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HEALTH CARE REFORM AND BEYOND: NEW OPPORTUNITIES IN THE VALUING OF GERIATRICS
2010 REYNOLDS GRANTEE 9TH ANNUAL MEETING
The American Geriatrics SocietyDedicated to the Health of Older Americans
October 26th, 2010St. Louis, MO
Jennie Chin Hansen, RN, MS, FAANCEO
• Elements of the 2010 Health Care Reform and its affect on Medicare, Geriatrics and Medicine
• Opportunities for Geriatrics and Geriatric Competencies in Health Reform Phase II
•Potential Opportunities for Geriatrics in GME Funding
•Our role as AGS
Agenda
• MOST EXPANSIVE HEALTH AND MEDICARE CHANGES SINCE 1965• COVERAGE• Increased-adding 32 million, children until 26 year old, no lifetime caps
• MEDICARE• Prevention, Accountability for Outcomes and Costs, New Models of
Chronic Care
• ADDING TO SOLVENCY OF MEDICARE (PART A)-12 YEARS (FROM 2017-2029)
Patient Protection and Affordable Care Act -PPACA
• Increased focus on physician/hospital/post acute care collaborations with ACOs, Medical Homes, Episode Bundling• Pilot programs to foster collaboration across disciplines-CMS Innovations Center• Increased funding for primary care, geriatricians, ANPs and community-based health centers•Expanded coverage for those under 65 at 133% of poverty level and Medicaid incentives for Home and Community Based Care
Key Elements of 2010 Health Care ReformWhat To Expect From the New Law
• Models of Care• Centers for Medicare and Medicare Services (CMS)
• Center for Medicare and Medicaid Innovation (CMI)
• $10 Billion dedicated until 2019-Pilots instead of Demonstration projects
• Significant shift: includes bundled payments; Medical and Health Care Homes; Accountable Care Organizations
Key Elements of 2010 Health Care Reform What To Expect From the New Law
• Financial Incentives to States to Receive Greater “Medicaid Match” money if they work to increase their proportion of Medicaid funding for Home and Community Based Care vs Nursing Home funding
• NEW LONG TERM Care Insurance-Community Living Assistance Services and Supports (CLASS) Act• Voluntary payroll contribution for long term care coverage• Vesting after 5 years of payment in system
• Minimum of $50/day ( $18, 250/yr)
Key Elements of 2010 Health Care Reform
Chronicity Care Benefits
1 out of 3 patients do not feel prepared to care for themselves when discharged from a hospital or treatment facility*• Patients lack guidance when they transition from hospital to home (BOOST/Harvard; NICHE/NYU; GRACE/Indiana University)• Patients are uncertain how to manage their own health issues•Community Care Transitions Demonstration Naylor and Coleman
Key Elements of 2010 Health Care Reform
Understanding Older Patients
*AARP’s Public Policy Institute
• Workforce • Health Resources and Services Administration (HRSA)
• Title VII & Title VIII (Geriatric Education Centers, Research Training and Multiple Disciplines)
• General Accountability Office (GAO)• HealthCare Workforce Commission-Selected (Multidisciplinary-University of VA,
Health Exec-Geriatrics Certification; Peter Buerhaus, PhD, RN, Vanderbilt, Chair)• Patient Center Outcomes Based Research Institute (PCORI)- Selected (many
physicians)
Key Elements of 2010 Health Care Reform Increase Collaboration and Training Across
Disciplines and Care with Evidence
Key Elements of 2010 Health Care ReformFraming Our Workforce
Ger
iatr
ics
Advancing Our “Geriatrics” Efforts for Societal Impact
Across specialties and disciplines
Opportunities in Systems of Care: 1.Health Care Homes, Accountable Care Organizations and Bundled Episodes of Care2.New Demonstrations under the Innovations Centers of CMS (chronic care demos)3.Transitions of Care Demos
TBD
Key Likely Impacts On Geriatrics and Older Adults
Leadership Roles:1.Patient Safety and Quality that affect the Geriatric Populations since that Affects both Economics and Reputations of provider systems2.Programmatic Design and Diffusion of Models of Care3.Committee Leadership and Service in Organizations across disciplines and care issues
Importance of Geriatricians and other colleagues’ leadership opportunities
• Mission: To improve the health, independence and quality of life of all older people
• Vision: Every older American will receive high quality patient-centered care
How AGS Supports Geriatrics Agenda Role of the American Geriatrics Society (AGS)
•Guide public policy through advocacy education so policy supports improved health and healthcare for older adults, especially those with multiple chronicities and frailty
•Raise Public Awareness of the need for high-quality, culturally sensitive geriatric healthcare
• Geriatrics Workforce Policy Studies Center (GWPS)-track supply and shortage
• Eldercare Workforce Alliance (EWA)-Cross Discipline
AGS Strategies and Collaboration Synergies
