The American Geriatrics Society
Dedicated to the Health of Older Americans
H E A LT H C A R E R E F O R M A N D B E YO N D :
N E W O P P O R T U N I T I E S I N T H E VA L U I N G O F
G E R I AT R I C S
2 0 1 0 R E Y N O L D S G R A N T E E 9 TH A N N UA L M E E T I N G
O c t o b e r 2 6 th, 2 0 1 0
St. Louis, MO
J e n n i e C h i n H a n s e n , R N , M S , FA A N
CEO
Agenda
• Elements of the 2010 Health Care Reform and its affect
on Medicare, Geriatrics and Medicine
• Opportunities for Geriatrics and Geriatric
Competencies in Health Reform Phase II
•P o t e n t i a l O p p o r t u n i t i e s f o r G e r i a t r i c s i n G M E F u n d i n g
•O u r r o l e a s A G S
Patient Protection and Affordable
Care Act -PPACA
• M O S T E X PA N S I V E H E A LT H A N D M E D I C A R E C H A N G E S
SINCE 1965
• COVERAGE
• Increased-adding 32 million, children until 26 year old, no lifetime
caps
• MEDICARE
•
Prevention, Accountability for Outcomes and Costs, New Models of
Chronic Care
• A D D I N G T O S O LV E N C Y O F M E D I C A R E ( PA R T A ) - 1 2 Y E A R S
(FROM 2017-2029)
Key Elements of 2010 Health Care Reform
What To Expect From the New Law
• Increased focus on physician/hospital/post acute care
collaborations with ACOs, Medical Homes, Episode
Bundling
• P i l o t p r o g r a m s t o f o s t e r c o l l a b o ra t i o n a c r o s s d i s c i p l i n e s CMS Innovations Center
• Increased funding for primary care, geriatricians, ANPs
and community -based health centers
•E x p a n d e d c o v e r a g e f o r t h o s e u n d e r 6 5 a t 1 3 3 % o f p o v e r t y
level and Medicaid incentives for Home and Community
Based Care
Key Elements of 2010 Health Care Reform
What To Expect From the New Law
•
Models of Care
•
Centers for Medicare and Medicare Services (CMS)
• Center for Medicare and Medicaid Innovation (CMI)
•
$10 Billion dedicated until 2019-Pilots instead of Demonstration
projects
•
Significant shift: includes bundled payments; Medical and Health
Care Homes; Accountable Care Organizations
Key Elements of 2010 Health Care
Reform
Chronicity Care Benefits
• F i n a n c i a l I n c e n t i v e s t o S t a t e s t o Re c e i v e G r e a t e r
“Medicaid Match” money if they work to increase
t h e i r p ro p o r t i o n o f M e d i c a i d f u n d i n g fo r H o m e a n d
C o m m u n i t y B a s e d C a r e v s N u rs i n g H o m e f u n d i n g
• N E W LO N G T E R M C a r e I n s u ra n c e - C o m m u n i t y L i v i n g
Assistance Services and Supports (CLASS) Act
•
•
Voluntary payroll contribution for long term care coverage
Vesting after 5 years of payment in system
•
Minimum of $50/day ( $18, 250/yr)
Key Elements of 2010 Health Care
Reform
Understanding Older Patients
1 out of 3 patients do not feel prepared to care for
themselves when discharged from a hospital or
treatment facility*
• Pa t i e n t s l a c k g u i d a n c e w h e n t h e y t r a n s i t i o n f r o m
h o s p i t a l t o h o m e ( B O O S T/ H a r v a r d ; N I C H E / N Y U ;
GRACE/Indiana University)
• Pa t i e n t s a r e u n c e r t a i n h o w t o m a n a g e t h e i r o w n h e a l t h
issues
•C o m m u n i t y C a r e Tr a n s i t i o n s D e m o n s t r a t i o n N a y l o r a n d
Coleman
*AARP’s Public Policy Institute
Key Elements of 2010 Health Care Reform
Increase Collaboration and Training Across
Disciplines and Care with Evidence
• Wo r k f o r c e
•
•
•
Health Resources and Services Administration (HRSA)
• Title VII & Title VIII (Geriatric Education Centers, Research
Tr a i n i n g a n d M u l t i p l e D i s c i p l i n e s )
General Accountability Office (GAO)
• H e a l t h C a r e Wo r k f o r c e C o m m i s s i o n - S e l e c t e d
( M u l t i d i s c i p l i n a r y - U n i v e r s i t y o f VA , H e a l t h E x e c - G e r i a t r i c s
C e r t i f i c a t i o n ; P e t e r B u e r h a u s , P h D , R N , Va n d e r b i l t , C h a i r )
Patient Center Outcomes Based Research Institute (PCORI) Selected (many physicians)
Key Elements of 2010 Health Care Reform
Framing Our Workforce
Geriatrics
GERIATRICIAN
Geriatric
Nurse/Nurse
Practitioner
Geriatric Social
Workers & Others
Geriatric
Pharmacists
