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AGS PUBLIC POLICY EFFORTS 2005 was a politically charged year, culminating in the December White House Conference on Aging and a concerted effort to retain Title VII funding for geriatrics health professions training. AGS leaders, staff, affiliates, and members participated in a well-orchestrated and comprehensive campaign to address these and other crucial legislative and regulatory issues. Here are a few highlights: The 2005 White House Conference on Aging From initial planning efforts in 2004 through the final adoption of conference resolutions and implementation strategies in December 2005, AGS members played key roles in the decennial White House Conference on Aging (WHCoA). The conference makes aging policy recommendations to the President and Congress. The AGS was well represented in every conference decision-making body, including the Policy and Advisory committees responsible for conference planning and follow-up. Thirteen AGS members gave presentations at a July 2005 mini-conference that the AGS helped plan. Resolutions on Geriatric Healthcare Workforce Issues developed at the mini-conference were then formally submitted to the WHCoA. Over three dozen AGS members, including AGS President, Dr. David Reuben, and Chair of the Board, Dr. Meghan Gerety, were appointed WHCoA delegates from their states. The Society's Future of Geriatric Medicine report served as a key resource for delegates before and during the conference, as they voted on 73 resolutions and crafted implementation strategies for the 50 resolutions that received the most delegate votes. According to Dr. Reuben, "The AGS Washington office and members were exceptionally well-prepared and amazingly influential. Moreover, several of the highest rated implementation strategies were based on AGS-suggested language, including approaches from the Future of Geriatric Medicine report." Ultimately, all of the Society's top 5 priorities were among the resolutions delegates identified as their final top 10. Medicare Physician Payment Inadequate reimbursement for geriatric care remains one of the major stumbling blocks to recruiting trainees into geriatrics and supporting physicians who care for older adults in a Medicare fee-for-service environment. Throughout 2005, in collaboration with the American Medical Association and 120 other state and national medical societies, the AGS urged Congress to block proposed Medicare cuts that would result in a 26% decrease in Medicare physician payments over the next 6 years, based on the seriously flawed Medicare "Sustainable Growth Rate" (SGR) formula. AGS worked with Congressional staff to develop bipartisan legislation that proposed repealing the SGR and replacing it with an annual update in Medicare reimbursement, based on reasonable increases in the costs of providing care. In late October, the Senate Finance Committee included a 1% update in the budget reconciliation package. Pay-for-Performance Pay-for-performance (or "P4P") programs offer financial rewards to clinicians who provide care that meets certain standards or measures intended to gauge quality and cost-effectiveness. Since 2004, efforts to incorporate P4P into Medicare policy have been gaining momentum, as policymakers view P4P as a way to contain Medicare costs. In response, the AGS has stepped up its involvement in this area, to ensure that any policies established by Medicare are in the best interests of older patients and their healthcare providers. To this end, the AGS has undertaken a multi-faceted approach in legislative, administrative, and stakeholder arenas. The Society continued these efforts throughout 2005. Among other things, AGS developed its own pay-for-performance proposal, which it has shared and will continue to share with the Center for Medicare and Medicaid Services (CMS), Congress, numerous quality work groups, and a coalition of medical organizations. The proposal emphasizes that unique P4P measures are needed to assess the quality of care provided to adults 75 and older, those who are frail, and those who are receiving palliative care near the end of life. The proposal employs new CPT® category II codes based on the Assessing the Care of the Vulnerable Elders (ACOVE) measures developed by the RAND Corporation. Through these efforts, the AGS was able to secure geriatrics language in both House and Senate bipartisan pay-for-performance bills. The AGS has representatives in key stakeholder groups monitoring P4P. It participated in an effort with 70 other national medical societies to develop and submit to Congress a five-year P4P phase-in plan. A letter accompanying the plan emphasized that P4P will be successful only if it eliminates the flawed SGR formula and takes into account a diversity of clinical practices and patient needs. The Society's P4P efforts are ongoing, as AGS continues to monitor Congressional and CMS plans and work with various coalitions to advocate for quality measures that reflect the complexities of caring for older adults with multiple, chronic conditions. To educate members and others about AGS' work to ensure that P4P is tied to quality geriatric care, the AGS Pay-for-Performance Position Statement, AGS Pay for Performance Proposals, and further information can be found on the AGS Web site's Pay for Performance (P4P) Primer page. Physician Voluntary Reporting Program (PVRP) As part of its overall quality improvement efforts, CMS in 2005 announced that it would launch a new Physician Voluntary Reporting Program (PVRP), focused on preventing chronic disease complications and avoidable hospitalizations, and improving the quality of care for Medicare beneficiaries. The PVRP, which launched in January 2006, will initially capture data with a core starter set of 16 clinically valid measures taken from numerous guidelines endorsed by physicians and their medical specialty societies. (Ultimately 36 measures will be utilized.) Thanks to the work of dedicated AGS members and staff, geriatrics measures are included in the PVRP. Falls assessment is one of the 16 core starter measures. Title VII Funding for Geriatrics Health Professions Training At the end of 2005, Congress approved a 2006 Budget that zeroed out funding for Title VII Geriatrics Health Professions Training programs -- with disastrous results. These programs, provided through the Bureau of Health Professions, include geriatrics academic career development (GACA) awards and Geriatrics Education Centers. As the number of new physicians entering geriatrics declines and those already in the field approach retirement, incentives rather than cuts are needed in programs that enhance the training and recruitment of geriatrics healthcare professionals. AGS and its members have advocated and continue to advocate tirelessly for the restoration of Title VII funding in the FY 2007 federal budget. 2005 Congressional Testimony Dr. Meghan Gerety, AGS Board of Directors Chair, testified before the House Ways and Means Health Subcommittee in 2005 on the growing workforce shortage in long-term care settings. She noted that the current system creates "an artificial gap between the medical components of long-term care and the equally important non-medical components." The result is an inefficient "patchwork system of payers, providers and settings, government and private programs and formal (paid) and informal (unpaid) caregivers," she explained. Medicare Chronic Care Improvement Pilot Program Mississippi Medicare Health Support is one of 10 voluntary, three-year CME chronic care improvement pilot projects launched in 2005, with help from AGS and other organizations. Each program enrolls between 15,000 and 30,000 beneficiaries with chronic diseases to test strategies to improve care delivery and cost-effectiveness. The aim is to incorporate successful elements of these pilot programs into national Medicare policy. Along with the American College of Physicians, the American Academy of Family Physicians, and other groups, the AGS provided advice on the program model's design prior to its implementation. The Society's focus was on best practices and clinical content, emphasizing the importance of physician involvement in care plan development and the role of information technology in providing feedback to physicians on patients' health status and progress toward treatment goals. Additional Policy Activities In addition to the above initiatives, the AGS was involved in numerous other legislative and regulatory issues, both individually and in coalition with other stakeholder organizations and coalitions, in 2005. This work included:
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