Keeping Seniors in the Loop

Dispelling Myths and Enhancing Understanding of PPACA Medicare Coverage

Many ambulatory patient visits are covered by Medicare, and many older adults on Medicare have concerns about continuation of their Medicare coverage. The Kaiser Family Foundation (KFF) recently released a Health Tracking Poll (July, 2010) of seniors on Medicare. One third of those polled believe that the Patient Protection and Affordable Care Act (PPACA) creates "death panels" and allows a government panel to make decisions about end-of-life care for people on Medicare (Altman, 2010). In addition, fifty percent said the law cut benefits previously provided to all people on Medicare. Only 33% knew that the PPACA eliminated copays and deductibles for many preventive services under Medicare, and only 26% knew that it provided bonus payments to doctors who provide primary care services under Medicare (Altman, 2010). Media coverage during the health care reform debates (usually presented in sound bites) may have contributed to or be the cause of these misperceptions.

Ambulatory care nurses can play a major part in dispelling misperceptions and enhancing understanding of new Medicare benefits within the PPACA. They can conduct informal teaching during patient visits, provide correct information about Medicare coverage, and share resources that allow seniors to access more detailed information.

"The Commonwealth Fund Blog" is an excellent resource that does much to dispel myths about health care reform. Karen Davis, president of The Commonwealth Fund, writes on The Commonwealth Fund Blog (2010) that the proposed coverage of end-oflife counseling by health care providers (the wrongly termed "death panels") is not a part of the PPACA. Davis also notes that the myth that health care reform will ration care can be dismissed by viewing the provisions that actually increase a patient's choice and access, as well as provide coverage for prevention and wellness. So, too, the myth that health care reform will cut Medicare benefits can be dispelled by viewing the actual provisions in the law. As discussed below, the PPACA improves drug coverage and provides incentives for doctors and hospitals to improve care and efficiency and decrease costs.

The Kaiser Family Foundation Web site (2010) provides a summary of key changes to Medicare resulting from the PPACA that has been signed into law. The PPACA:

  • Phases in coverage of the "doughnut hole" in Medicare part D prescription drug coverage. The phasein begins with a $250 rebate to any Medicare enrollee with any spending in the "hole" in 2010. Then a series of yearly changes in coverage for costs in the "doughnut hole" are prescribed, so that enrollees in 2020 will be responsible for only 25% of costs of drugs in the "hole." This is down from 100% in 2010.
  • Improves coverage for prevention. Beginning in 2011, no coinsurance or deductibles will be charged in traditional Medicare and a free annual comprehensive wellness visit and personalized prevention plan will be covered by Medicare. Many other preventive services for adults, women, and children will also be covered (Healthcare.gov, 2010).
  • Provides a 10% bonus payment for primary care services furnished by primary care physicians, nurse practitioners, and clinical nurse specialists (effective 2011-2015).
  • Creates the Independence at Home demonstration program to provide high-need Medicare enrollees (those with two or more chronic conditions) with primary care services in their home.
  • Encourages doctors and health care providers to work together to better meet needs of patients and reduce waste such as duplicate or unnecessary testing. Health providers will receive incentives to coordinate across a range of health settings - from the hospital to the home - to ensure the best health outcomes for seniors.
  • Establishes value-based purchasing, with incentive payments for hospitals that meet certain quality performance standards.

Ambulatory care nurses who go online to seek information on health care reform and the PPACA provisions need to remember that health care reform is a "hot" political issue. There are organizations and individuals who are very supportive of health care reform and those who want to maintain the status quo; each group is guided by political ideology and philosophy. Therefore, the provider or source of information on the Internet should be scrutinized. Political philosophy will influence how the act and law are viewed and described. It is best to visit the home page of the source Web site and read the organization's mission, vision, and philosophy so you can make a judgment as to whether you are getting a balanced view of health reform and the PPACA.

Senior citizens who are Medicare recipients will need assistance from ambulatory care nurses to stay informed of changes, dispel misconceptions, and encourage them to take advantage of health and wellness opportunities now funded by Medicare. Since many of the PPACA provisions are phased in over the next few years, education, reassurance, and provision of resources that seniors can access will be an ongoing process. However, the outcomes can lead to healthier, more vital seniors who have fewer worries about the quality and costs of health care.


Sheila A. Haas, PhD, RN, FAAN, is a Professor, Niehoff School of Nursing, Loyola University of Chicago, Chicago, IL. She can be reached at shaas@luc.edu

References
Altman, S. (2010). Pulling it together: Health reform's six-month checkup. Retrieved fromhttp://www.kff.org/pullingittogether/Health-reforms-six-monthcheckup.cfm

Davis, K. (2010). The way forward with health reform. Retrieved from http:// www.commonwealthfund.org/Content/Blog/The-Way-Forward-with- Health-Reform.aspx.

Healthcare.gov. (2010). Preventive services covered under the affordable care act. Retrieved from http://www.healthcare.gov/ law/about/provisions/services/lists.html Kaiser Family Foundation. (2010). Summary of key changes to Medicare in 2010 health reform law. Retrieved from http://www.kff.org/healthreform/7948.cfm