2006 Decision to Increase Investment in Policy Advocacy
Continues to Yield Important Accomplishments

--This, the second in a series of stories about AGS’ public policy advocacy efforts,
focuses on key AGS  policy accomplishments since 2006 --

Earlier this year, the Justice Department began drafting legislation to ensure that nursing home residents who need controlled pain medications get these drugs in a timely manner.  The department’s move marked a breakthrough in an effort led by the American Geriatrics Society (AGS) and other organizations to revise a policy that sometimes left residents waiting hours for relief.  And it came on the heels of a Senate Special Committee on Aging hearing at which then- AGS President Cheryl Phillips, MD, had been invited to testify.  During the hearing, Dr. Phillips eloquently explained the consequences of the medication policy and outlined needed changes.

Dr. Phillips’ invitation to testify before the Senate committee was a key policy accomplishment for the AGS that later led to another major accomplishment—the pending change in legislation concerning the dispensing of controlled pain medications in long-term care. Together, these achievements illustrate what policy advocacy is, and isn’t, all about.

“People think policy advocacy is lobbying for legislation in Washington,” says Peter Hollmann, MD, who chairs the AGS’ Public Policy Committee. “It’s important to realize that advocacy work is broader than that.  It involves building relationships and coalitions – those are also important policy accomplishments.  So is being asked to give public testimony or to join a task force, and meeting with policymakers in Washington and shaping the way they approach problems.  Advocacy is about making recommendations and providing information about regulations and payment in our field, and being recognized as a trusted source for expertise and honest, timely comment.  AGS has achieved a great deal in all of these ways.”

Playing a Key Role in the IOM Geriatrics Workforce Report 
Since 2006, when the AGS Board of Directors decided to place greater emphasis on public policy advocacy, the society has, increasingly, been chalking up public policy accomplishments. One of its first major achievements following the Board’s decision, Dr. Hollmann notes, dates back to 2007. That year, then-AGS Executive Vice President Linda Hiddemen Barondess approached the Institute of Medicine (IOM) and proposed that it evaluate the nation’s readiness to care for its rapidly aging population.  Cory Rieder of the John A. Hartford Foundation and Christopher Langston, then at The Atlantic Philanthropies, led the effort to bring together a coalition of private foundations to fund the report.  The following year the IOM published its groundbreaking report, Retooling for an Aging America: Building the Health Care Workforce, warning that the nation’s eldercare workforce was far too small and unprepared to do the job.  

The report raised awareness of the need to prepare for the coming “Age Boom” -- and it significantly boosted the AGS’ profile in policy circles.  The week the report was released, then-AGS President Todd Semla, PharmD, was invited to discuss the report’s findings and recommendations with the Senate Special Committee on Aging.   Since then, AGS members have been invited to testify before the committee on issues related to elder healthcare several times.

“Our relationship with the Senate Special Committee on Aging has been very important,” says Dr. Semla. “We’ve become one of the go-to organizations for that committee and this has helped advance our policy advocacy work.”

Facilitating Member Involvement in Successful Policy Advocacy Efforts
Following the Board’s 2006 decision to increase its public policy efforts, the AGS hired a bipartisan policy advocacy firm in Washington, DC, expanded its policy staff, and launched the society’s web-based Health in Aging Advocacy Center, which involves members and others in campaigns on behalf of policy and initiatives supporting elder care.  These investments have paid off.  The center, for example, has facilitated AGS’ ability to mobilize members and other advocates in a wide range of successful advocacy campaigns.  These have included campaigns to reverse and block Sustainable Growth Rate formula-mandated cuts in Medicare payments to physicians and other providers; to restore and help secure funding for Title VII and VIII training programs for geriatrics healthcare professionals and nurses; and to support the National Institutes of Health and National Institute on Aging.

Advancing Essential Coalition Work 
AGS’ advocacy efforts also emphasize face-to-face meetings and coalition work.  In related work on behalf of funding for aging research across NIH institutes, AGS Chief Executive Officer Jennie Chin Hansen RN, MS, and leaders of other eldercare organizations met with NIH Director Francis Collins, MD, PhD, last December to highlight the importance of research focusing on aging.  The Obama Administration’s 2012 budget proposal, released two months later, called for increased funding for both the NIA and Title VII and VIII programs.

The society has tallied a wide range of advocacy successes in coalition with other organizations.  In 2007, it joined with the American Academy of Family Physicians (AAFP), the American Academy of Home Care Physicians (AAHCP), and the American College of Physicians (ACP), to successfully advocate for more appropriate Medicare reimbursement for house calls to homebound elders.  The society’s work as a member of the broad-based Eldercare Workforce Alliance (EWA)—a coalition of 29 organizations co-convened by AGS Chief Operating Officer Nancy Lundebjerg, MPH, and Steven Dawson, President of PHI—has also advanced AGS’ goals of  increasing the ranks of healthcare professionals and direct care workers, and enhancing their training and ability to improve elder care. Like the AGS, the EWA meets with lawmakers and their staff, shares information, issues policy briefs, offers testimony, and advocates for legislation supporting training for all eldercare workers. Both the AGS and EWA, for example, recently endorsed the Medicare Home Health Planning Improvement Act. This important legislation would allow physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to order home health care for Medicare patients.  Current law allows only physicians to do so.

