AGS Public Policy Efforts

In keeping with the strategic plan calling for greater emphasis on public policy advocacy that AGS' Board of Directors endorsed in 2006, the Society stepped up efforts to influence policy affecting older Americans' access to quality healthcare. AGS leaders, staff, affiliates, and members joined with other likeminded organizations and individuals to successfully advocate for changes in Medicare reimbursement, restoration of funding for Title VII Geriatrics Health Professions Programs, and other measures over the course of the year. The March launch of AGS' Health in Aging Advocacy Center greatly facilitated these efforts. Here are a few 2006 highlights:

Health in Aging Advocacy Center

To make it easier for members and others to participate in advocacy efforts on behalf of policy supporting quality healthcare for older Americans, the AGS launched its online Health in Aging Advocacy Center in early March. The advocacy center provides AGS staff with tools for alerting AGS and ADGAP members and others who register with the center to policy developments and AGS advocacy campaigns. Our Advocacy Alert emails link to the center, where visitors can -- with a single click -- get the latest information on these campaigns. With another click, they can access easy-to-customize letters to their representatives and senators urging action on behalf of quality elder healthcare. With a final click, on the site's "Tell a Friend" button, they can send emails to friends and colleagues notifying them of AGS campaigns and providing links to the Advocacy Center. The 15 campaigns the center spearheaded in 2006 engaged a total of more than 1,800 participants, who sent more than 3,300 letters to 387 members of Congress.

During the year, the Communications and Public Affairs staff launched campaigns aimed at reforming the Medicare physician payment system; restoring federal funding for Title VII Geriatrics Health Professions Programs; supporting the proposed "Keeping Seniors Safe From Falls Act"; reauthorizing the Older Americans Act; and ensuring adequate funding for the National Institute on Aging.

Medicare Physician Payment

In February, Congress approved and President Bush signed legislation rescinding a 4.4% cut in the Medicare physician fee schedule that had taken effect January 1. The cut was triggered by Medicare's controversial Sustainable Growth Rate (SGR) formula, which mandates physician fee cuts whenever growth in Medicare patients' use of physician services exceeds growth in gross domestic product. AGS members and other advocates of quality healthcare for older adults campaigned vigorously against the cut and for payment reform. In addition to rescinding the pay cut, legislators agreed to reimburse physicians for revenue lost during the weeks it was in effect.

Later in 2006, AGS launched a second concerted campaign against a SGR-mandated 5.1% fee cut slated to take effect January 1, 2007. In December, legislators postponed the cut for another year, leaving the fee schedule unchanged but offering a 1.5% bonus to physicians reporting basic quality data.

AGS advocated successfully for other changes in the physician fee schedule in 2006 as well. In June, Medicare endorsed significant changes in the schedule, effective January 1, 2007, including changes AGS proposed and for which it advocated. These changes called for the largest increases in payments for evaluation and management services since the fee schedule was established in 1992. A key change for geriatricians revised physician work relative value units for evaluation and management services by adopting recommendations that the Resource-Based Relative Value Scale Update Committee (RUC) made as part of its five year review process. The AGS was a key member of the coalition that reviewed the evaluation and management codes and presented them to the RUC. In addition, then-AGS Board Chair Meghan Gerety, MD, chaired the RUCs 5-year review committee, which determined the process the RUC used to evaluate the evaluation and management codes.

As 2006 came to a close, AGS planned to continue advocating for payment reform, including revocation of the SGR.

Title VII Funding for Geriatrics Health Professions Training Programs

Throughout 2006, AGS and ADGAP members, and AGS in coalition with other organizations and supporters, continued to advocate tirelessly for restoration of federal funds for Title VII Geriatrics Health Professions Programs. In December 2005, Congress eliminated all fiscal year (FY) 2006 funding for the programs -- which include geriatric faculty fellowships, the geriatric academic career awards program, and the nation's Geriatric Education Centers.

In January, as Congress readied for a return to the Capitol, the Society launched the first of dozens of 2006 alerts and campaigns urging Title VII grantees, AGS members and others to contact their Congressmen in support of the programs. Among other things, AGS provided sample letters to legislators, key phone numbers and other information. Grantees, members and other advocates responded, joining vigorous grassroots advocacy campaigns on behalf of funding. In the wake of these efforts, Congress restored funds for the programs in February 2007, earmarking $31.5 million for the programs for the remainder of FY 2007. As 2006 neared an end, AGS planned further advocacy efforts urging Congress to include funds for these crucial programs in future budgets.

Pay-for-Performance

As initiatives to incorporate pay-for-performance (P4P) policies and programs into Medicare gained ground, AGS continued its efforts to ensure that such policies and programs are in the best interests of older patients and their healthcare providers. P4P offers clinicians financial rewards for providing care that meets certain quality standards.

Among other things, AGS leaders met with Centers for Medicare and Medicaid Services (CMS) and National Quality Forum administrators in Washington in March to stress the importance of including geriatric quality measures in P4P initiatives. AGS has developed its own pay-for-performance proposal, which it has shared with CMS, Congress, numerous quality work groups, and other 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. AGS has also worked with the RAND Corporation to convert several of its Assessing the Care of Vulnerable Elders (ACOVE) measures into codes that could be used in Medicare P4P programs. In addition, as part of the American Medical Association's Physician Consortium for Performance Improvement, AGS played a significant role in assisting with the development of geriatrics measures for CMS' Physician Voluntary Reporting Program, a demonstration pay-for-reporting program launched early in 2006. Looking ahead to 2007, AGS planned to continue to monitor Congressional and CMS plans regarding P4P and to work with various coalitions to advocate for quality measures reflecting the complexities of caring for older adults with multiple, chronic conditions.

Older Americans Act

AGS advocated for reauthorization of the Older Americans Act (OAA) in 2006 as well. One of the key resolutions of the 2005 White House Conference on Aging (WHCoA)-to which AGS sent more than three dozen delegates-called for reauthorization of the act, which provides support and funding for senior center services, meals, transportation, and home care for older adults, and caregiver support for those caring for older people. Congress approved and the president signed legislation reauthorizing the OAA in October.

Falls Prevention Legislation

During 2006, AGS also advocated for legislation to address the growing problem of falls and fall-related injuries among older adults and planned to continue these efforts in 2007.