In certain circumstances, the best way to bring about reform is through incremental change. In others, a sea change is necessary. This latter approach, I'm convinced, is the one we need to take to remake healthcare for older adults -- and others -- in this country.

To bring about specific, targeted changes - reworking the way Medicare reimburses healthcare providers so careers in geriatrics are financially viable, for example -- we need to effect broad changes in our nation's healthcare systems. Without sweeping system-wide reforms that make the care of older adults more effective and economical, we simply won't be able to sustain future growth in Medicare and private healthcare spending. We need systemic changes that, among other things, adequately support geriatrics healthcare research and training, provide for better primary and preventive care, care coordination, and interdisciplinary team care, and lead to the development of new models of care. These are key elements of cost-effective, quality care for seniors.

With growing shortages of healthcare providers trained to care for older adults, and looming budget crises, we need to start making these health systems changes now. The Institute of Medicine's recent report, "Retooling for an Aging America: Building the Health Care Workforce," [see related story] is a resounding endorsement of these and other systemic changes for which the American Geriatrics Society has long advocated. We need to take the IOM report and run with it without delay. The eldest of the nation's 77 million baby boomers reach retirement age in less than three years.

With the coming Age Boom in mind, members of AGS' leaders and staff met in New York for the Society's second annual "Public Policy Summit" in January. Over the course of the two-day session, our group came up with the following list of broad public policy objectives on which the Society is focusing its public policy advocacy efforts this year:

• Address the acute and growing nationwide shortage of geriatricians (physicians with advanced training in the care of older people) and all geriatrics healthcare professionals; and ensure that other healthcare providers have training that prepares them to meet the unique healthcare needs of older people
• Strengthen primary and preventive care and care coordination
• Effect healthcare financing reform that ensures all older adults access to high quality healthcare
• Ensure that value-based purchasing and other quality initiatives take into account the unique healthcare needs of all older patients
• Step-up research concerning healthy aging, the prevention, diagnosis and treatment of age-related health problems, and the cost-effectiveness of various approaches to care; and ensure that older adults are adequately represented in research trials
• Expand older adults' healthcare options to include in-home and other care that enables them to live independently as long as possible; help older adults and their caregivers better understand their healthcare needs and make the most of Medicare and other benefits; and provide caregivers with adequate resources and support

The group also identified specific strategies for achieving each objective. To address the growing shortage of geriatrics healthcare professionals, for instance, we identified key strategies aimed at boosting recruitment into geriatrics. These include continuing our public policy advocacy efforts on behalf of Sen. Barbara Boxer's and Rep. Rosa DeLauro's proposed loan forgiveness initiatives for professionals who complete training in geriatrics and care for older adults for designated periods of time. And they include continued advocacy on behalf of Title VII Geriatrics Health Professions Programs. These geriatrics training programs reach tens of thousands of healthcare providers each year.

Our list of strategies aimed at strengthening cost-effective primary and preventive care and care coordination includes continued advocacy work on behalf of Sen. Blanche Lincoln's Geriatric Assessment and Choric Care Coordination Act. And advocacy on behalf of substantive Medicare payment restructuring that adequately and more appropriately compensates healthcare providers is among the strategies we're pursuing to effect needed healthcare finance reform.

Pursuing these and other strategies to achieve long-term, system-wide changes doesn't mean neglecting to address imminent threats, like the pending 10.6% cut in Medicare payments to physicians that's slated to take effect July 1. AGS continues to urge Congress to block the cut -- and legislators appear likely to do so, as they have in previous years following similar AGS advocacy campaigns. But we can't stop there. We also need to address the deficiencies in our healthcare systems that have and continue to set the stage for these and other funding crises year after year.

To bring about this level of change, we need to make another change - in the way AGS advocates for policy priorities that enhance elder healthcare. Increasingly, we need to work in broad coalitions with other likeminded organizations. AGS is a relatively small organization and, despite an extremely dedicated, involved membership and staff, we simply can't do this all on our own. We need to work in coalition with organizations like the AARP [see related story], the American College of Physicians, the American Academy of Family Physicians, the American Medical Association, and nursing, social work, and pharmacy organizations.

As I start my term as AGS President, I look forward to working in coalition, with all of you, and other likeminded individuals and groups, toward lasting healthcare systems reforms that will benefit not only older Americans, but all Americans, for decades to come.