673

Before continuing your advocacy of this Bill I request that you make available to the entire membership the text of the bill and include the concerns raised by members’ comments on the article for the weekend of May 31, Jun 1 of this year, especially those of Anne and PaulE, as well as those of myself and others. These related comments should also be presented to the entire membership.
Before advocating for anything in the name of the membership of this magnitude of empact, instead of the top down approach, the membership should be informed and have a voice, otherwise you will appear to be just another AARP.
Thank you for your consideration on this matter and know this is not a suggestion, but a request.

Ivan Berry

PaulE
8 years ago
Reply to  Ivan Berry

I approve of your e-mail Ivan. Thank you for taking the initiative.

By the way, my general view of the federal government is that it should largely focus on the responsibilities outlined within the Constitution and not attempt to micro-manage every facet of our lives with legislation heaped upon legislation for every conceivable thing one can think of. In short, a federal government of limited powers that largely doesn’t encroach upon every facet of our lives, simply because they believe they can or think they should. After all, not every issue or problem requires a federal law or regulation. In many instances, federal laws have either actually created a problem where none existed beforehand or aggravated an existing problem by forcing an incorrect or poorly designed solution upon the public.Think Obamacare, Community Reinvestment Act, the so-called War on Poverty, Dodd-Frank, most of the EPA regulations of the last 15 years, etc., etc. All shining examples of the federal government at its worst.

Ivan Berry
8 years ago
Reply to  PaulE

You are most welcome, and again, thank you. You always have a way of adding needed info.

Ivan Berry
8 years ago
Reply to  Ivan Berry

And by the way, when’s the last time you remember hearing the statement, “Let’s not make a Federal case out of it?” That’s retorical and doesn’t require an answer. Used to hear it quite often before everything became a federal issue. Thanks again. Later.
Ivan

treecat
8 years ago

Anne: Thank you for your explanation. Sometimes we do need someone to explain things. I can’t pass votes and read them later. I just wish there was some way we could get rid of Pelosi, Reed and a few others but there are no age limits and no term limits. Just voting and I am afraid that hasn’t worked. I was getting anxious as I found our votes in Calif didn’t count for the Presidential Election. There were other states whose votes were counted. That was a shock.

Annette
8 years ago

How about repeal not fix this damn Obamacare!!! I’m sick of everyone tiptoeing around this nazi healthcare bill! Get rid of it already! Amac should be pushing harder for repeal and replacing this! We the people don’t want a single payer system ! We didn’t vote for it most are against it and it was shoved at us! Ugh Discusting administration and all who pander to them need to leave office now! Term limits ! Vote them all out now!! November can’t come fast enough! We will soon look like nazi germany!

Judy Conger
8 years ago
Reply to  Annette

Amen and Amen!!

PaulE
8 years ago
Reply to  Annette

Annette,

First we need a veto proof majority in the Senate before we can repeal Obamacare. There is NO way to repeal Obamacare with only the House. Harry Reid will not bring up for a vote any bill originating in the House for repeal of Obamacare. The House has sent him something like 30 different bills, since Obamacare was passed over the years, for its repeal. They all ended up in the waste basket in Reid’s office. If you want Obamacare and the rest of the Obama agenda reversed, then get everyone you know, as well as yourself, to vote Republican in November.

As for term limits, no politician is going to vote for bill that would kick him or her out of the best paying job, with the most generous benefit package, their ever going to get. We already have term limits by the way. It’s called voting in the primaries to change who is potentially on the ballot. If the American people are too lazy or too apathetic to exercise their rights, no politician is going to look out for their interests.

Anne
8 years ago

Well now I can understand why I never heard a response regarding the disadvantage of the “Bundling and Coordinating Post-Acute Care.” I almost died due to this incentive and the pilot program allowing substandard quality of care and services. I have spent months of rehabilitive care paid for out of pocket so of course this “saves” the Medicare program since it depletes my retirement savings and reduces my quality lifestyle that I worked so hard for AND paid taxes towards the program, as well as, all other programs. I am an AMAC member and up until now I felt the idea of listenining to its members was foremost but it is apparent AMAC has an aligned agenda too.

