The American Geriatrics Society Dedicated to the Health of Older Americans

1. The American Geriatrics SocietyDedicated to the Health of Older Americans Health Care Reform and beyond: New Opportunities in the Valuing of Geriatrics 2010 Reynolds Grantee 9th Annual meeting October 26th, 2010 St. Louis, MO Jennie Chin Hansen, RN, MS, FAAN CEO

2. Agenda 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

3. Patient Protection and Affordable Care Act -PPACA 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)

4. Key Elements of 2010 Health Care ReformWhat To Expect From the New Law 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

5. Key Elements of 2010 Health Care Reform What 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

6. Key Elements of 2010 Health Care Reform Chronicity Care Benefits 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)

7. Key Elements of 2010 Health Care Reform Understanding Older Patients 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 *AARP’s Public Policy Institute

8. Key Elements of 2010 Health Care Reform Increase Collaboration and Training AcrossDisciplines and Care with Evidence 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)

9. Key Elements of 2010 Health Care ReformFraming Our Workforce Geriatrics

10. Advancing Our “Geriatrics” Efforts for Societal Impact Across specialties and disciplines

11. Key Likely Impacts On Geriatrics and Older Adults Opportunities in Systems of Care: Health Care Homes, Accountable Care Organizations and Bundled Episodes of Care New Demonstrations under the Innovations Centers of CMS (chronic care demos) Transitions of Care Demos TBD

12. Importance of Geriatricians and other colleagues’ leadership opportunities Leadership Roles: Patient Safety and Quality that affect the Geriatric Populations since that Affects both Economics and Reputations of provider systems Programmatic Design and Diffusion of Models of Care Committee Leadership and Service in Organizations across disciplines and care issues

13. How AGS Supports Geriatrics Agenda Role of the American Geriatrics Society (AGS) 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

14. AGS Strategies and Collaboration Synergies 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

15. How AGS Supports Geriatrics Agenda Achievements in Health Reform 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 AARP 2010

16. Geriatrics Education and Training Programs under Titles VII of PHSA (FY 2010) GACAs * GECs * Fellowships

17. Geriatrics Nursing Education Program under Title VIII of PHSA (FY 2010) NursingWorkforce *

18. Geriatrics Programs under Title VIIFunding in Millions

19. 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)

20. 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]

21. Key MedPAC Recommendations on GME • Establish performance-based payments for GME • Greater accountability and reward education and training that will improve the value of our health care delivery system • Increase the Transparency of Medicare’s GME Subsidies • Secretary to annually publish report of DGME and IME received by each hospital • Studies: • Workforce needs by numbers and specialty • How residency programs affect the financial performance of sponsoring institutions and whether residency specialties should be supported equally • Strategies for increasing diversity of health professional workforce

22. 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), AGS Emory, UCSF, Northwestern, Meharry, Howard, UNC, Johns Hopkins, Partners, UC Davis, Washington Un, Un Wash, Un Texas System

23. 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

24. TODAY American Geriatrics Society (AGS) - advancing the importance of the issues of geriatrics and elevating its value in the health care

25. 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

26. 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

27. Advancing Our Field and Issues • Why: Societal Imperative-individually and collectively • Why: Extraordinary Financial Spend on Public and Private Resources ineffectively used: 30% of $2.3Trillion • Who: 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!

28. The American Geriatrics SocietyDedicated to the Health of Older Americans THANK YOU! October 26, 2010 Jennie Chin Hansen, RN, MSN, FAAN CEO jhansen@americangeriatrics.org