The annual meeting is now well behind us. Our yearly conference serves to recharge our batteries with knowledge and networking. It supplies us with tools to improve the care we provide and the positive reinforcement that much of what we are doing is right.

With our energy restored by time with friends and colleagues, we return to our home organizations and institutions to face the same challenges that were there when we left for Chicago. We need that energy, because the challenges we face are significant. It is hard to train healthcare professionals in geriatrics programs when institutional, state and federal funds are reduced. And it is even harder to fight for more program money when we are struggling to recruit students and faculty to fill slots in programs. There's the ultimate challenge: recruiting talented and committed individuals into a field where reimbursement does not keep up with practice expenses and financial support for the widespread use of the team-based approach in most practice models is lacking.

That these challenges were on all of our minds was apparent during the annual meeting. I heard the same questions repeatedly in Chicago: "How are we addressing some of the challenges facing training programs?" "How is AGS using momentum for healthcare reform to improve quality of care, including care coordination and chronic care delivery?" "What are we doing to build coalitions with other organizations?" and "What is AGS doing about reimbursement?'" Let me tackle each of these:

As this issue of AGS News went to press in late July, the Senate leadership had just announced that it wouldn't be able to pass healthcare reform legislation before Congress' August recess, as President Obama had urged. Nonetheless, with just days to go before they headed home for their summer break, both Senate and House leaders were rushing to make as much progress with health reform as possible.

While there are many hurdles ahead, it's important to recognize that there has already been progress on important fronts. Stepping up its policy advocacy efforts once again, AGS policy staff and leadership were in a flurry of discussions and meetings with legislative offices throughout the spring and summer, providing input and language critical to ensuring older adults adequate access to trained geriatric healthcare professionals and appropriate care. AGS continued this work both independently and in coalition with other likeminded organizations. On June 23 ("Hill Day"), members of AGS and other organizations that comprise the Eldercare Workforce Alliance (EWA) -- a coalition co-convened by AGS Deputy Executive Vice President Nancy Lundebjerg -- visited and called scores of lawmakers and Congressional staff to urge passage of legislation aimed at strengthening the eldercare workforce. The Alliance also a published a full-page ad in Roll Call listing key reforms essential to ensuring older adults access to appropriate care. (See related story)

With Congress hammering out proposed reform bills and other healthcare legislation, we're now seeing results from our ongoing advocacy efforts. Not all of the initiatives for which we've been advocating have been included in reform or related legislation -- we're still working on that -- but some significant initiatives have. The news out of Washington on this front is exciting -- our advocacy is being heard!

The Senate Health, Education, Labor and Pensions (HELP) Committee's "Affordable Health Choices Act," for example, includes important language that would provide grants to Geriatric Education Centers (GECs) to expand training in geriatrics, chronic care management and long-term care for health professions faculty and professionals, and for family caregivers. The Senate legislation would also support the development of curricula and best practices in geriatrics, and help address the need for affordable long-term care and improved prevention strategies -- including those aimed at preventing unnecessary hospital admissions and readmissions. In addition, the HELP bill would both establish federal traineeships for nurses pursuing advanced training in geriatrics and fund training opportunities for direct-care workers. It calls for the creation of a national center charged with ensuring an adequate healthcare workforce. And it would expand eligibility for Geriatric Academic Career Awards (GACAs) to include additional healthcare professionals. The GACAs, along with the GECs and geriatric faculty fellowships for physicians, dentists and behavioral and mental health professionals are Title VII Geriatrics Health Professions Programs. On a related front, the House approved a Labor-Health and Human Services-Education appropriations bill in July that would allocate $41.9 million in funds for Title VII Geriatrics Health Professions Programs in fiscal year 2010 -- 35.5% more than in the current fiscal year. That's a significant increase. The Senate is expected to act on its version of the appropriations bill in the fall.