I provided details and documents that support the downside of this program. I was at a top notch University Hospital that provided the care but as most are now administratively directed hospital based physicians the care is not neglected but compromised to “meet” these guidelines. This forced area hospitals to merge and buy suppliers and nursing/rehabilitive services so the facilities and providers can maximize the profit margins. This takes away from finding another provider and shuts down the competitive market plus the person finding real “quality” care when a provider isn’t.

I think if those deciding these changes lived in the real world they would realize this bill affects those most vunerable. Also there is another aspect of the Medicare budget report. The total dollars reported should show the budget listing the administrative costs to administer the program seperate from the total spent. Also break out the MediCAID dollars and stop that waste now!

Ivan Berry
8 years ago
Reply to  Anne

Anne, that sheds some light on a subject that I am totally unfamiliar with. See my response to PaulE below and see how uninformed I am on this subject. Could you possible address my questions to PaulE?
I have my doubts as to anything working to improve anything reagarding medical until someone like Dr. Ben Carson gets involved, someone who actually knows something about health care.

Anne
8 years ago
Reply to  Ivan Berry

Ivan,

First I’d like to establish you do keep your Primary Care Provider. The idea is cost containment.
This bill is to allow coordination of your healthcare and aligns the care with a diagnosis.

What this means is a primary diagnosis is decided to require specific needs related for care. It takes it one step further by saying you must use the specific facilities, suppliers, nursing home, home infusion therapy provider, Home Health Care provider, and other related care WHEN discharged from a hospital. This forces you to “accept” the choice made by a facility that receives a “bonus incentive” for containing your choices under the guise of “high quality” care. In reality you find that these are providers of “basic” quality care that if you were given a choice you would NOT have used.

Also this means there will be a request of all your medical records for a Third Party Coordinator to review and then decide what care you receive and then that Coordinator will direct your Primary Care Provider (PCP) on your future care.

The problem with this is you will not get to choose your own provider of service (s) when the diagnosis or the emergent circumstance occurs since you must use the selected associated providers that are “basic” and “acceptable” quality of care. The area hospitals have aligned with purchasing the providers of care (listed upon hospital admission) that you “must” use when you return home. This will remove your choices in your aftercare. You are to use or lose… unless you pay out-of-pocket. The benefit is in the pockets of the hospital and the various vendor providers. It’s a win win for them since the facilities receive the bonus incentive plus the profit from the hospital owned vended services that only provide basic quality. Also there are some aftercare prescribed services not covered at all or it will be a covered service only if provided in a recommended nursing home or rehab.

Third Party Coordinator will decide tests, prescriptions, and referred services you can receive when you visit your PCP and your associated specialists, as well as, your hospital care. Your entire medical records are reviewed on a periodic basis. You will receive less supportive tests and if your PCP or Specialist would decide different to the recommendation of the Third Party Coordinator they would be penalized but you would need to pay out-of-pocket for those tests. You will be in a controlled care package similar to an HMO or advantage plan even though you are in the fee-for-service Medicare. The PCP loses the ability to fully direct your care due to the Third Party Coordinator recommendations. But if the PCP and/or Specialists follows the recommended direction of the Third Party Coordinator that provider receives a bonus incentive too. It is important to know this restricts your care. You will be assessed per your overall health and provided a determination of your care by people that are not physicians or other supportive medical providers beut by people trained to look for specific diagnoses and to align that diagnosis with a predetermined package of care. This is not personalized care.

Ivan Berry
8 years ago
Reply to  Anne

Anne, thank you so much. With my age and two types of severe disease that have so far been controlled though not cured, my care has thus far been somewhat expensive, but has been at the top of the quality spectrum. I can well imagine what would happen if this coordinaing and bundling got in the way. At 73 yrs, I still feel good most of the time and spend a lot of time helping younger folk understand about real economics, monitary policy, Constitutional principles and that we are a Constitutional Republic and not a Democracy, giving out copies of the Declaration of Independance and the Constitution, as well as trying to enlighten them on the principle of real vs fiat money and a means of storing wealth vs investing. I can well see that I am not an asset to the totalitarian state and should be expendable in their eyes. How many of the rest of us would they like to get rid of? Makes even sceptics suspicious of the leadership. Would that more would wake up and realize what is happening to our country.
Again, thank you for the explanation. It was of great help.