The Affordable Care Act includes numerous provisions for which the society has long advocated, including provisions to step up training for geriatrics healthcare professionals, direct-care workers, and seniors’ family caregivers. In a presentation to the Association of Directors of Geriatric Academic Programs last year, Diane Meier, MD—who was a Health and Aging Policy Fellow working with the Senate Health, Education, Labor and Pensions (HELP) Committee— noted:  “At the end of the day, the HELP staff recognized that EWA had done its homework in terms of working within the coalition to achieve consensus among members.  They thought that was a remarkable achievement for such a diverse group and decided to include the programs and investments that EWA had advocated for in the Senate’s bill.”

“Both the IOM report and our workforce efforts have facilitated our work on the Hill with healthcare reform,” adds AGS President Barbara Resnick, PhD, RN, CRNP.  “As a result of those and related efforts we now have relationships with legislators and their staff that we never had before.”

Expanding its Role in Regulatory and Quality Measurement Initiatives
AGS’ regulatory work was also expanded as a result of the Board’s 2006 decision.  The society was already involved in key task forces and panels, such as the American Medical Association's (AMA’s) House of Delegates and AMA/Specialty Society Relative Value Scale Update Committee (RUC). But in 2006, the society engaged a Washington-based regulatory team to assist with these efforts.  That investment has paid off as well. In 2008 former AGS president Meghan Gerety, MD, held a seat on the RUC and chaired the   five-year review that resulted in the Centers for Medicare and Medicaid Services (CMS) approving the highest increase in evaluation and management code valuations since the codes were established.

As part of its expanded policy advocacy role, AGS determined that it should also increase its involvement in initiatives specifically aimed at enhancing the quality of care older adults receive.  As a result, the society established its Quality and Performance Measurement Committee, which has overseen the society’s participation in national efforts to develop and disseminate quality measures.  In this work, AGS has focused on providing a voice at the table to ensure that the needs of frail older adults included in the measure development process.  Since 2007, AGS has participated in more than 50 measure development panels and AGS-nominated members have led five of these panels.  Society members have reviewed and provided input on roughly 60 measures.  The AGS’ Caroline Blaum, MD, MS, has been serving on the Executive Committee of the Physician Consortium for Performance Improvement (PCPI) that is coordinated by the American Medical Association, and other AGS members have been participating in key National Quality Forum (NQF) panels.  In addition, a number of AGS leaders and members serve on the Geriatrics Measure Advisory Panel of the National Committee for Quality Assurance.  AGS has consistently articulated that quality measurement needs to take into account multi-morbidity and patient preferences. 

“We were delighted when the National Quality Forum announced that it was establishing a task force to look at multi-morbidity, and even more so when we learned that Dr. Blaum would chair this group,” Dr. Resnick notes. 

Most recently, Ms. Hansen, former AGS Board Chair Cheryl Phillips, MD, board members Steven Counsell, MD, and Debra Saliba, MD, MPH, and members Sean Morrison, MD, Tom von Sternberg, MD,  and Bruce Leff, MD, were tapped to participate in the NQF’s  new Measures Applications Partnership (MAP) initiative, to advise the Department of Health and Human Services regarding the selection of measures for public reporting and payment programs. The NQF also appointed the AGS an organizational member of a key MAP workgroup. (See “CEO Update,” for more)

Establishing the AGS as the Go-To Source for Elder Healthcare Information
Other important initiatives that the AGS launched after committing to greater involvement in policy advocacy include its “Hill Visits” program and the creation of its “SWAT teams.”  Every Congressional session, the AGS coordinates visits for member volunteers who meet with lawmakers and their staff on Capitol Hill to discuss initiatives and programs central to providing quality eldercare.  And throughout the year, “SWAT” teams comprised of AGS members respond quickly when policymakers, their staff, administrators, and journalists need information relevant to eldercare policy.

“These initiatives have catapulted our presence on the Hill,” says Dr. Semla.  “Not only are our staff on the Hill more often, our members are showing up as well. And that’s made a big difference.  We’re there, we know our field, and we’ve made contacts and friends in Washington.”

Attesting to the importance of persistence in policy advocacy, a wide range of eldercare –friendly provisions included in the Affordable Care Act were originally part of stand-alone legislative proposals, Dr. Hollmann points out.  Provisions calling for coordinated care for older patients with dementia and multiple, complex health problems, for example, were originally part of the RE-Aligning Care Act (formerly the Geriatric Assessment and Chronic Care Coordination Act) proposed by former Senator Blanche Lincoln.

The reform law includes provisions to advance the evaluation and implementation of coordinated, interdisciplinary care and other promising models of care for complex older patients—models for which AGS advocated.  The law also offers geriatricians and other primary care providers a 10% Medicare bonus for specified primary care services.  The society was a staunch advocate for this measure and others advancing elder health. (See http://www.americangeriatrics.org/files/documents/Adv_Resources/Geri.Friendly.Provisions.ACA.pdf for more about the many “geriatrics friendly” provisions in the healthcare reform law that AGS championed.) 

 “Many of these are provisions that we and other organizations had been talking about for many years,” Dr. Hollmann notes, underscoring the importance of investing for the long-haul.

“I’d say that the AGS’ most important policy accomplishment has been becoming the “go-to” organization when it comes to aging and health issues,” concludes Dr. Philips.  “It’s taken a lot of work and time, but it’s now rare for there to be an issue about aging and healthcare policy that AGS isn’t invited to the table to discuss.”