CMA Alert | May 26, 2022

Special Report: Telehealth and the Medicare Population: Building a Foundation for the Virtual Health Care Revolution

From 2019 to 2020, the use of telehealth by Medicare beneficiaries increased over 6,000%. As the United States slowly emerges from the COVID-19 pandemic, this exponential expansion of telehealth and virtual care options are poised to change our nation’s health care landscape, with the enticing potential of improving access to care. With significant change also comes significant challenges, however, and when considering how to grow telehealth in a way that benefits all equally, it will be essential to examine and address the racial, social, and economic disparities that are already beginning to drive a “digital divide” in this country that could impact the quality of care that people receive.

The Center for Medicare Advocacy (the Center) has recently released an examination of these issues through a report entitled Telehealth and the Medicare Population: Building a Foundation for the Virtual Health Care Revolution. Authored by Chiplin Medicare and Health Policy Fellow Cinnamon St. John, the Center’s report explores current gaps in accessibility and infrastructure, discusses how these gaps could stand in the way of ensuring that all Medicare beneficiaries have equal access to the advantages that telehealth can provide, and highlights key policy priorities that should inform the design of future regulation and legislation.

While grounded in research, the report’s findings were additionally informed by interviews with experts from around the nation about the experiences (both challenges and conveniences) that older adults and people with disabilities have had when utilizing virtual care. We examined these issues through the lens of what we call “T.A.P. Challenges: Technology, Accessibility, and Peopleware.” Throughout the report, we describe driving factors and key considerations behind each of these three categories of T.A.P. challenges, illustrated by examples from the field.

While the Center recognizes the value of telehealth services and is heartened by the potential to increase access to the country’s health care system, we are also committed to ensuring that no beneficiaries are caught in the chasm created by the digital divide – created through disparities between those who can afford access and are able to utilize technology, and those who cannot. Furthermore, telehealth must supplement, not replace, in-person care options. In the early days of the pandemic, as the critical role of virtual care solutions became clear, the Center published 11 guiding principles to aid in making decisions about whether and how to expand Medicare coverage for telehealth. In addition to the findings and recommendations included in our most recent report, these guiding principles still hold true today.

The Centers for Medicare & Medicaid Services (CMS) has professed a commitment to addressing health disparities as a foundation of all its work “in every program and across every community.” In recognizing “systemic racism, persistent poverty and other disparities,” the Biden Administration, too, pledged a commitment to pursuing a comprehensive approach to advancing equity for all. This special telehealth report is aimed at advocates, lawmakers, and policy makers to aid in the creation of holistic policies that, as much as possible, do not create an unintended consequence of widening the digital divide.

Let us build upon the lessons learned through the pandemic to help create a future where better health, quality care, and equality are realized.

Read or download the full report here: https://medicareadvocacy.org/wp-content/uploads/2022/05/Telehealth-Report_CMA_final.pdf

Comments On Mandatory Staffing Ratios for Nursing Homes Due to CMS by June 10

As part of the annual proposed rule updating Medicare Part A payments to skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) includes a Request for Information about mandatory staffing levels for nursing homes.[1] CMS asks 17 questions about staffing. Commenters may answer some or all of the questions or they may submit comments focused solely on their own experiences, concerns, and recommendations about nurse staffing levels. 

Recognizing the complexity of the 17 questions in the Request for Information, the National Consumer Voice for Quality Long Term Care hosted a webinar on May 25. Nursing home advocates from California Advocates for Nursing Home Reform, the Center for Medicare Advocacy, Justice in Aging, and the Long-Term Care Community Coalition joined Consumer Voice in drafting a set of comments and discussing these comments and staffing issues at the webinar.

The draft comments, which commenters are invited to use, if they like, to support their own comments, are available at https://theconsumervoice.org/uploads/files/actions-and-news-updates/RFI_Comment_Outline.pdf. Consumer Voice includes more information about submitting comments on its website, https://theconsumervoice.org/. The Center for Medicare Advocacy will also share its comments in early June.