Anne
8 years ago
Reply to  Ivan Berry

Ivan,
I feel that it is a controlled systemic method of forcing more out-of-pocket costs on those that have the means in order to maintain the overall medical costs for Medicare recipients. If there was a true effort made to control medical costs then Congress needs to address the misuse of funds by the MediCAID and medical community.

MediCAID is running amok with funds. The Department of Welfare doesn’t have a reporting system of claims and costs spent. MediCAID pays for services Medicare never allowed paid. This runs the total Medicare reported dollars UPwards to the public. If one looks around at the medical community you will see how many NEW facilities and NEW fragmented levels of medical care is developing. The medical world is lucrative.

i keep hearing from the medical providers that it is a shame I am not on MediCAID. Well forgive me for not being there and that I worked hard all my life. I have Medicare, Blue Cross and Blue Sheild, and Veterans Administration care and I still pay quite a bit out-of-pocket. Also I will never qualify for MediCAID since I have a high personal pension that eliminates MediCAID or assistance programs for me.

Yes our generation see the inefficiencies of Federal and State programs, laws, and regulations. Those that are complacent, apathetic people will NEVER understand how much these Government intrusions are eroding our lives UNTIL it impacts them and their quality of life. I always advocate quality of life. I worked hard throughout my life. I am seeing the erosion of life too.

IT IS TIME TO TAKE BACK OUR RIGHTS! Voting out the current political legislation is a slow process and those placed into the system tend to perpetuate the problem. I dislike the future legacy left to our children and grandchildren. BUT those generations never will understand the difficulties of ours that we overcame just to have a good life. This generation feel that our generation has depleted their future so they are apathetic to our needs. They will not stand up for us. They are concerned about themselves.

HAM
8 years ago

I concur PaulE. This all or nothing attitude that some have could cause the Conservstive/Republicans another big loss this election and possible irreparable damage. Whether you consider yourself Tea Party or
Republican, we are all Conservatives and see the need to change the direction our country is well on the way to becoming. It is extremely important we all vote Republican in November even as PaulE says, you have to hold your nose. If you stay home because you don’t have your favorite candidate on the ballot, you are doing nothing but hurting yourself. All Consetvative/Republicans votes are needed to keep control of the house and gain control of the Senate to slow down Obama’s agenda until we can replace him with a President who truly loves this country and the freedom of choice we have always been proud of.

PaulE
8 years ago

For this and any other similar bills being originated in the House of Representatives to have a chance of being passed by Congress as a whole (that means the Senate for anyone who doesn’t realize it) and then enacted into law over the certain veto of Obama for all such bills, every conservative American has to show up and vote this November. No excuses!

Sitting at home and pouting that that the Republican on the ballot in your district “isn’t conservative enough” on one of the social issues, isn’t going to cut it anymore. Not when the country is being pushed hard towards becoming a socialist democracy, with all that that entails in just a few more short years. Remember, we’re just one liberal / progressive vote short on the Supreme Court from the progressive agenda being given a rubber stamp of approval. Focus on the big picture of how close we really are to losing everything that makes America a truly exceptional nation. So it’s time to lose the “purity or nothing” attitude, when it comes to voting this November.

We cannot afford another repeat of 2012, where people just sat home, rather than vote for Romney. He was far from perfect or even the best possible candidate for the job, but he would have been a hell of a lot better than four more years of Obama. Just look back at the last two years and tell me how Romney would have done worse than Obama. So hold your nose, if you have to this November, and vote Republican, if you want one last shot at saving the country. If not, all it’s going to produce is either a continuation of the status quo, where Democrats retain control of the Senate for another two years or the unthinkable: Republicans lose control of the House and we have the Democrats and Nancy Pelosi are back in control.

Glenn E.
8 years ago
Reply to  PaulE

AMEN!

Ivan Berry
8 years ago
Reply to  PaulE

Great Point, PaulE.
However, I would like a better explanation of what the bill proposes. I like my doctors and would like to keep them, but a Coordinator? Do you happen to know what that means? So far, my wife and I coordinate our own medical care between doctors, keeping each apprised of what the others are doing.
Note: I have become accustomed to your explanations on past issues and may be asking too much. If so, in this instance, ignore this posting. Bundling? Guess I haven’t kept up with the terminology.