Advancing Our “Geriatrics” Efforts for Societal Impact
Research
Academic
Clinical
Physicians
Nurses/NPs
Other Prof
Internal Med
Subspecialties
Advanced Practice
Nurses
Social Workers
Surgical Specialties
Critical Care Nurses
Home Care Workers
Diagnostic Specialties
Nursing Assistants
Physical/Occupationa
l Therapists
Other Specialties
Other Nursing
Specialties
Other HCPs
Across specialties and disciplines
Key Likely Impacts On Geriatrics and
Older Adults
O p p o r t u n i t i e s i n Syste m s o f C a re :
1 . H e a l t h C a re H o m e s , A c co u nta b l e C a re
O rga n i zat i o n s a n d B u n d l e d E p i s o d e s o f C a re
2 . N e w D e m o n st rat i o n s u n d e r t h e I n n ovat i o n s
C e nte rs o f C M S ( c h ro n i c ca re d e m o s )
3 . Tra n s i t i o n s o f C a re D e m o s
Importance of Geriatricians and other
colleagues’ leadership opportunities
L e a d e rs h i p Ro l e s :
1 . Pat i e nt S a fe t y a n d Q u a l i t y t h at affe c t t h e
G e r i at r i c Po p u l at i o n s s i n c e t h at A ffe c t s b o t h
Eco n o m i c s a n d Re p u tat io n s o f p rov i d e r
syste m s
2 . P ro g ra m m at i c D e s i g n a n d D i ff u s i o n o f M o d e l s
o f C a re
3 . C o m m i tte e L e a d e rs h i p a n d S e r v i c e i n
O rga n i zat i o n s a c ro s s d i s c i p l i n e s a n d ca re
issues
How AGS Supports Geriatrics Agenda
Role of the American Geriatrics Society (AGS)
• Mission:
To i m p rove t h e h e a l t h , i n d e p e n d e n c e a n d
q u a l i t y o f l i fe o f a l l o l d e r p e o p l e
• Vision: Ever y older American will receive high
quality patient -centered care
AGS Strategies and
Collaboration Synergies
•G u i d e p u b l i c p o l i c y t h r o u g h a d v o c a c y e d u c a t i o n s o
policy supports improved health and healthcare for
older adults, especially those with multiple
chronicities and frailty
•R a i s e P u b l i c A w a r e n e s s o f t h e n e e d f o r h i g h - q u a l i t y,
culturally sensitive geriatric healthcare
• Geriatrics Workforce Policy Studies Center (GWPS)-track supply
and shortage
• Eldercare Workforce Alliance (EWA)-Cross Discipline
How AGS Supports Geriatrics Agenda
Achievements in Health Reform
• Geriatric education and training; career awards; comprehensive
geriatric education (Sec. 5305)
•Geriatric Academic Career Awards (GACAs) to physicians, advanced
practice nurses, clinical social workers, pharmacists, and psychologist
• Creates Geriatric Career Incentive Awards to foster greater interest
among a variety of health professionals in entering the field of
geriatrics, long-term care, and chronic care management
• Those eligible include advanced practice nurses, clinical social
workers, pharmacists, or students of psychology pursuing a
doctorate or other advanced degree in geriatrics
AARP 2010
Geriatrics Education and Training Programs under
Titles VII of PHSA (FY 2010)
GACAs *
GECs *
Provides grants to health professions schools and healthcare
facilities to provide multidisciplinary training in geriatrics
45 Geriatric Education Centers (-4) at $17 mil
Fellowships
Trains physicians, dentists, and behavioral/mental health
professionals who decide to teach geriatrics
13 Geriatric Training Programs (+3) at $8 mil
Geriatrics Nursing Education Program under Title VIII
of PHSA (FY 2010)
Nursing
Workforce *
 Prepares RNs who will care for older Americans, develop
and share curriculum, train faculty members, and provide
continuing education.
 29 Geriatric Nursing Education (+1) at $4.5 mil
Geriatrics Programs under Title VII
Funding in Millions
$40.0
$35.0
$30.0
$25.0
$20.0
$15.0
$10.0
$5.0
$0.0
FY 2005
FY 2006
FY 2007
FY 2008
Title VII
FY 2009
FY 2010
Medicare Dollars for GME
versus Funding for Title VII & VIII
DGME -$3.0 bil
IGME - $6.5 bil
$3.5 B of the $6.5 B
is higher than
empirically calculated
expenditures for
teaching
Geriatrics Programs
under Title VII & VIII $38 million
DGME-Direct Graduate
Medical Education
IGME-Indirect Graduate
Medical Education
(hospitals)
MedPAC Report on GME
June 2010 Chapter 4
 Recommendations for improving GME to support a reformed
delivery system
 Commission Assessment:


