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HEALTH CARE REFORM LEGISLATIVE OPTIONS

Medical Homes and Community Health Teams: We have been a strong supporter of the concept of a patient-centered medical home as a promising approach to promote primary care and encourage not only care coordination throughout the care continuum but patient self-efficacy as well. The committee’s idea of establishing “community health teams” to support the medical home model takes in to account the reality that most Americans receive their care from small clinical practices. Therefore, the infrastructure support that is proposed in the draft legislation could help small practices become medical homes that can live up to the promise of the concept. However, we urge that the definition of medical home be expanded to include non-physician clinicians, such as advance practice nurses.

Emergency Care Response and Research: Section 1204 proposes competitive grants for regionalized systems for emergency care response and Section 498D provides support for emergency medicine research. Subsection (d)2(vi) requires applicants for such grants to address pediatric concerns related to the integration, planning, preparedness, and coordination of emergency medical services for infants, children, and adolescents; and section 498D(b) provides for pediatric emergency medical research. We urge the committee to also require that prospective grantees be required to address a similar list for geriatric patients and for the Secretary to conduct research applicable to a geriatric population as well. There is an increasing trend in emergency departments (ED) for visits from older patients: visit rates over the past 11 years have seen substantial increases among patients age 50 and older. In addition, patients over the age of 75 are more likely to arrive at the ER via emergency medical transport (49 percent) than all other patients (4.2 percent) Finally, older adults are especially vulnerable during disasters and face special risks due to the fact that they are more likely to have chronic illnesses, functional limitations, as well as greater sensory, physical, and cognitive disabilities than younger persons.

Reducing and Reporting Hospital Readmissions: Almost one fifth of Medicare patients discharged from a hospital were readmitted within 30 days; these readmissions cost Medicare $17.4 billion in 2004. These hospital stays, many of which are preventable, pose a major concern—from both a quality and financial perspective—and must be addressed. AARP concurs with the Committee that information about rates of readmission should be reported to hospitals so that they have the opportunity to act on the information and take steps to eliminate preventable readmissions. We also believe this information should be reported to the public so that patients and clinicians can factor it into their choice of hospitals and also to stimulate improvement (because we know that publishing performance information gets the attention of the provider community and encourages them to pay attention to the data.)

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