PaulE
8 years ago
Reply to  Ivan Berry

Hi Ivan,

This bill appears to be more along the lines of conceptual things that could be implemented to strengthen Medicare and potentially reduce costs in the process, than actually spelling out definitive items in great detail. Unfortunately, this like many other bills put forth relies on the eventual discussions / negotiations between House and any subsequent Senate version of the bill to provide the level of detail we would expect to see up front.

At this stage, given the dim prospects of Harry Reid allowing any House Republican initiated bills to come up for a vote in the Senate, this is more of a bill put forth to show the American people the type of options the Republicans are thinking about pursuing, if they ever get the actual opportunity to get legislation passed by the full Congress. Your way of doing the coordination of medical care between doctors is how most of the people I know get it done. It works surprisingly well, cost nothing and you know the information is getting conveyed properly without any unnecessary middle man or agency. Hope this helps.

Ivan Berry
8 years ago
Reply to  PaulE

It does, and thank you, PaulE.

Anne
8 years ago
Reply to  Ivan Berry

Ivan,
This bill is to allow coordination of your healthcare and aligns the care with a diagnosis. What this means is a primary diagnosis is decided to require specific needs related for care. It takes it one step further by saying you must use the specific facilities, suppliers, nursing home, home infusion therapy provider, Home Health Care provider, and other related care when discharged from a hospital. This forces you to “accept” the choice made by a facility that receives a “bonus incentive” for containing your choices under the guise of “high quality” care. In reality you find that these are providers of “basic” quality care that if you were given a choice you would NOT have used. Also this means there will be a request of all your medical records for a third party Coordinator to review and then decide what care you receive and then that Coordinator will direct your Primary Care Provider (PCP) on your future care. This will remove your choices also since it will prevent your seeking another provider for your concerns unless you pay out-of-pocket.

The problem with this is you will not get to choose your own provider of service (s) when the diagnosis or the emergent circumstance occurs since you must use the selected associated providers that are “basic” and “acceptable” quality of care. The area hospitals have aligned with purchasing the providers of care (listed upon hospital admission) that you “must” use when you return home. This will remove your choices in your care. You are to use or lose… unless you pay out-of-pocket. The benefit is in the pockets of the hospital and the various vendor providers. It’s a win win for them since the facilities receive the bonus incentive plus the profit from the hospital owned vended services that only provide basic quality. And the Third Party Coordinator will decide tests, prescriptions, and referred services you can receive when you visit your PCP and your associated specialists. Your medical records are reviewed on a periodic basis. You will receive less supportive tests. You will be in a controlled care package similar to an HMO or advantage plan. The main provider of service loses the ability to fully direct your care due to the third party recommendations. But if the provider follows the recommended direction of the Third Party Coordinator that provider receives a bonus incentive too.

PaulE
8 years ago
Reply to  Anne

Thank you Anne. This was my understanding of the premise of medical bundling and the use of a medical coordinator as well. The problem I saw with the proposed H.R. bill is that it lacked the specificity of detail you’ve outlined and was merely a conceptual framework for a potential solution. Almost a kind of high-level overview put forth to demonstrate to the public that the Republicans can “do something”, without providing any of the essential specifics and necessary safeguards to insure against the kind of potential patient abuses you’ve outlined. Again, thank you for spending the time to document the process flow for everyone’s benefit.

My sense is we’re going to see a lot of these type of bills being cranked out between now and November, as the Republicans try to show the public they are “doing something” to address the health care issue. The problem I have with either Party simply “doing something” for the sake of “doing something” is that they either don’t think the problem through all the way, which just causes more problems down the road, or they simply throw a lot of ideas out, like spaghetti against a wall, to see what sticks. I would prefer and hope that all the Republicans in Congress would take the time to formulate well thought out and workable solutions. That would be a true net benefit to all Americans. God know we don’t get any of that from any of the Democrats in Congress.

Ivan Berry
8 years ago
Reply to  PaulE

Anne and PaulE, you have been of great service to all thinking members regarding the essentials of our medical situation and I for one am greatly appreciative. I had no understanding about this subject until your combined enlightenment. Now, I am more able to resist these types of encroachment into our personal business and will attempt to inform our representives both at the State level and in Washington. Again, thank you both.

Ivan

Anne
8 years ago
Reply to  PaulE

PaulE,

Yes conceptual cranked out bills that do not affect them since they are NOT a part of the coverage. I am definite one that watches these bills since the impact is eroding the middle class towards becoming the lower class elite.

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