• Geriatric education and training; career awards; comprehensive geriatric education (Sec. 5305)•Geriatric Academic Career Awards (GACAs) to physicians, advanced practice nurses, clinical social workers, pharmacists, and psychologist• Creates Geriatric Career Incentive Awards to foster greater interest among a variety of health professionals in entering the field of geriatrics, long-term care, and chronic care management• Those eligible include advanced practice nurses, clinical social workers, pharmacists, or students of psychology pursuing a doctorate or other advanced degree in geriatrics
How AGS Supports Geriatrics Agenda Achievements in Health Reform
AARP 2010
Geriatrics Education and Training Programs under Titles VII of PHSA (FY 2010)
GACAs *
GECs *
Fellowships
Geriatrics Nursing Education Program under Title VIII of PHSA (FY 2010)
Nursing Workforce *
Geriatrics Programs under Title VIIFunding in Millions
Medicare Dollars for GME versus Funding for Title VII & VIII
Geriatrics Programs under Title VII & VIII - $38 million
DGME-Direct Graduate Medical Education
IGME-Indirect Graduate Medical Education (hospitals)
MedPAC Report on GME June 2010 Chapter 4
Recommendations for improving GME to support a reformed delivery system
Commission Assessment: 1. GME system not aligned with reforms essential for increaseing quality
and value; 2. Providers will needs skills to:
Integrate care across settings Improve quality Use resources efficiently
3. FFS payment signals physician career choices (along with other factors) [Mark Miller, Executive Director, MedPAC October 24, 2010]
Key MedPAC Recommendations on GME
1. Establish performance-based payments for GME1. Greater accountability and reward education and training that will
improve the value of our health care delivery system
2. Increase the Transparency of Medicare’s GME Subsidies1. Secretary to annually publish report of DGME and IME received by each
hospital
3. Studies:1. Workforce needs by numbers and specialty2. How residency programs affect the financial performance of sponsoring
institutions and whether residency specialties should be supported equally
3. Strategies for increasing diversity of health professional workforce
Macy Foundation and Association of Academic Health Centers (AAHC) -October 24-25, 2010
“Optimizing the Structure, Support, Oversight and Accountability of GME to Best Meet the Needs of the American People”
Aligning financing and regulation of GME in US to better align with contemporary societal need and changing practice environments
MedPAC, COGME, AAMC, ACGME, AMA, VA, NEJM (Iglehart), AGSEmory, UCSF, Northwestern, Meharry, Howard, UNC, Johns Hopkins, Partners, UC Davis, Washington Un, Un Wash, Un Texas System
Making the Case for Geriatrics and its Competencies
AGS started 68 years ago identifying the issues Advancing the field JAGS-one of the one hundred most highly regarded in this past 100 years Beeson, Williams and Jahnigen Scholars Certificate of Added Qualification in Geriatrics
Today the need is compelling yet the struggle continues to be mighty
Many collaborators and colleagues e.g. Foundations (Reynolds, John A. Hartford, Atlantic Philanthropies) ACP,
AAFP, VA, SGIM, Home Care, Palliative Care, Hospitalists, GSA, Nursing, Pharmacists, Social Workers and others
Bi-partisan support and concern, federal and state, Opportunities: CMS , AARP (the public), Health Plans, other foundations,
and other funders
TODAY
American Geriatrics Society (AGS) - advancing the importance of the issues of geriatrics and elevating its value in the health care
Current Value Equation
Current and Ongoing Work:
Geriatrics for Specialists Initiative (GSI): Burton and Solomon Academic Directors for Geriatric Programs (ADGAP): 20 years
and in review GEMMSTAR (NIA)-codifying the Jahnigen program CRIT (Chief Residents-Sharon Levine) Geriatrics Workforce Data (Gregg Warshaw and Libbie Bragg)
and Eldercare Workforce Alliance (EWA-Nancy Lundebjerg and Steve Dawson) Geriatric Competencies Surgical Specialties (American Board of Surgery), Opthamology,
Urology, Emergency Medicine and others
Building the Case: 2010 and BeyondAdvancing and Embedding
Opportunities to Make the Value Equation: Current Initiatives:
Aligning the strength and potential of AGS Advancing our work in mission adoption with other specialties
(we are now a member of the Council of Medical Specialty Societies-CMSS)
GEMMSTAR
Future Work: Leverage Current Policy: 30 Day Readmission and Some Never
Events (making the “business case in quality and safety”)-building on work done
ACOs, Medical Homes, Bundled Payments vs FFS GME influence
Advancing Our Field and Issues
Why: Societal Imperative-individually and collectivelyWhy: Extraordinary Financial Spend on Public and
Private Resources ineffectively used: 30% of $2.3TrillionWho: All of us-cross discipline and especially those of us
who know the “chronicity space”Where: Acute AND AMBULATORY (where people spend
most of their lives)When: We need you NOW!
THANK YOU!
The American Geriatrics SocietyDedicated to the Health of Older Americans
October 26, 2010Jennie Chin Hansen, RN, MSN, FAAN