1. GME system not aligned with reforms essential for increaseing quality
and value;
2. Providers will needs skills to:
Integrate care across settings
 Improve quality
 Use resources efficiently



3. FFS payment signals physician career choices (along with other factors)
[Mark Miller, Executive Director, MedPAC October 24, 2010]
Key MedPAC Recommendations on GME
1.
Establish performance-based payments for GME
Greater accountability and reward education and training that will
improve the value of our health care delivery system
1.
Increase the Transparency of Medicare’s GME Subsidies
Secretary to annually publish report of DGME and IME received by each
hospital
1.
2.
3.
1.
2.
3.
Studies:
Workforce needs by numbers and specialty
How residency programs affect the financial performance of sponsoring
institutions and whether residency specialties should be supported
equally
Strategies for increasing diversity of health professional workforce
Macy Foundation and Association of Academic Health
Centers (AAHC) -October 24-25, 2010
“Optimizing the Structure, Support, Oversight and
Accountability of GME to Best Meet the Needs of the
American People”
 Aligning financing and regulation of GME in US to better align
with contemporary societal need and changing practice
environments
MedPAC, COGME, AAMC, ACGME, AMA, VA, NEJM (Iglehart),
AGS
Emory, UCSF, Northwestern, Meharry, Howard, UNC, Johns
Hopkins, Partners, UC Davis, Washington Un, Un Wash, Un
Texas System
Making the Case for Geriatrics and its Competencies
 AGS started 68 years ago identifying the issues
 Advancing the field
 JAGS-one of the one hundred most highly regarded in this past 100 years
 Beeson, Williams and Jahnigen Scholars
 Certificate of Added Qualification in Geriatrics
 Today the need is compelling yet the struggle continues to be
mighty
 Many collaborators and colleagues



e.g. Foundations (Reynolds, John A. Hartford, Atlantic Philanthropies) ACP,
AAFP, VA, SGIM, Home Care, Palliative Care, Hospitalists, GSA, Nursing,
Pharmacists, Social Workers and others
Bi-partisan support and concern, federal and state,
Opportunities: CMS , AARP (the public), Health Plans, other foundations,
and other funders
TODAY
American Geriatrics Society (AGS) - advancing the
importance of the issues of geriatrics and elevating its
value in the health care
Current Value Equation
 Current and Ongoing Work:





Geriatrics for Specialists Initiative (GSI): Burton and Solomon
Academic Directors for Geriatric Programs (ADGAP): 20 years
and in review
GEMMSTAR (NIA)-codifying the Jahnigen program
CRIT (Chief Residents-Sharon Levine)
Geriatrics Workforce Data (Gregg Warshaw and Libbie Bragg)
and Eldercare Workforce Alliance (EWA-Nancy Lundebjerg and
Steve Dawson) Geriatric Competencies

Surgical Specialties (American Board of Surgery), Opthamology,
Urology, Emergency Medicine and others
Building the Case: 2010 and Beyond
Advancing and Embedding

Opportunities to Make the Value Equation:
 Current Initiatives:
 Aligning the strength and potential of AGS
 Advancing our work in mission adoption with other specialties
(we are now a member of the Council of Medical Specialty
Societies-CMSS)
 GEMMSTAR
 Future Work:
 Leverage
Current Policy: 30 Day Readmission and Some Never
Events (making the “business case in quality and safety”)building on work done
 ACOs, Medical Homes, Bundled Payments vs FFS
 GME influence
Advancing Our Field and Issues
 Why: Societal Imperative-individually and collectively
 Why: Extraordinary Financial Spend on Public and
Private Resources ineffectively used: 30% of $2.3Trillion
 Who: All of us-cross discipline and especially those of us
who know the “chronicity space”
 Where: Acute AND AMBULATORY (where people spend
most of their lives)
 When: We need you NOW!
The American Geriatrics Society
Dedicated to the Health of Older Americans
THANK YOU!
October 26, 2010
J e n n i e C h i n H a n s e n , R N , M S N , FA A N
C EO
jhansen@americangeriatrics.org