The Center contends that the 1987 Nursing Home Reform Law gives the Secretary full authority to set minimum staffing standards.[2] The Center also recognizes that staffing is a complex issue, requiring many actions in addition to mandatory staffing levels. Nevertheless, there can be no question that mandating staffing levels in nursing homes is one of the most important ways to improve staffing and make residents’ lives better. President Biden’s nursing home reform agenda[3] puts this decades’ long advocacy goal within reach. Anyone with experiences in nursing homes is encouraged to submit comments to CMS by the June 10 deadline.

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[1] CMS, “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; Request for Information on Revising the Requirements for Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels,” CMS-1765-P, https://www.govinfo.gov/content/pkg/FR-2022-04-15/pdf/2022-07906.pdf, discussed in “CMS Begins Process of Setting Mandatory Nurse Staffing Standards for Nursing Facilities” (CMA Alert, Apr. 14, 2022), https://medicareadvocacy.org/cms-begins-process-of-setting-mandatory-nurse-staffing-standards-for-nursing-facilities/
[2] The Secretary has the duty and responsibility “to assure that requirements which govern the provision of care in skilled nursing facilities under this subchapter, and the enforcement of such requirements, are adequate to protect the health, safety, welfare, and rights of residents and to promote the effective and efficient use of public moneys.”  42 U.S.C. §§1395i-3(f)(1), 1396r(f)(1), Medicare and Medicaid, respectively.  These dual duties – ensuring that care standards and their enforcement adequately protect residents and effectively and efficiently using public reimbursement – give the Secretary ample authority to develop and enforce minimum mandatory staffing standards.
[3] “Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes” is at https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/, discussed in “Biden Administration Issues Bold and Comprehensive Nursing Home Reform Agenda” (CMA Alert, Mar. 3, 2022), https://medicareadvocacy.org/bidens-bold-2022-nursing-home-reform-agenda/

Elder Justice “No Harm” Newsletter | Vol 4, Issue 3 Now Available

In the Elder Justice Newsletter, we highlight citations, including deficiencies related to abuse, neglect, and substandard care, that have been identified as not causing any resident harm. The goal of this brief newsletter is to shed light on the issue of so-called “no harm” deficiencies, which typically result in no fine or penalty to the nursing home.

In honor of Memorial Day, this Elder Justice Newsletter is dedicated to those living in veterans’ homes across the United States.

This newsletter focuses on the following “no harm” violations:

• Pronounced dead: Staff fail to verify resident’s CPR status.
• Unquenched thirst: Dehydration lands resident in hospital.
• Sexual harassment: Residents at risk for unwanted and inappropriate touching.
• ‘I will make the rest of your time here miserable’: Nursing home administrator verbally abuses resident.
• Out of time: Staff fail to assist resident with basic hygiene services.
• In the dark: Facility fails to notify family members of significant change.

Do YOU think these deficiencies caused “no harm”? Click to download the Newsletter.

FREE WEBINAR | Choosing the Medicare Option That’s Right For You When You Are Living With Paralysis

Wednesday June 1, 2022 @ 2 – 3:00 PM EDT

A Webinar for the Christopher and Dana Reeve Foundation by the Center for Medicare Advocacy, presented by Center for Medicare Advocacy Associate Directors Kathy Holt and David Lipschutz.

The program will explore the pros and cons of getting Medicare through the traditional public program or a private managed-care Medicare Advantage program, whether you’re:

• New to Medicare, 
• Seeking to change your Medicare option during the annual election period, or 
• Wondering if your changing life circumstances might present other opportunities for choosing how you get Medicare.

The presentation will also examine: 

• Resources to optimize the decision on how you get Medicare, 
• Strategies to avoid late enrollment penalties, 
• Coordinating insurance when you have other types of health coverage, in addition to Medicare, and
• Programs that may assist in paying for the costs of Medicare.

Register Now:
https://attendee.gotowebinar.com/register/5475548536534188816