While millions of seniors will be getting expanded prescription drug discounts in the next few years, one of the hidden costs may be that home health services will become harder to get.

Turns out that a change in how home health care agencies get paid by Medicare was tucked into the massive Medicare prescription drug bill, which President Bush signed last month. Instead of a 3.3 percent raise this year, home health agencies will get a 2.5 percent raise.

By itself, the reduced increase would cause minor concern.

But the slowdown comes just as the home health industry was recovering from sharp funding cuts in the late 1990s that chased about a third of the agencies nationwide out of business.

The new increases don't keep up with rising costs, agency directors say. And they don't account for an expected increase in demand for services as the population ages.

"I think we're going to see further reductions in the field," says Warren Falberg, president and chief executive of the Visiting Nurses Association. "It's an unfortunate issue because home care still represents one of the best health care bargains in the country."

It is unlikely that seniors will see deep cuts in care in 2004.

But some agencies may try to avoid patients that need money-losing extra visits, and care may become more impersonal as agencies trim their budgets, says Mary Jane Stumpf, owner of M.J. Nursing Registry Inc.

MAD COW CONNECTION: Recent concerns about mad cow disease -- especially references to abnormal proteins called prions -- reminded some Cincinnati residents about a Walnut Hills High School graduate who won the Nobel Prize.

In 1997, Dr. Stanley B. Prusiner won the Nobel Prize for medicine for his discovery of prions, an infectious kind of protein found in neural tissues that has been linked to several forms of brain-wasting disease.

Prusiner, 61, did his work in San Francisco, where he has lived since 1968. However, Prusiner's father, Lawrence, was an architect in Cincinnati for 25 years and Prusiner spent much of his childhood here, graduating in 1960 from Walnut Hills. "During my time at Walnut Hills High School, I studied Latin for five years, which was to help me immensely later in the writing of scientific papers. But I found high school rather uninteresting and was most fortunate to be accepted by the University of Pennsylvania where I majored in chemistry," Prusiner wrote in a bio produced after he won the Nobel Prize.

CUTTING TO THE BONE? Orthopedists' business costs jumped 12.3 percent in 2002 compared to 2001, while their revenue increased by 6.6 percent, according to the Medical Group Management Association. The main reasons: a 26 percent spike in medical malpractice costs and an 8 percent bump in staff costs.

E-mail tbonfield@enquirer.com