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September 25, 2024

Medicare promoting 'age-friendly' hospitals in quality push

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Medicare will begin compensating hospitals for providing quality data to support "age-friendly" medical care as the government seeks to bolster private sector efforts to adapt to the aging population.

Starting in January, hospitals will report on a slew of measures to assess whether they are improving care for older patients in emergency departments, operating rooms and other settings. The Centers for Medicare and Medicaid Services laid out the new policy in the Medicare Inpatient Prospective Payment System final rule for fiscal 2025, which it published last month.

Older adults make up an increasingly large share of the population and have higher healthcare utilization rates than younger people, according to the federal Administration for Community Living. But older adults, especially those with disabilities, frequently face challenges that harm their health and well-being.

Hospitals will need to follow report that they are:

Attesting each year that they have procedures to enable patients’ healthcare goals, such as determining whether living wills and healthcare proxies are included in care plans;
Reviewing medication regimens and eliminating unnecessary prescriptions;
Implementing frailty screenings and interventions, such as for mobility or cognition;
Assessing social vulnerabilities such as isolation or elder abuse;
Designating age-specialized leadership within hospitals.

A CMS spokesperson said the attestation requires the presence of “age-friendly leadership,” a clinician or committee that has expertise in care for older adults. That role should ideally be filled by a professional with advanced geriatrics training, such as a physician, nurse practitioner or physician assistant, the spokesperson said.

Starting in fiscal 2027, Medicare payment incentives for reporting the age-friendly measures will take effect.

“It's an important lift, but it's a fairly hefty lift,” Dr. Clifford Ko, Director of the research and optimal patient care division at the American College of Surgeons, said during a webinar on the new measures last week.

This approach has the potential to improve care and constrain spending, based on the results of a similar American College of Surgeons initiative. Obtaining certification from the surgical specialist group costs about $10,000 a year, but the benefits outweigh the expense, according to one study.

Participants in the American College of Surgeons Geriatric Surgery Verification program recorded shorter lengths of stay, lower rates of complications such as postoperative delirium and fewer readmissions, according to a report the Annals of Surgery Open published in May.

“Each additional day in the hospital may add variable costs of $650 to $1,000,” researchers from the Center for Geriatric Surgery at Baltimore-based LifeBridge Health's Sinai Hospital wrote. “If 100 older surgical patients were spared that additional day, the savings would be $65,000 to $100,000.”

Rani Snyder, vice president of program for the John A. Hartford Foundation, said the CMS measures are a step in the right direction, especially since they won't generate significant additional costs. The next step should be advancing from “pay-for-reporting” to pay-for-performance, she said.

CMS is targeting systems of care rather than focusing on specific providers within hospitals, which reflects workforce shortages, especially among geriatrics specialists, Snyder said. The agency needs to extend these age-friendly policies to other types of providers, she said.

“We know that healthcare comes in many settings and ultimately we want this kind of measure to be applied in ambulatory settings, nursing homes, convenience care clinics and in home care — everywhere that older people receive care must offer the best possible quality,” Snyder said.

Jill Sage, chief of quality affairs for the American College of Surgeons, anticipates more emphasis on this population through the Medicare system.

“Since improving care for older adults has been identified as a top national priority, this measure is just the first step in building out a more robust set of measures to improve care for the Medicare population, including looking at rolling out outcome measures in the future,” Sage said at the American College of Surgeons event.

The measures are based on older adult-focused hospital accreditation programs developed by the American College of Surgeons, the American College of Emergency Physicians, the Institute for Healthcare Improvement and the John A. Hartford Foundation.

These organizations and trade groups such as the American Hospital Association have been seeking similar aims on their own via resource sharing groups, planning meetings and accreditation programs. For instance, the AHA is offering age-friendly planning webinars from this month through March as part of its sixth year recruiting hospitals to an ongoing age-friendly action group.

“Investing in better, older adult care and quality is probably a very wise thing to do, and that's what we are seeing a lot of hospitals doing right now,” Ko said.