Now for a few words on reimbursement. AGS has long advocated for a more rational, equitable means of determining Medicare reimbursement. And the House reform bill, "America's Affordable Health Choices Act of 2009 (H.R. 3200)," has some great things in it for geriatrics. Among those are proposed changes to the Sustainable Growth Rate (SGR) formula that would eliminate the annual threat of untenable SGR-mandated cuts. These changes would create a service pool limited to evaluation and management services and other preventive care services (the vast majority of services provided by geriatricians are evaluation and management services) with its own yearly update. In a related development, the Centers for Medicare and Medicaid Services' (CMS') annual Physician Fee Schedule proposal, released in July, would both boost payments to "geriatric specialists" and other primary care physicians by 8 to 6% and lessen the likelihood of steep SGR-mandated cuts by reclassifying payments for physician-administered drugs so these are no longer categorized as outlays for physician services.

There's more. AGS has long argued that geriatric physicians, who actually provide more "primary care" per practitioner than other clinicians based on office-based claims, should be explicitly included in any efforts to enhance payment for primary care. The House's "America's Affordable Health Choices Act of 2009" would make geriatricians eligible for a proposed primary care incentive payment by adding "specialization in geriatrics" to the definition of a primary care practitioner. This definition would also enable geriatricians to participate in primary care training programs. As this issue of AGS News went to press, our ears on the ground in Congress alerted us that the Senate Finance Committee's draft bill would also include a primary care bonus and define geriatrics as a primary care discipline. Other news -- that elements of "The ReAligning Care Act," which AGS has long championed, may be included in chronic care coordination pilot programs in both House and Senate measures -- was also quite encouraging. The Act would fill a gap in traditional Medicare by covering comprehensive geriatric assessment and care coordination services for high-risk and high-cost beneficiaries with multiple chronic health conditions, including dementia.

As July came to a close, AGS leaders, public policy staff, and our Washington representatives continued to work on a strategy for ensuring that proposals put forward by Sen. Barbara Boxer (D-CA) -- for a loan forgiveness program that would provide loans to members of the geriatrics interdisciplinary team -- would be included in health reform. Loan forgiveness is an important tool for recruiting trainees into geriatrics. And in another important development this summer, the Health Resources and Services Administration announced that geriatrics health professionals were eligible to apply for new loan repayment funding through the National Health Service Corps (NHSC) Loan Repayment Program -- which recently received $300 million in supplementary funding via the American Recovery and Reinvestment Act. The NHSC program repays up to $50,000 of primary care medical, dental and mental health professionals' loans in exchange for two years of service at an approved site in a Health Professional Shortage Area. Candidates can apply for the additional funds through September 2010, or until funds are exhausted, whichever comes first.

As Congress' summer recess neared, AGS leaders, policy staff, and Washington representatives were also working on strategies for maintaining the geriatrics health professions content of both the House and Senate bills through the negotiations between the two chambers that will ultimately lead to submission of a single bill for the President's signature. The Eldercare Workforce Alliance was also at work planning a second Hill Visit and National Call In Day for mid-September. We're looking well ahead!

In order to sustain any positive momentum generated by improved reimbursement and loan forgiveness, however, we have to have strong, well-supported training programs that attract significantly greater numbers of qualified applicants. We're making progress in this area as well. The Association of Directors of Geriatric Academic Programs (ADGAP) has identified specific challenges in this area and has proposed approaches that CMS and policy makers could take to improve the stability of many of our geriatric fellowship programs. And ADGAP and AGS leadership are working to identify specific steps to address this critical issue. One exceptional resource for those involved with these programs, a resource that I just finished reading, is the recently released report, "Managing Programmatic Growth and Development in Academic Geriatrics." Funded by the John A. Hartford Foundation, the report should, as David Reuben, M.D, notes, "be required reading for every geriatrics program director." I would add that it is relevant to anyone working within an organization to establish and enhance geriatric healthcare models and programs.

Clearly, we face significant challenges and merely doing the "same old same old" won't work. But I remain very optimistic that if ever we have had the opportunity to make real changes in payment, in delivery and in support for academic programs, this is the time. It will be neither easy nor a given that all these changes will be realized, but without this effort we will certainly fail. To use a running metaphor, we are running a marathon in a storm - but we've recently experienced a new boost in the form of a strong tail wind supporting us. We have the attention of our nation's top health policy leaders. I do see positive changes ahead for AGS, for each of us as healthcare professionals who have chosen geriatrics as our path, and for the seniors whose healthcare we are struggling to improve.